title: Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel.
abstract: BACKGROUND
  Being physically active has multiple benefits for cancer patients. Despite this only 23% are active to the national recommendations and 31% are completely inactive. A cancer diagnosis offers a teachable moment in which patients might be more receptive to lifestyle changes. Nurses are well placed to offer physical activity advice, however, only 9% of UK nurses involved in cancer care talk to all cancer patients about physical activity. A change in the behaviour of nurses is needed to routinely deliver physical activity advice to cancer patients. As recommended by the Medical Research Council, behavioural change interventions should be evidenced-based and use a relevant and coherent theoretical framework to stand the best chance of success.
  
  
  OBJECTIVE
  This paper presents a case study on the development of an intervention to improve the frequency of delivery of very brief advice (VBA) on physical activity by nurses to cancer patients, using the Behaviour Change Wheel (BCW).
  
  
  METHODS
  The eight composite steps outlined by the BCW guided the intervention development process. An iterative approach was taken involving key stakeholders (n = 45), with four iterations completed in total. This was not defined a priori but emerged during the development process.
  
  
  RESULTS
  A 60 min training intervention, delivered in either a face-to-face or online setting, with follow-up at eight weeks, was designed to improve the capability, opportunity and motivation of nurses to deliver VBA on physical activity to people living with cancer. This intervention incorporates seven behaviour change techniques of goal setting coupled with commitment; instructions on how to perform the behaviour; salience of the consequences of delivering VBA; a demonstration on how to give VBA, all delivered via a credible source with objects added to the environment to support behavioural change.
  
  
  CONCLUSIONS
  The BCW is a time consuming process, however, it provides a useful and comprehensive framework for intervention development and greater control over intervention replication and evaluation.
authors.affiliation: Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK. Electronic address: jwebb@macmillan.org.uk.
authors.forename: J
authors.initials: J
authors.lastname: Webb
authors.affiliation: Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK.
authors.forename: J
authors.initials: J
authors.lastname: Foster
authors.affiliation: Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK.
authors.forename: E
authors.initials: E
authors.lastname: Poulter
mesh_terms: D001521:Behavior Therapy / Q000379:methods* / Q000458:organization & administration*; D005240:Feasibility Studies; D006801:Humans; D008019:Life Style; D009043:Motor Activity; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology; D006113:United Kingdom
keywords: Behaviour change wheel; Cancer; Physical activity; Very brief advice