Let's Move with Leon-A qualitative evaluation of a UK digital intervention to improve physical activity in people with a musculoskeletal condition.

OBJECTIVE: This article presents a qualitative evaluation of a 13-week digital intervention, 'Let's Move with Leon', designed to improve physical activity in people with a musculoskeletal condition. STUDY DESIGN: A qualitative evaluation embedded within a randomised controlled trial assessing the effectiveness of the intervention at improving self-reported physical activity. METHODS: A total of 184 participants received the intervention and were asked each week for 13 weeks to provide comment on their use and the usefulness of the digital physical activity behaviour change intervention. In addition, after 13 weeks, 12 participants took part in a semistructured interview to understand their use and the usefulness of the intervention. A thematic analysis was conducted on the combined qualitative data set. RESULTS: A total of 128 of the 184 intervention participants (70.11%) provided at least one qualitative comment over the course of the evaluation (mean number of comments per participant = 5); in total, 674 comments were received. The thematic analysis identified three themes: (1) dipping in and out, (2) one size does not fit all and (3) monitoring and feedback. The qualitative data suggest that participants used the intervention sporadically, dipping in and out due to other commitments, and competing programmes, their changing physical ability, confidence and motivation. Not getting off to a good start was detrimental to use; many wanted to come back to the programme at a more appropriate time. A 'one size fits' approach catered for some but not all participants. Whilst not a predetermined intervention component the act of monitoring levels of activity as a data collection method seemed to encourage physical activity but may also result in negative social comparisons. CONCLUSION: Digital physical activity behaviour change interventions are not one-size-fits-all; personalisation is key. Monitoring of activity by a named person can create commitment. Many dip in and out. Digital physical activity behaviour change interventions could complement physiotherapy exercises for people with musculoskeletal conditions. Signposting to local activities should be considered.

The effect of population model choice and network topologies on extinction time patterns in dendritic ecological networks.

Models of populations in habitat networks are vital for understanding and linking processes and patterns across individuals, environments, ecological interactions, and population structures. River ecosystem models combine the physical structure of the networks with the biological processes of the organisms using structural and functional models, respectively. Previous studies on dendritic river networks have employed different functional (population) models and either directly claimed or implied that the results illustrate general properties of actual river systems. However, these studies have used different approaches and assumptions when modeling population characteristics and behavior, and it is possible that inferences regarding a system may vary based on the combination of functional model and the spatial structure of a network. This study aims to understand if different functional models in river systems produce substantially different model results and, therefore, whether conclusions are model-dependent. We compare variation in extinction time and occupancy proportion of river networks with linear, trellis, dendritic and ring-lattice topologies, using three population models (uniform, age-class and individual based) and one metapopulation-based (patch-occupancy) model. Dendritic, linear, and trellis structures did not show notable differences among extinction times for any of the four models. The difference between topologies was higher for the patch-occupancy model compared to the three population models. There were significant differences in the variations of patch-occupancy between the metapopulation and the population models, but the three population models of differing complexity produced broadly similar results. Therefore, if the occupancy data is obtained based on local subpopulations, spatial arrangement and connectivity does not appear to be the sole predictor of single-species metapopulation responses. We conclude that the outputs from functional models are robust to assumptions and varying levels of detail as long as they contain at least some detail at the level of individuals within habitat nodes. Also, if we are modeling network-scale populations, models that include at least some detailed information on individuals are a far better choice than considering populations implicitly.

Applying and Assessing Participatory Approaches in an Environmental Flows Case Study.

Environmental flows (e-flows) management takes place within a complex social-ecological system, necessitating the involvement of diverse stakeholders and an appreciation of a range of perspectives and knowledge types. It is widely accepted that incorporating participatory methods into environmental flows decision-making will allow stakeholders to become meaningfully involved, improving potential solutions, and fostering social legitimacy. However, due to substantial structural barriers, implementing participatory approaches can be difficult for water managers. This paper assesses the effectiveness of an e-flows methodology that combines elements of structured decision-making and participatory modeling, whilst constrained by project resources. Three process-based objectives were identified by the group at the start of the process: improving transparency, knowledge exchange, and community ownership. We evaluated the success of the approach according to those objectives using semi-structured interviews and thematic analysis. In evaluating how well the participatory approach achieved the process objectives, we found that at least 80% of respondents expressed positive sentiment in every category (n = 15). We demonstrate that the values-based process objectives defined by the participant group are an effective tool for evaluating participatory success. This paper highlights that participatory approaches can be effective even in resource-constrained environments when the process is adapted to fit the decision-making context.

An in vitro biofilm model system to facilitate study of microbial communities of the human oral cavity.

The human oral cavity is host to a diverse microbiota. Much of what is known about the behaviour of oral microbes derives from studies of individual or several cultivated species, situations which do not totally reflect the function of organisms within more complex microbiota or multispecies biofilms. The number of validated models that allow examination of the role that biofilms play during oral cavity colonization is also limited. The CDC biofilm reactor is a standard method that has been deployed to study interactions between members of human microbiotas allowing studies to be completed during an extended period under conditions where nutrient availability, and washout of waste products are controlled. The objective of this work was to develop a robust in vitro biofilm-model system from a pooled saliva inoculum to study the development, reproducibility and stability of the oral microbiota. By employing deep sequencing of the variable regions of the 16S rRNA gene, we found that the CDC biofilm reactor could be used to efficiently cultivate microbiota containing all six major phyla previously identified as the core saliva microbiota. After an acclimatisation period, communities in each reactor stabilised. Replicate reactors were predominately populated by a shared core microbiota; variation between replicate reactors was primarily driven by shifts in abundance of shared operational taxonomic units. We conclude that the CDC biofilm reactor can be used to cultivate communities that replicate key features of the human oral cavity and is a useful tool to facilitate studies of the dynamics of these communities.

Non-local second-order boundary value problems with derivative-dependent nonlinearity.

We prove the existence of multiple positive solutions of nonlinear second-order nonlocal boundary value problems with nonlinear term having derivative dependence. We allow the nonlinearity to grow quadratically with respect to derivatives. We obtain a priori bounds for norms of derivatives by using a recently obtained Gronwall-type inequality. Three examples illustrate some of the results. This article is part of the theme issue 'Topological degree and fixed point theories in differential and difference equations'.

Evaluating the Ecological Benefits of Management Actions to Complement Environmental Flows in River Systems.

Globally, many river systems are under stress due to overconsumption of water. Governments have responded with programmes to deliver environmental water to improve environmental outcomes. Although such programmes are essential, they may not be sufficient to achieve all desired environmental outcomes. The benefits of environmental water allocation may be improved using 'complementary measures', which are non-flow-based actions, such as infrastructure works, vegetation management and pest control. The value of complementary measures is recognised globally, but their ecological benefits are rarely well understood, either because there is limited experience with their application, or the importance of context- and location-specific factors make it difficult to generalise benefits. In this study, we developed an approach to evaluate complementary measures at different levels of detail as a mechanism to aid decision-making. For systems that require a rapid, high-level evaluation, we propose a score-based multi-criteria benefit assessment module. If more ecological detail is necessary, we outline a method based on conceptual models, expert elicitation and probability assessment. These results are used to populate a cumulative benefit assessment tool. The tool evaluates the benefits of proposed measures in the wider context by including variables such as flow, dependence on ongoing maintenance and additional ecological values. We illustrate our approach through application to the Murray-Darling Basin, Australia. As many water recovery programmes mature into their evaluation phases, there is an increasing need to evaluate the ecological benefits of including complementary measures in the toolkit available to policy makers.

Antimicrobial Activity of the Quinoline Derivative HT61 against Staphylococcus aureus Biofilms.

Staphylococcus aureus biofilms are a significant problem in health care settings, partly due to the presence of a nondividing, antibiotic-tolerant subpopulation. Here we evaluated treatment of S. aureus UAMS-1 biofilms with HT61, a quinoline derivative shown to be effective against nondividing Staphylococcus spp. HT61 was effective at reducing biofilm viability and was associated with increased expression of cell wall stress and division proteins, confirming its potential as a treatment for S. aureus biofilm infections.

A simulation-based approach to assess the power of trend detection in high- and low-frequency water quality records.

To provide more precise understanding of water quality changes, continuous sampling is being used more in surface water quality monitoring networks. However, it remains unclear how much improvement continuous monitoring provides over spot sampling, in identifying water quality changes over time. This study aims (1) to assess our ability to detect trends using water quality data of both high and low frequencies and (2) to assess the value of using high-frequency data as a surrogate to help detect trends in other constituents. Statistical regression models were used to identify temporal trends and then to assess the trend detection power of high-frequency (15 min) and low-frequency (monthly) data for turbidity and electrical conductivity (EC) data collected across Victoria, Australia. In addition, we developed surrogate models to simulate five sediment and nutrients constituents from runoff, turbidity and EC. A simulation-based statistical approach was then used to the compare the power to detect trends between the low- and high-frequency water quality records. Results show that high-frequency sampling shows clear benefits in trend detection power for turbidity, EC, as well as simulated sediment and nutrients, especially over short data periods. For detecting a 1% annual trend with 5 years of data, up to 97% and 94% improvements on the trend detection probability are offered by high-frequency data compared with monthly data, for turbidity and EC, respectively. Our results highlight the benefits of upgrading monitoring networks with wider application of high-frequency sampling.

A randomised control trial and cost-consequence analysis to examine the effects of a print-based intervention supported by internet tools on the physical activity of UK cancer survivors.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a print-based intervention supported by Internet tools at improving physical activity in cancer survivors compared with a standard letter recommendation. Prediagnosis physical activity and self-efficacy were hypothesised to predict physical activity improvement. STUDY DESIGN: Waiting list randomised control trial and cost-consequence analysis. METHODS: Adult cancer survivors who could become physically active without prior medical approval were randomised to receive either a print-based intervention supported by Internet tools (intervention, n = 104) or a standard letter recommendation (control, n = 103). Physical activity was assessed at 12 weeks with maintenance assessed at 24 weeks in the intervention arm. The number needed to treat was calculated, and a cost-consequence analysis completed. RESULTS: Participants in receipt of a print-based intervention supported by Internet tools improved their physical activity by 36.9% over 12 weeks compared with 9.1% in the control arm. Physical activity was maintained at 24 weeks in the intervention arm. A total of 6.29 cancer survivors needed to receive the intervention for one cancer survivor to improve their physical activity over a standard letter recommendation. Intervention delivery cost £8.19 per person. Prediagnosis physical activity and self-efficacy did not predict physical activity improvement. CONCLUSION: A print-based intervention supported by Internet tools offers a promising low-cost means to intervene to improve physical activity in cancer survivors. The study was registered with the International Standard Randomised Controlled Trials Number registry (registration number: 66418871), and ethical approval was received from the University of Surrey (reference: UEC/2017/023/FHMS).

A mixed methods process evaluation of a print-based intervention supported by internet tools to improve physical activity in UK cancer survivors.

OBJECTIVE: A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third of them do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits and the contextual factors influencing these, identifying for whom it is a useful resource. METHODS: The process evaluation used mixed methods, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12 weeks, 56 open-text responses and 17 semistructured interviews. RESULTS: The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fight cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention's printed components were more popular and well used than the Internet tools. Use of the printed intervention components was positively correlated with physical activity improvement but use of the Internet tools was not. Women were more likely to use the intervention's printed components than men. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours. CONCLUSION: The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fight cancer but with low levels of physical activity. Use of the intervention's printed components is more likely to improve physical activity than the Internet tools, and the components are more likely to be used by women. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.

Comparison of ammonia emissions related to nitrogen use efficiency of livestock production in Europe.

The increasing global demand for food and the environmental effects of reactive nitrogen losses in the food production chain, increase the need for efficient use of nitrogen (N). Of N harvested in agricultural plant products, 80% is used to feed livestock. Because the largest atmospheric loss of reactive nitrogen from livestock production systems is ammonia (NH3), the focus of this paper is on N lost as NH3 during the production of animal protein. The focus of this paper is to understand the key factors explaining differences in Nitrogen Use Efficiency (NUE) of animal production among various European countries. Therefore we developed a conceptual framework to describe the NUE defined as the amount of animal-protein N per N in feed and NH3-N losses in the production of milk, beef, pork, chicken meat and eggs in The Netherlands, Switzerland, United Kingdom, Germany, Austria and Denmark. The framework describes how manure management and animal-related parameters (feed, metabolism) relate to NH3 emissions and NUE. The results showed that the animal product with the lowest NUE had the largest NH3 emissions and vice versa, which agrees with the reciprocal relationship between NUE and NH3 within the conceptual framework. Across animal products for the countries considered, about 20% of the N in feed is lost as NH3. The significant smallest proportion (12%) of NH3-N per unit of Nfeed is from chicken production. The proportions for other products are 17%, 19%, 20% and 22% for milk, pork, eggs and beef respectively. These differences were not significantly different due to the differences among countries. For all countries, NUE was lowest for beef and highest for chicken. The production of 1 kg N in beef required about 5 kg N in feed, of which 1 kg N was lost as NH3-N. For the production of 1 kg N in chicken meat, 2 kg N in feed was required and 0.2 kg was lost as NH3. The production of 1 kg N in milk required 4 kg N in feed with 0.6 kg NH3-N loss, the same as pork and eggs, but those needed 3 and 3.5 kg N in feed per kg N in product respectively. Except for beef, the differences among these European countries were mainly caused by differences in manure management practices and their emission factors, rather than by animal-related factors including feed and digestibility influencing the excreted amount of ammoniacal N (TAN). For beef, both aspects caused important differences. Based on the results, we encourage the expression of N losses as per N in feed or per N in product, in addition to per animal place, when comparing production efficiency and NUE. We consider that disaggregating emission factors into a diet/animal effect and a manure management effect would improve the basis for comparing national NH3 emission inventories.

Adaptive Management of Environmental Flows.

Adaptive management enables managers to work with complexity and uncertainty, and to respond to changing biophysical and social conditions. Amid considerable uncertainty over the benefits of environmental flows, governments are embracing adaptive management as a means to inform decision making. This Special Issue of Environmental Management presents examples of adaptive management of environmental flows and addresses claims that there are few examples of its successful implementation. It arose from a session at the 11th International Symposium on Ecohydraulics held in Australia, and is consequently dominated by papers from Australia. We classified the papers according to the involvement of researchers, managers and the local community in adaptive management. Five papers report on approaches developed by researchers, and one paper on a community-led program; these case studies currently have little impact on decision making. Six papers provide examples involving water managers and researchers, and two papers provide examples involving water managers and the local community. There are no papers where researchers, managers and local communities all contribute equally to adaptive management. Successful adaptive management of environmental flows occurs more often than is perceived. The final paper explores why successes are rarely reported, suggesting a lack of emphasis on reflection on management practices. One major challenge is to increase the documentation of successful adaptive management, so that benefits of learning extend beyond the project where it takes place. Finally, moving towards greater involvement of all stakeholders is critical if we are to realize the benefits of adaptive management for improving outcomes from environmental flows.

River Bank Erosion and the Influence of Environmental Flow Management.

Environmental flows aim to influence river hydrology to provide appropriate physical conditions for ecological functioning within the restrictions of flow regulation. The hydrologic characteristics of flow events, however, may also lead to unintended morphologic effects in rivers, such as increases in riverbank erosion beyond natural rates. This may negatively impact habitat for biota, riparian infrastructure, and land use. Strategic environmental flow delivery linked to monitoring and adaptive management can help mitigate risks. We monitor riverbank condition (erosion and deposition) relative to environmental flows on the Goulburn River, Victoria, Australia. We describe the process of adaptive management aimed at reducing potential impacts of flow management on bank condition. Field measurements (erosion pins) quantify the hydrogeomorphic response of banks to the delivery of planned and natural flow events. Managed flows provide opportunities for monitoring riverbank response to flows, which in turn informs planning. The results demonstrate that environmental flows have little influence on bank erosion and visual perceptions in the absence of monitoring are an unreliable guide. This monitoring project represents a mutually beneficial, science-practice partnership demonstrating that a traditional 'know then do' approach can be foreshortened by close collaboration between researchers and managers. To do so requires transparent, often informal lines of communication. The benefits for researchers-a more strategic and targeted approach to monitoring activities; and benefits for the practitioners-reduced time between actions and understanding response; mean that a learn by doing approach is likely to have better outcomes for researchers, stakeholders, the public, and the environment.

Make the Most of the Data You've Got: Bayesian Models and a Surrogate Species Approach to Assessing Benefits of Upstream Migration Flows for the Endangered Australian Grayling.

Environmental water managers must make best use of allocations, and adaptive management is one means of improving effectiveness of environmental water delivery. Adaptive management relies on generation of new knowledge from monitoring and evaluation, but it is often difficult to make clear inferences from available monitoring data. Alternative approaches to assessment of flow benefits may offer an improved pathway to adaptive management. We developed Bayesian statistical models to inform adaptive management of the threatened Australian grayling (Prototroctes maraena) in the coastal Thomson River, South-East Victoria Australia. The models assessed the importance of flows in spring and early summer (migration flows) for upstream dispersal and colonization of juveniles of this diadromous species. However, Australian grayling young-of-year were recorded in low numbers, and models provided no indication of the benefit of migration flows. To overcome this limitation, we applied the same models to young-of-year of a surrogate species (tupong-Pseudaphritis urvilli)-a more common diadromous species expected to respond to flow similarly to Australian grayling-and found strong positive responses to migration flows. Our results suggest two complementary approaches to supporting adaptive management of Australian grayling. First, refine monitoring approaches to allow direct measurement of effects of migration flows, a process currently under way. Second, while waiting for improved data, further investigate the use of tupong as a surrogate species. More generally, alternative approaches to assessment can improve knowledge to inform adaptive management, and this can occur while monitoring is being revised to directly target environmental responses of interest.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles.

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

The impact of hoist sling fabrics on interface pressure whilst sitting in healthy volunteers and wheelchair users: A comparative study.

AIM OF THE STUDY: To evaluate the effect of three sling fabrics on gluteal interface pressure whilst sitting in a population of wheelchair users and to compare these to data previously collected in a pilot study with a healthy population. MATERIALS AND METHODS: A repeated measures experimental design was used with 32 adult wheelchair users (15 women, 17 men). Healthy population pilot study consisted of 61 participants (51 women, 10 men) recruited from staff and students at The University of Salford. METHODS: Gluteal pressures at six pressure zones were recorded using the X-sensor PX100 pressure sensor at 30 s intervals for 10 min. Data were collected in 4 conditions with participants seated in a standardised chair, followed by the chair with slings made of three different fabrics. RESULTS: The spacer fabric reduced the mean gluteal pressure more effectively than slipfit and polyester (p = 0.014 and p = 0.01 respectively, 95%CI) and reduced peak pressure at the left ischial tuberosity and coccyx when compared to the slipfit (p = 0.003 and p = 0.005) with the wheelchair users. When comparing data with the pilot study, the mean gluteal pressure and peak pressures at the ischial tuberosities and coccyx were significantly higher in the wheelchair user group (p < 0.005). CONCLUSION: The fabric identified as the most effective in reducing mean and peak pressures in both groups was the spacer fabric, suggesting that a spacer fabric sling is more likely to reduce the risk of pressure ulcer development. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Sex-based differences in outcomes with bivalirudin or unfractionated heparin for transcatheter aortic valve replacement: Results from the BRAVO-3 randomized trial.

BACKGROUND: Women comprise almost 50% of patients undergoing transcatheter aortic valve replacement (TAVR) and previous studies have indicated higher rates of procedural complications and bleeding in women compared to men. It is unknown whether men and women demonstrate a differential response to bivalirudin versus unfractionated heparin (UFH) in TAVR. We sought to evaluate outcomes by sex and type of anticoagulant from the Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement (BRAVO-3) trial of transfemoral TAVR. METHODS: BRAVO-3 was a randomized multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH (31 centers, n = 802). The primary endpoint was 48 h major bleeding defined as Bleeding Academic Research Consortium (BARC) type ≥3b. Major adverse cardiovascular events (MACE) were a composite of 30-day death, myocardial infarction, or stroke. Net adverse cardiovascular events (NACE) were a composite of BARC ≥3b bleeding or 30-day MACE. We examined the outcomes in men and women. RESULTS: The total cohort included 49% women (n = 391, 195 received bivalirudin and 196 UFH) and 51% men (n = 411, 209 received bivalirudin and 202 UFH). Women were older than men with fewer comorbidities including coronary artery disease, atrial fibrillation, diabetes but similar EuroSCORE I. Women received smaller sheath and device sizes compared with men without differences in the use of vascular closure devices. At 48-hr post-TAVR there was no difference in bleeding or vascular complications in women compared to men. The use of bivalirudin did not result in significantly lower bleeding at 48 hr or 30-days compared to UFH. CONCLUSIONS: There was no difference in early outcomes with bivalirudin versus UFH in men or women undergoing contemporary TAVR. © 2016 Wiley Periodicals, Inc.

Multidetector computed tomography sizing of bioprosthetic valves: guidelines for measurement and implications for valve-in-valve therapies.

AIM: To describe a technique for bioprosthetic multidetector computed tomography (MDCT) sizing and to compare MDCT-derived values against manufacturer-provided sizing. MATERIALS AND METHODS: Fourteen bioprosthetic stented valves commonly used in the aortic valve position were evaluated using a Philips 256 MDCT system. All valves were scanned using a dedicated cardiac CT protocol with a four-channel electrocardiography (ECG) simulator. Measurements were made of major and minor axes and the area and perimeter of the internal stent using varying reconstruction kernels and window settings. Measurements derived from MDCT (MDCT ID) were compared against the stent internal diameter (Stent ID) as provided by the valve manufacturer and the True ID (Stent ID + insertion of leaflets). All data were collected and analysed using SPSS for Mac (version 21). RESULTS: The mean difference between the MDCT ID and Stent ID was 0.6±1.9 mm (r=0.649, p=0.012) and between MDCT ID and True ID 2.1±2 mm (r=0.71, p=0.005). There was no difference in the major (p=0.90), minor (p=0.87), area (p=0.92), or perimeter (p=0.92) measurements when sharp, standard, and detailed stent kernels were used. Similarly, the measurements remained consistent across differing windowing levels. CONCLUSION: Bioprosthetic stented valves may be reliably sized using MDCT in patients requiring valve-in-valve (VIV) interventions where the valve type and size are unknown. In these cases, clinicians should be aware that MDCT has a tendency to overestimate the True ID size.

Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel.

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). METHOD: 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. CONCLUSION: 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.

Increasing the frequency of physical activity very brief advice by nurses to cancer patients. A mixed methods feasibility study of a training intervention.

OBJECTIVES: To examine the impact, acceptability, practicability and implementation of a training intervention, designed using the Behaviour Change Wheel, on the delivery of very brief advice on physical activity, by nurses to cancer patients. STUDY DESIGN: A mixed methods feasibility study. METHOD: A purposeful sample of nurses (n = 62) were recruited across two delivery arms, face-to-face (n = 55) and online (n = 7). Frequency of delivery of physical activity advice was collected at baseline with follow-up at 12 weeks. The 'capability, opportunity and motivation' of nurses to deliver very brief advice was measured via questionnaire. Semi-structured phone interviews (n = 14) were completed and analyzed thematically. A cost consequence analysis was undertaken. RESULTS: The intervention improved the 'capability, opportunity and motivation' of nurses resulting in a change in knowledge, attitudes and beliefs towards physical activity. The intervention was both acceptable and practical. Face-to-face was the preferred mode of delivery, however there was also value in the online option. The cost of delivery per participant was £33.87 for face-to-face delivery, and £103.83 for online delivery inflated due to low recruitment numbers. A significant improvement was seen in delivery of very brief advice at 12 weeks (Z = -4.39, P ≤ 0.01). CONCLUSION: The intervention is acceptable, practical and improves delivery of very brief advice on physical activity by nurses to cancer patients in the short-term. Both face-to-face and online delivery should be considered.