A process evaluation of nurses’ experiences with a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease.

Abstract

Background: Cardiovascular diseases(CVD) are mainly caused by modifiable risk factors such as physical activity(PA), increasing PA is an important behavioural target to reduce CVD risk. A widely accepted concept to change behaviour is self-management. Patients need to adopt self-management behaviours, and nurses need to change their behaviour in providing tailored information and support. A complex behaviour change intervention(BCI) was developed to change nurses’ and patients’ behaviour, the nurse-led Activate intervention. Nurses received an extensive training programme to change their behaviour in intervention delivery. To understand and explore its effectiveness, a process evaluation needed to be performed. Objective: To evaluate the nurse-led Activate intervention by exploring primary care nurses’ experiences with the training programme and with delivering the Activate intervention. Method: A generic qualitative design, using semi-structured interviews for data collection and the six steps of Braun and Clarke’s thematic analysis were performed. Results: Fourteen nurses were interviewed. Nurses perceived the intervention as feasible for patients with CVD risk and low PA levels. The trial consultation context was perceived as both positive and negative. The learning process of nurses emerged from the data, which was influenced by the interaction between five themes: their learning mode, perceived self-confidence, motivation throughout the process and their ability and success in mastering and incorporating skills. Conclusion: A pattern in the learning process of nurses was identified, influencing nurses’ success in delivering the intervention according to protocol. Nurses’ training, behaviour and experiences influence intervention delivery, underlining the importance of exploring nurses’ experiences and providing an extensive training programme to change nurses’ behaviour in delivering BCIs. Implications of key findings: In future BCI development, factors influencing nurses’ learning process should be taken into consideration. However, further research is needed to explore effective training components for nurses.