Table 1 Findings from Stage 1 systematic reviews, stakeholder consultation [round 1], qualitative research and cost estimation

Systematic review of reviews of brief interventions (BIs): [16]

BCTs identified as potentially feasible, acceptable and effective:

Eleven strategies were identified by at least 5 out of 32 stakeholders:

Health check (HC) observations:

Self-monitoring interventions:

• Three BI reviews and seven general PA intervention reviews were included. No reviews focusing on VBIs were identified.

1.1 Goal setting (behaviour)

1. Information about behaviour-health link (n = 14);

• HC follows a strict template, and lasts approximately 10 minutes.

• Estimated cost of pedometer and consumables (e.g. patient information booklet; a PA diary) = £13.30.

• BIs ranged from 1–3 minutes to 30 minutes. Very few were VBIs (<5 minutes).

1.2 Problem Solving

2. Planning (n = 12);

• Questions about PA/exercise are minimal and vague, e.g. ‘how much exercise do you do?’

• Estimated cost of nurse time = £8.66 (2010 prices).

• Majority of BIs and VBIs were delivered face to face, but were poorly defined in terms of active ingredients.

1.4 Action Planning

3. Tailoring (n = 11);

• Advice on PA not given in the vast majority of HCs observed.

• Total estimated cost = £21.96 per patient.

• Evidence favoured the use of supplements (e.g. written materials) to brief advice.

1.5 Review behaviour goals(s)

4. Signposting (n = 10);

Patient Interviews (n = 51):

Implementation Intentions (action planning) Interventions:

• Uncertainty about the effectiveness, feasibility and acceptability of BIs and VBIs that could be delivered in a routine primary care consultation.

1.6 Discrepancy between current behaviour and goals

5. Time management/ identify opportunities (n = 9);

• Patients wanted nurse to ask more detailed questions about their current PA.

• Estimated cost of consumables (e.g. printed material for patients; log books) = £2.30.

Meta-analysis of the effects of pedometer use on daily PA [17]:

1.9 Commitment

6. General encouragement (n = 7);

• Patients unclear about the definition of ‘exercise’ and ‘PA’.

• Estimated cost of nurse time = £8.66 (2010 prices).

• Pedometers are an effective intervention for increasing PA [pedometers increased steps by 2000 [11] to 2419 [10] steps per day.

2.2 Feedback on behaviour

7. Social support (n = 7);

• Many patients felt that they had not been given PA advice.

• Total estimated cost = £10.96 per patient.

2.3 Self-monitoring of behaviour

8. Exercise prescription/ referral (n = 6);

• Patients wanted tailored PA advice.

Conclusion:

3.1 Social support (unspecified)

9. Goal-setting (n = 6);

• Patients felt that PA advice would be best given at a follow-up appointment (after HC results were fed back to them).

• The costs of self-monitoring and implementation intention interventions are relatively small, comprising initial consultations, stationery, and follow-up consultations to review patient progress.

4.1 Instruction on how to perform the behaviour

10. Self-monitoring (n = 5);

• Patients felt that PA advice was not necessary if HC results indicated that they were ‘healthy’.

5.1 Information about health consequences

11. Provide instruction (n = 5)

Implications for a PA VBI:

5.3 Information about social and environmental consequences

• There is a need for a VBI focusing on PA in the HC.

5.4 Monitoring of emotional consequences

• A 5 minute VBI should fit into a HC.

5.6 Information about emotional consequences

• Patients should be asked detailed questions about their current PA.

8.7 Graded Tasks

• Patients should be made aware of the definition of PA (e.g. what counts as ‘moderate’ intensity).

12.5 Adding objects to the environment

• PA advice should be tailored to the individual (e.g. their current activity, lifestyle, capability etc.)

15.4 Self-talk

• PA advice should highlight the benefits of PA with less emphasis on PA as a treatment for a health problem.