Table 6 Themes and sub-themes with supporting quotes

Healthy lifestyle

Feeling fitter – both as a goal and an outcome

[via translator] She said that before the trial she feels so tired and she sometimes was worrying because she had… granddaughter but now she feel good and she can enjoy going … she can enjoy with her granddaughter in the park or sometimes around they walk. (IDN14)

I mean you know I think it has made a difference and it does make me think about where I’m walking and how far I’m walking and the health benefits, so yes, I think it was a really good thing and I think it would be a really great thing if more people could actually have the support to do something like that. (IDN30)

Sleep

..when I go walking, it helps and I sleep better as well when I go walking, and come back, I have a better night’s sleep, and all aches and pain disappear. (IDN34)

Weight loss – both as a goal and an outcome

And since the beginning of the uhh trial I’ve lost just over a stone in weight… I feel fitter now than I have done for years. (IDN11)

I want to lose some weight and make myself healthy, just healthy, you know. (IDN28)

Awareness of walking as part of a healthy lifestyle

I think you know umm getting people to increase their step count is a great idea because it’s an easy way of exercising and you know and the health benefits are good, so I’m very much supportive of the aims of the study…You become more aware of the benefits of walking. (IDN38)

Physical health

Specific health problems – worsening and improving

I do have arthritis…and I had a bad spell during the middle where I’d done something to my knee..it was a pulled muscle or something.. So I struggled to walk too far. (IDN3)

I was having some physio, that was in January, and with the combination of the physio and the walking, and I don’t know whether it was just because of swinging my arms and there was more movement, but I think it helped with that as well, and even the physio said he thought it had helped. (IDN30)

Pain

..now what I have noticed is that, if I’m in to exercise regimes, that are sustained and regular, I feel much less of that pain. (IDN10)

I had suffering a back ache, you know, and leg pain and things like that, but when I go walking, it helps. (IDN34)

Environment

Primary care as the location

Yes, that was good, because obviously it was very near home so it was ideal. (IDN15)

Yes, I mean I think it’s … it’s good being able to do that. It’s fairly local for me, you know, easy to get to. Much easier than if I had to go to a hospital you know so, yes, that was easy. (IDN30)

Weather/season/climate

I enjoyed the fresh air and the exercise and I felt better for it. (IDN2)

In winter it dies down a little bit, anyway, you just want to get out of cold and rain and you just make it home asap and you’re just less active. So there’s a seasonal thing definitely, you know, so if it’s summer, you are out and about all day anyway. (IDN1)

Well obviously it’s much nicer to go for a walk in the spring or the summer or the autumn, so if you do hand these things out in the winter, people don’t think I’ll go for a walk, oh no, God it’s cold out there, it’s raining. (IDN13)

Locality for walking

..it was really nice to start going out for little walks in the neighbourhood and finding places, little parks, and little cafes that I hadn’t been to before, so that was another positive thing. (IDN6)

I think I’m lucky. I’ve got a small park, close to me and so whereas I may have walked to the shops, I would do three circuits or so of that and then go on to the shops. (IDN35)

Work

It depends what I’m doing because if I’m at work, then I’m obviously not as active because I’m in a small confined space and I just walk up and down when I need to sort of thing. (IDN7)

An awful lot of what I maybe can do now is likely sedentary involvement. I’m doing online work which really confines me to sitting you know and doing a lot of work on the computer. And I have to make a conscious effort both for going out and doing the necessary walking. (IDN10)

Pets

I have moved in to a place with three dogs, can’t get any better, so I walk more I think maybe now. (IDN1)

I know this week I haven’t got the dog and we’ve been really busy and I’ve been much more car bound so I would dread to think what my steps were this week. And that’s why I think, having a dog, is fantastic, because you have to go out anyway. (IDN33)

Routine

Fixed routine – unable to increase walking

I didn’t find it physically that difficult to actually reach it, but just very time consuming and I just with working I found that I..just didn’t have the sort of time or enthusiasm for doing that. (IDN2)

The walking is because I do the same all the time you know. Every day is my routine walk you know, going to work... Because you know I do it every day, the walking in this way, I don’t need any help for anyone. (IDN4)

I’ve had a very bad year, work-wise, well I’m working under a lot of pressure, and time to go and do things wasn’t really there. (IDN22)

I mean there is a limit to the amount of exercise … time I can spend exercising in a day. (IDN31)

Fluctuating routine – sometimes allowing for walking, sometimes not

Well I don’t think I ever reached the actual total targets. I did on odd days. But you know it was all depended on my umm … commitment because, if I was you know … out somewhere and that, I couldn’t do the walking, it was alright when I was just at home and I could just walk round the roads and get my steps up, do you see what I mean? (IDN19)

I mean, to me, it very much depends what’s going on in my life. I have a dog, I have a husband who at the beginning of last year changed his job so he’s at home much more, which has changed my routine enormously. And I … that has really affected my exercising. But I mean on a daily basis I’m very busy. So I’m probably good on steps, yes. But when I don’t have the dog, which I haven’t done for the last few weeks, then it goes down enormously. (IDN33)

New/flexible routine

…a really good outcome, I’ve just thought, we hardly ever use the car. Only when I do a big shop. Or we’re going to visit someone, we hardly ever use the car. That’s a real plus. (IDN18)

Yes, everyone in my house now, we don’t drive to the shops, we all walk to the shops…Because I’m the one who drives so I just say I’m not driving, I’m walking.. so we end up walking, so that’s the influence, it was easier for me just to jump in to the car, now I have to think twice do I really have to? (IDN21)

I did try to increase it to five times a week, and I’ve certainly kept that up now, so for instance, I’ve been to the gym this morning. Tomorrow I’ll make sure that I walk in to town and walk back again, so that at least five times a week, doing at least minimum of 30 minutes, but three times a week it’s an hour or more. I think the PACE-UP programme has kind of set me off on a new regime of keeping fit. (IDN39)

Monitoring

Targets

It seemed like a challenge and I think it’s one of those things as well that, when you’re … you’re given a challenge, umm… I think I started slipping once it had finished and that is because I didn’t have that challenge there anymore. (IDN30)

It was very positive, it was very positive in that every time I managed to achieve and go beyond it was … there was a real boost. (IDN37)

Sometimes it was a bit demoralising because you kind of thought, oh, I can’t possibly do that number of steps, you felt like you were never reaching your goal, so that was probably a bit … it wasn’t de-motivating but it’s a slightly demoralising to think you’re not reaching your targets isn’t it, so I think maybe the targets … should consider the targets you are setting people with a time or maybe I just should walk faster or something. (IDN38)

Self-efficacy/self-monitoring

Well part of it, part of it, but I myself pushed myself more as well because I didn’t go to the nurse that often, then I was on my own, so I had to be dependable on my own strength and walk. (IDN12)

What would she say, walk a bit quicker, eat a bit less? It’s common sense I knew in the first place…I don’t think a nurse or anybody else telling me what I should do would really make much difference, quite honestly. (IDN23)

I’m quite a self-motivated person so I don’t … I think if I’ve agreed to do something, then I will try and achieve that target, whether somebody tells me face to face or by post, so I think it’s dependent on the individuals maybe, individual choice. (IDN38)

External monitoring and feedback

So that even when I feel like I am giving up, it’s more like I am thinking, but no, somebody will be watching me! (IDN21)

..it’s having someone to get some feedback from because then you know you aren’t doing things in vain. (IDN22)

There’s nothing like the fact that you know you’re going to meeting someone and talk about it to make you do it, you know, when I was at work, we used to have this thing about, as I said, you’d rather do things they enjoy or things they are checked up on… It’s basically the routine of being checked up on by someone else and being part of a group of people. (IDN29)

Yes, it would have been incredibly useful, yes, it would have been. It would have been, for two-fold, one to get some sort of feedback, the other one just to sustain that level of interest in the programme. Purely because you’re having to … you’re being monitored and you’re having to respond to certain key stones, key points, and I think by the very nature of human beings, when we’re being monitored, we do things. (IDN37)

Equipment used for monitoring

Oh I did always look. Actually it was quite … and if I had had a low … the weekend tends to be lower, it did just jog my … yes, it made me think, okay, fine, I must do a little bit more. (IDN33)

I wasn’t too sure about its accuracy because sometimes I would do a similar route and it would give a different reading, quite a large different reading. (IDN11)

Sometimes it [the pedometer] didn’t pick things up, I used to get annoyed because it wouldn’t pick things up in the gym, I’d think oh, I’ve just done about 2,000 strides, and I’ve looked down and think, ooh, you didn’t get any of that. (IDN43)

Social perspectives

Peer support/encouragement (including positive thoughts about group setting)

It’s a bit like talking to people who are in the same situation as yourself, you know, because no-one understands the issues of someone better than someone who is in that situation themselves. I’m not saying that there are other ways of coaching and supporting people, but I’m just thinking of the things that tend to change peoples’ behaviour. (IDN29)

I think sometimes it can be helpful to talk in a group because you might have an idea that somebody else hasn’t thought of and vice versa. (IDN30)

I think you could sort of encourage each other, yes, it’s more fun doing stuff with other people really isn’t it. (IDN43)

Meeting others (including positive thoughts about group setting)

Sometimes I’m walking, and I meet somebody, and they will stop and talk to me and ask me the reason why. And I’ll say to them, walk with me, and we would talk, you know, and that I think that was very good. (IDN9)

Sometimes it’s a way of getting to meet other people in your area that you could actually, I suppose say, shall we all do this together and something like that, you never know. (IDN18)

Impact on others

I’ve got a son of 16, its made me kind of like if he says can I have lift or something like that, I say, and because I do a lot of driving with my job, the last thing I want to do is get in the car, I say, no, but I’ll walk up there with you, and sometimes he says no thanks, I’ll walk on my own, but its made me more … I think its increased his walking as well because of … because of this. I think it has been really good from that point of view, yes. (IDN16)

I think we’ve now managed to encourage our sister-in-law to start walking. She’s now been going out walking because she can see the benefits of how we’ve got on, you know, because we go for quite long brisk walks and we don’t get out of breath or anything, so umm she sort of thought, oh, well I’ll start my walking now, because she’s quite overweight. (IDN20)