title: Process evaluation of physical activity counselling with and without the use of mobile technology: A mixed methods study.
abstract: BACKGROUND
  A monitoring-and-feedback tool was developed to stimulate physical activity by giving feedback on physical activity performance to patients and practice nurses. The tool consists of an activity monitor (accelerometer), wirelessly connected to a Smartphone and a web application. Use of this tool is combined with a behaviour change counselling protocol (the Self-management Support Programme) based on the Five A's model (Assess-Advise-Agree-Assist-Arrange).
  
  
  OBJECTIVE
  To examine the reach, implementation and satisfaction with the counselling protocol and the tool.
  
  
  METHODS
  A process evaluation was conducted in two intervention groups of a three-armed cluster randomised controlled trial, in which the counselling protocol was evaluated with (group 1, n=65) and without (group 2, n=66) the use of the tool using a mixed methods design.
  
  
  METHODS
  Sixteen family practices in the South of the Netherlands.
  
  
  METHODS
  Practice nurses (n=20) and their associated physically inactive patients (n=131), diagnosed with Chronic Obstructive Pulmonary Disease or Type 2 Diabetes, aged between 40 and 70 years old, and having access to a computer with an Internet connection.
  
  
  METHODS
  Semi structured interviews about the receipt of the intervention were conducted with the nurses and log files were kept regarding the consultations. After the intervention, questionnaires were presented to patients and nurses regarding compliance to and satisfaction with the interventions. Functioning and use of the tool were also evaluated by system and helpdesk logging.
  
  
  RESULTS
  Eighty-six percent of patients (group 1: n=57 and group 2: n=56) and 90% of nurses (group 1: n=10 and group 2: n=9) responded to the questionnaires. The execution of the Self-management Support Programme was adequate; in 83% (group 1: n=52, group 2: n=57) of the patients, the number and planning of the consultations were carried out as intended. Eighty-eight percent (n=50) of the patients in group 1 used the tool until the end of the intervention period. Technical problems occurred in 58% (n=33). Participants from group 1 were significantly more positive: patients: χ(2)(2, N=113)=11.17, p=0.004, and nurses: χ(2)(2, N=19)=6.37, p=0.040. Use of the tool led to greater awareness of the importance of physical activity, more discipline in carrying it out and more enjoyment.
  
  
  CONCLUSIONS
  The interventions were adequately executed and received as planned. Patients from both groups appreciated the focus on physical activity and personal attention given by the nurse. The most appreciated aspect of the combined intervention was the tool, although technical problems frequently occurred. Patients with the tool estimated more improvement of physical activity than patients without the tool.
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands; Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands. Electronic address: renee.verwey@zuyd.nl.
authors.forename: R
authors.initials: R
authors.lastname: Verwey
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands. Electronic address: s.vanderweegen@vilans.nl.
authors.forename: S
authors.initials: S
authors.lastname: van der Weegen
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Spreeuwenberg
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department Family Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Tange
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department Family Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands; Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: de Witte
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods*; D003924:Diabetes Mellitus, Type 2; D005246:Feedback; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D009043:Motor Activity; D010349:Patient Compliance; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive; D000068997:Smartphone; D011795:Surveys and Questionnaires
keywords: Behaviour change; Motor activity; Physical activity counselling; Primary care nursing; Process evaluation; Remote sensing technology; Self-management support