Acceptability of feasibility of an intervention to increase physical activity in older adults with chronic pain: Health Care Assistants’ views in the iPOPP pilot trial.

Problem

Physical activity levels are low in people >65 years and those with chronic musculoskeletal pain, yet increased physical activity can lead to reduced pain. Walking is acceptable to older people with pain, but effectiveness of walking interventions hasn’t been established in this population. Ahead of a main trial, the iPOPP pilot trial investigated feasibility and acceptability of a walking intervention delivered by 5 Health Care Assistants (HCAs) (4 general practices) in an individually randomised three arm trial (usual primary care, pedometer only and iPOPP, n=50 each arm). iPOPP comprises: Week 1 face-HCA consultation (walking action plan, pedometer, walking diary, pain toolkit, discuss walking behaviour/barriers, goal setting; week 2 follow-up face-to-face or telephone, review progress and goals, relapse prevention strategies; weeks 3-10 weekly motivational prompts (postcard, email or text).

Approach

As part of a process evaluation, 4 out of 5 HCAs agreed to participate in a semi-structured interview. Interviews were audio recorded and transcribed verbatim. Data were mapped to the Theoretical Domains Framework to identify influences on HCA behaviour (barriers and enablers to implementation of iPOPP), in order to inform the design of a main trial.

Findings

Most factors facilitating HCAs to implement iPOPP emerged in four overlapping TDF domains: Knowledge; Beliefs about capabilities; Skills; and, Memory, attention and decision processes. HCAs described how knowing evidence about the relationship between joint pain and exercise increased confidence to discuss walking in consultations. Skills development and changes in consultation practice (e.g. asking open questions) resulted from iPOPP training (e.g role play). During consultations HCAs found a laminated prompt card useful to remind them of intervention components. All HCAs perceived that interventions tools (e.g. diary logs, pedometers) helped to motivate patients to walk. The main barrier to implementation of iPOPP was participants’ current levels of physical activity. HCAs struggled to advise patients who perceived themselves already physically active. There were also mixed views on completion of the online case report forms. One HCA described herself as not being computer literate whilst others found it useful in prompting what had to be done during the consultation.

Consequences

Investigating feasibility and acceptability is an important stage in the development and evaluation of complex interventions as randomised controlled trials in primary care are often unsuccessful due to suboptimal intervention and/or trial design. HCAs’ views of the iPOPP trial were overall positive, indicating the iPOPP intervention is acceptable to HCAs working in primary care. However we have identified some areas for further optimisation (content of training programme, use of case report forms). These findings will be compared with data from audio recorded consultations and interviews with patients to provide further evidence of acceptability and feasibility ahead of a main trial.