Results
The development process, guided by the behavior change wheel (BCW), produced a fully specified 3.5-hour, small-group training for GPs focused on the very brief 3As method (ask/assess, advise, assist) for physical activity advice in patients with coronary heart disease.
- The study was a formative intervention development study within the OptiCor project.
- The training is structured and delivered in small groups over 3.5 hours.
- It targets GPs' delivery of very brief PA advice in routine CHD primary care in Germany, where no structured, theory-informed training had previously been reported.
Results
The training combines several components: theoretical input, guided self-reflection and group discussion, moderated role-plays, experiential PA learning, consultation materials, and on-demand videos.
- Theoretical input covers PA and CHD.
- Role-plays are moderated and use simulated patients.
- Experiential learning uses PA stimuli.
- Practical consultation materials and short on-demand good practice videos are included.
Methods
The intervention was developed from multiple evidence sources that identified needs, barriers, and preferences related to PA advice.
- Sources were a cross-sectional survey, interviews, and focus groups with GPs and patients from the OptiCor project, plus guideline recommendations and behavior change theory.
- Findings were mapped onto COM-B (capability, opportunity, motivation-behavior) components to identify determinants of GP behavior.
- The determinants were specified using the theoretical domains framework (TDF).
Methods
The BCW intervention function matrix and the BCT taxonomy were used to select intervention functions and specify training components.
- The BCW intervention function matrix informed discussions of suitable intervention functions and training components.
- Intervention components were specified using the behavior change technique (BCT) taxonomy.
- This supports transparent description and replication.
Results
GPs were involved throughout development to ensure relevance, feasibility, and acceptability, and a preimplementation training rehearsal led to minor refinements.
- GP involvement spanned the whole development process.
- Outputs included minor refinements after the preimplementation rehearsal.
Results
The development produced several defined outputs beyond the training itself, including a behavioral specification, a behavioral diagnosis, BCT-specified components, and fidelity procedures.
- Outputs: a refined behavioral specification of GP-delivered PA advice.
- A COM-B/TDF-based behavioral diagnosis of determinants of GP advising behavior.
- BCT-specified training components.
- Fidelity procedures to support standardized delivery.
Background
The intervention was designed to address known barriers: limited GP familiarity with PA guidelines for CHD, insufficient skills for very brief advice, and time constraints.
- PA advice remains infrequent in general practice despite strong evidence of PA benefits in CHD management.
- The intervention targets determinants of GP advising behavior identified in the behavioral diagnosis.
Conclusions
Following development, the training and evaluation procedures were tested in a pragmatic pilot cluster randomized controlled trial (reported separately), and a full-scale pragmatic cRCT evaluating effects on GP behavior is ongoing.
- The pilot cRCT preceded the full-scale trial.
- The effectiveness of the training on GP behavior has not been established in this paper.