Developing an intervention to reduce sedentary behaviour in non-ambulant young people with long-term disabilities (domore)

Bradbury, Marilyn Ann ORCID: 0000-0001-6000-7229 (2025). Developing an intervention to reduce sedentary behaviour in non-ambulant young people with long-term disabilities (domore). University of Birmingham. Ph.D.

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Abstract

There is strong evidence that sedentary behaviour (> six - eight hours / day) increases risk of all-cause mortality, risk and incidence of cardiovascular disease mortality and incidence of type 2 diabetes in adults. Reducing children and young people’s sedentary behaviour is also likely to positively impact health outcomes. Guidelines therefore advise children and adults to limit their sedentary time.
Children and young people with disabilities experience barriers to reducing sedentary behaviour. Non-ambulant young people (NAYP) with physical disabilities spend more time sedentary than able-bodied and ambulant young people with disabilities. No evidence-based interventions for NAYP specifically target sedentary behaviour.
The aim of this thesis was to co-design a digital behaviour change intervention (mobile application), which supports NAYP to reduce and break up sedentary behaviour by promoting light physical activity. The app was co-designed in partnership with stakeholders, using the Six Steps in Quality Intervention Development (6SQuID) model. Stakeholders included NAYP aged 12-25 years, family members of NAYP, health and educational professionals and experts in sedentary behaviour, disability and behaviour change / intervention development.
Step one of the 6SQuID, defining and understanding the problem and its causes, is reported in Chapters 2, 3 and 4. Undertaking a systematic search and review of the literature relating to sedentary behaviour and NAYP contributed to a defining of the problem and informed intervention development (Chapter 2). To understand the problem and its causes, a thematic analysis of data generated by stakeholders was undertaken to identify barriers and facilitators of sedentary behaviour of NAYP. Two data collection methods were used: an innovative digital methodology (crowdsourcing) (Chapter 3) and virtual co-design workshops and interviews (Chapter 4). This was the first time crowdsourcing had been used to collect data as part of the 6SQuID. The Systems of Sedentary Behaviours (SOS) Framework describes six determinants of sedentary behaviour. The barriers and facilitators of sedentary time in NAYP identified by stakeholders were categorised into the six SOS Framework determinants of sedentary behaviour, prior to step two.
In step two (Chapter 5), stakeholders ranked the SOS Framework determinants of sedentary behaviour according to their potential for change. Three SOS Framework determinants which were amenable to change were selected. Fifteen barriers / facilitators to address within the intervention were chosen from these three determinants. The 15 barriers / facilitators were combined to formulate five intervention goals.
Step three (chapter 6) involved selection of a mid-range theory (Self-Determination Theory) to inform development of programme theory and production of a logic model for the intervention. Using the Behaviour Change Wheel (COM-B) approach, 11 mechanisms of action and 32 behaviour change techniques were selected from two taxonomies. Further data collection with stakeholders informed this decision making. Potential unintended outcomes of the intervention were discussed.
The thesis concludes at step four of the 6SQuID, delivering the change mechanisms. An implementation plan was formulated with stakeholders. A prototype app was produced and evaluated, using the Person-Based Approach to supplement the 6SQuID model. A table of changes prioritised modifications to be made in a first iteration of optimisation prior to feasibility testing (step five). Strengths and limitations of this work and directions for future research are outlined in Chapter 8.

Type of Work:	Thesis (Doctorates > Ph.D.)
Award Type:	Doctorates > Ph.D.
Supervisor(s):	Supervisor(s) Email ORCID Duda, Joan L. (Joan Lynne) UNSPECIFIED UNSPECIFIED Fenton, Sally UNSPECIFIED UNSPECIFIED Neilson, Susan UNSPECIFIED orcid.org/0000-0003-4275-9341
Licence:	All rights reserved All rights reserved All rights reserved All rights reserved
College/Faculty:	Colleges > College of Life & Environmental Sciences
School or Department:	School of Sport, Exercise and Rehabilitation Sciences
Funders:	National Institute for Health Research
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > H Social Sciences (General) R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
URI:	http://etheses.bham.ac.uk/id/eprint/15676

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