title: A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar.
abstract: BACKGROUND
  Visualisation techniques are used in a range of healthcare interventions. However, these frequently lack a coherent rationale or clear theoretical basis. This lack of definition and explicit targeting of the underlying mechanisms may impede the success of and evaluation of the intervention. We describe the theoretical development, deployment, and pilot evaluation, of a complex visually mediated behavioural intervention. The exemplar intervention focused on increasing physical activity among young people with asthma. We employed an explicit five-stage development model, which was actively supported by a consultative user group. The developmental stages involved establishing the theoretical basis, establishing a narrative structure, visual rendering, checking interpretation, and pilot testing. We conducted in-depth interviews and focus groups during early development and checking, followed by an online experiment for pilot testing. A total of 91 individuals, including young people with asthma, parents, teachers, and health professionals, were involved in development and testing.
  
  
  RESULTS
  Our final intervention consisted of two components: (1) an interactive 3D computer animation to create intentions and (2) an action plan and volitional help sheet to promote the translation of intentions to behaviour. Theory was mediated throughout by visual and audio forms. The intervention was regarded as highly acceptable, engaging, and meaningful by all stakeholders. The perceived impact on asthma understanding and intentions was reported positively, with most individuals saying that the 3D computer animation had either clarified a range of issues or made them more real. Our five-stage model underpinned by extensive consultation worked well and is presented as a framework to support explicit decision-making for others developing theory informed visually mediated interventions.
  
  
  CONCLUSIONS
  We have demonstrated the ability to develop theory-based visually mediated behavioural interventions. However, attention needs to be paid to the potential ambiguity associated with images and thus the concept of visual literacy among patients. Our revised model may be helpful as a guide to aid development, acceptability, and ultimately effectiveness.
authors.affiliation: Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Murray
authors.affiliation: Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling Innovation Park, Stirling, FK9 4NF Scotland.
authors.forename: Gaylor
authors.initials: G
authors.lastname: Hoskins
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling Innovation Park, Stirling, FK9 4NF Scotland.
authors.forename: Silje
authors.initials: S
authors.lastname: Skar
authors.affiliation: 3D Visualisation Aesthetics Lab, Art & Design University of New South Wales, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: McGhee
authors.affiliation: Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX England ; Fuse, the UK CRC Centre of Excellence for Translational Research in Public Health, NewCastle, UK.
authors.forename: Falko F
authors.initials: FF
authors.lastname: Sniehotta
authors.affiliation: Volunteer Centre Borders, First Floor, Riverside House, Ladhope Vale, Galashiels, TD1 1BT Scotland.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Asthma UK Scotland, Hayweight House, 4th Floor, 23 Lauriston Street, Edinburgh, EH3 9DQ Scotland.
authors.forename: Gordon
authors.initials: G
authors.lastname: Brown
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hagen
authors.affiliation: University of California, Merced, 5200 N. Lake Road, Merced, CA 95343 USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Cameron
authors.affiliation: Health Informatics Centre, University of Dundee, Dundee, DD1 4HN Scotland.
authors.forename: Claire
authors.initials: C
authors.lastname: Jones
authors.affiliation: Duncan of Jordanstone College of Art and Design, University of Dundee, Dundee, Scotland.
authors.forename: Dylan
authors.initials: D
authors.lastname: Gauld
keywords: 3D animation; 3D computer animation; Asthma; Interdisciplinary; Intervention development; Mixed-methods; Visual