title: "It's not just about walking.....it's the practice nurse that makes it work": a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care.
abstract: BACKGROUND
  Physical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations.
  
  
  METHODS
  Semi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis.
  
  
  RESULTS
  Five key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of 'pre-trial' and 'delivery of the intervention'. Two additional 'post-trial' themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging.
  
  
  CONCLUSIONS
  Delivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting.
  
  
  BACKGROUND
  PACE-Lift ISRCTN 42122561 , PACE-UP ISRCTN 98538934 .
authors.affiliation: Faculty of Health, Social Care & Education, Kingston & St George's University of London, London, SW17 ORE, UK. c.beighton@sgul.kingston.ac.uk.
authors.forename: Carole
authors.initials: C
authors.lastname: Beighton
authors.affiliation: College of Health and Life Sciences, Brunel University London, Middlesex, UB8 3PH, UK. christina.victor@brunel.ac.uk.
authors.forename: Christina
authors.initials: C
authors.lastname: Victor
authors.affiliation: Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK. rnormans@sgul.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Normansell
authors.affiliation: Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK. sgjd250@sgul.ac.uk.
authors.forename: Derek
authors.initials: D
authors.lastname: Cook
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary's University of London, London, E1 2AT, UK. s.m.kerry@qmul.ac.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Kerry
authors.affiliation: Research Department of Primary Care & Population Health, University College, London, NW3 2PF, UK. s.iliffe@ucl.ac.uk.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK. mussher@sgul.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.affiliation: Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK. pwhincup@sgul.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.affiliation: Health Economics Research Group, Brunel University, Uxbridge, UB8 3PH, UK. Julia.fox-Rushby@brunel.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Fox-Rushby
authors.affiliation: Independent Psychology Research Consultant, Southampton, UK. alison.woodcock@chalto.co.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Woodcock
authors.affiliation: Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK. tharris@sgul.ac.uk.
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
mesh_terms: D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000193:education; D003695:Delivery of Health Care; D015438:Health Behavior; D006801:Humans; D009726:Nurses; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D016138:Walking