Challenging assumptions underlying physical activity promotion for health care professionals in Australia : A data‐prompted interview study

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY 4.0 h ps://c ea i ecommons.o g/licenses/by/4.0/ Challenging assump ions unde lying physical ac i i y p omo ion o heal h ca e p o essionals in Aus alia : A da a‐p omp ed in e iew s udy © 2023 The Au ho s. Heal h P omo ion Jou nal o Aus alia Published e sion Kwasnicka, Dominika; Po ho , Sebas ian; Hagge , Ma in S.; Vandelano e, Co neel; Reba , Amanda; Sho , Camille E.; C ook, Dawn; Ga dne , Benjamin Kwasnicka, D., Po ho , S., Hagge , M. S., Vandelano e, C., Reba , A., Sho , C. E., C ook, D., & Ga dne , B. (2023). Challenging assump ions unde lying physical ac i i y p omo ion o heal h ca e p o essionals in Aus alia : A da a‐p omp ed in e iew s udy. Heal h P omo ion Jou nal o Aus alia, Ea ly View. h ps://doi.o g/10.1002/hpja.784 2023 SHORT RESEARCH ARTICLE Challenging assump ions unde lying physical ac i i y p omo ion o heal h ca e p o essionals in Aus alia: A da a-p omp ed in e iew s udy Dominika Kwasnicka 1,2 | Sebas ian Po ho 3 | Ma in S. Hagge 4,5 | Co neel Vandelano e 6 | Amanda Reba 7 | Camille E. Sho 8,9 | Dawn C ook 10 | Benjamin Ga dne 11 1 NHMRC CRE in Digi al Technology o T ans o m Ch onic Disease Ou comes, Melbou ne School o Popula ion and Global Heal h, Uni e si y o Melbou ne, Melbou ne, Aus alia 2 SWPS Uni e si y o Social Sciences and Humani ies, Facul y o Psychology, W oclaw, Poland 3 Depa men o Social Wo k, Educa ion and Communi y Wellbeing, No humb ia Uni e si y, Newcas le upon Tyne, UK 4 Depa men o Psychology, Uni e si y o Cali o nia, Me ced, USA 5 Depa men o Spo Sciences, Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä, Finland 6 Physical Ac i i y Resea ch G oup, Apple on Ins i u e, School o Heal h, Medical and Applied Sciences, Cen al Queensland Uni e si y, Rockhamp on, Aus alia 7 School o Heal h, Medical and Applied Sciences, Cen al Queensland Uni e si y, Rockhamp on, Aus alia 8 Melbou ne Cen e o Beha iou Change, Melbou ne School o Psychological Sciences, Pa k ille, Vic o ia, Aus alia 9 Melbou ne School o Heal h Sciences, Uni e si y o Melbou ne, Pa k ille, Vic o ia, Aus alia 10 Se co, Fiona S anley Hospi al, Mu doch, Wes e n Aus alia, Aus alia 11 Depa men o Psychology, Uni e si y o Su ey, Guild o d, UK Co espondence Benjamin Ga dne , Depa men o Psychology, Elizabe h F y Building, Uni e si y o Su ey, Guild o d GU2 7XH, UK. Email: benjamin.ga dne @su ey.ac.uk Funding in o ma ion Aus alian Resea ch Council, G an /Awa d Numbe : FT210100234; Cen al Queensland Uni e si y; Cu in Heal h Inno a ion Resea ch Ins i u e, Cu in Uni e si y; Heal h Collabo a i e Resea ch Ne wo k; Na ional Heal h and Medical Resea ch Council, G an /Awa d Numbe : APP1090517; S . John o God Subiaco Hospi al; Suomalainen Tiedeaka emia; TEKES Handling edi o : B yce B ickley Abs ac Issue Add essed: In e en ions a ge ing heal h ca e p o essionals' beha iou s a e assumed o suppo hem in lea ning how o gi e beha iou al ad ice o pa ien s, bu such assump ions a e a ely examined. This s udy in es iga ed whe he key assump- ions we e held ega ding he design and deli e y o physical ac i i y in e en ions among heal h ca e p o essionals in applied heal h ca e se ings. This s udy was pa o he ‘Physical Ac i i y Tailo ed in e en ion in Hospi al S a ’ andomised con- olled ial o h ee a ian s o a web-based in e en ion. Me hods: We used da a-p omp ed in e iews o explo e whe he he in e en ions we e deli e ed and ope a ed as in ended in heal h ca e p o essionals wo king in ou hospi als in Wes e n Aus alia (N=25). Da a we e analysed using codebook hema ic analysis. Resul s: Fi e hemes we e cons uc ed: (1) heal h ca e p o essionals' pe cei ed ole in changing pa ien s' heal h beha iou s; (2) wo k- ela ed ba ie s o physical ac i i y in e en ion adhe ence; (3) heal h ca e p o essionals' use o beha iou change T ial egis a ion: Aus alian New Zealand Clinical T ial Regis y: ACTRN12616000462482. Recei ed: 23 May 2023 Re ised: 20 July 2023 Accep ed: 21 July 2023 DOI: 10.1002/hpja.784 This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s use, dis ibu ion and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. © 2023 The Au ho s. Heal h P omo ion Jou nal o Aus alia published by John Wiley & Sons Aus alia, L d on behal o Aus alian Heal h P omo ion Associa ion. Heal h P omo J Aus al. 2023;1–9. wileyonlinelib a y.com/jou nal/hpja 1 echniques; (4) con amina ion be ween g oups; and (5) pe cep ions o in e en ion ailo ing. Conclusions: The in e en ion was no expe ienced by pa icipan s, no did hey implemen he in e en ion guidance, in he way we expec ed. Fo example, no all heal h ca e p o essionals el esponsible o p o iding beha iou change ad ice, ime and shi cons ain s we e key ba ie s o in e en ion pa icipa ion, and con amina- ion e ec s we e di icul o a oid. So Wha ? Ou s udy challenges assump ions abou how heal h ca e p o essionals espond o beha iou change ad ice and possible knock-on bene i s o pa ien s. Applying ou lea nings may imp o e he implemen a ion o heal h p omo ion in e - en ions in heal h ca e se ings. KEYWORDS heal h ca e p o essionals, in e ne , online, physical ac i i y, andomised con olled ial, ailo ing 1|INTRODUCTION Heal h ca e p o essionals who ha e di ec con ac wi h pa ien s a e o en asked wi h gi ing heal h beha iou ad ice. Encou aging heal h ca e p o essionals o p o ide oppo unis ic beha iou al ad ice o pa ien s can imp o e pa ien s' heal h beha iou and heal h. 1,2 How- e e , no all heal h ca e p o essionals hemsel es engage in posi i e heal h beha iou s. Fo example, a su ey o Aus alian nu sing s u- den s ound a ound hal had unbalanced die s, and 92% ailed o mee ac i i y guidelines. 3 This has he po en ial o comp omise he c edibil- i y o e ec i eness o ad ice o pa ien s. 4 A emp s ha e been made o suppo heal h ca e p o essionals o imp o e hei own heal h, and by ex ension, hei pa ien s' heal h. 5 These ha e been a leas pa ly based on he expec a ion ha p o es- sionals will ansla e knowledge and p ac ices gained om changing hei own beha iou in o enhanced suppo o pa ien s. 6 This expec- a ion can be decons uc ed in o a se o co e assump ions: heal h ca e p o essionals will adhe e o beha iou change ecommenda ions, lea n new heal h p omo ion s a egies om doing so, and use hese lea nings o p omo e beha iou change among hei pa ien s. How- e e , i is unclea whe he such assump ions a e ounded. Unde - s anding how heal h p o essionals espond o physical ac i i y p omo ion in e en ions deli e ed o hem in applied heal h ca e se - ings will help o assess whe he assump ions unde pinning in e en- ion design and deli e y a e me . The cu en s udy explo es he expe iences o heal h ca e p o es- sionals in he Physical Ac i i y Tailo ed in e en ion in Hospi al S a (PATHS) ial, 7 which e alua ed h ee compu e - ailo ed in e en ion a ian s on physical ac i i y among heal h ca e p o essionals in Aus alia. The PATHS in e en ions we e based on h ee co e assump ions: speci ically, ha in esponse o a ailo ed se o beha - iou change echniques, heal h ca e p o essionals would (a) adhe e o he in e en ion by implemen ing he echniques in o hei own li es, (b) lea n how o bes ad ise pa ien s on e ec i e beha iou change s a egies and (c) be willing and able o implemen hese s a egies in subsequen encoun e s wi h pa ien s. This s udy p esen s a seconda y analysis o in e iew da a om he PATHS ial p ocess e alua ion, 1 o add ess he esea ch ques ion: ‘Did co e assump ions made when designing he PATHS in e en ion hold, and i no , why?’The s udy a ose om ou pos - ial e lec ions on he in e iew da a and was no p eplanned. 2|METHODS 2.1 |The PATHS ial We designed he ou -a m, andomised con olled ‘PATHS’ ial o es he e ec i eness o h ee a ia ions o a ailo ed physical ac i i y in e en ion agains a non- ailo ed con ol. Pa icipan s we e heal h ca e p o essionals om one o ou hospi als in Pe h, Wes e n Aus alia, ec ui ed ia ad e isemen s on he hospi al in ane , pos - e s, lea le s and p esen a ions a s a mee ings (see Kwasnicka e al. 7 ). All ull- ime and pa - ime hospi al s a who sel - epo ed <150 min o mode a e physical ac i i y pe ypical week we e eligible o he ial. T ial exclusion c i e ia we e: sel -decla ed physical condi- ion p e en ing inc eased physical ac i i y; no mobile phone wi h SMS unc ionali y; no in e ne access ou side o wo k; al eady mee - ing weekly ecommended le els o physical ac i i y; o pa icipa ing in ano he s uc u ed physical ac i i y p og am. 2.2 |Design, pa icipan s and p ocedu e This s udy used semi-s uc u ed da a-p omp ed in e iew me hods, 8 whe eby in e iew ques ions we e in o med by quan i a i e da a collec ed a an ea lie ime poin . Pa icipan s we e a subsample o PATHS ial comple e s, ec ui ed by di ec email o in-pe son in i a- ion. All pa icipan s who comple ed he PATHS ial and a ended he inal ial ollow-up session (a 3 mon hs pos -baseline; n=109) we e 2KWASNICKA ET AL. 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License eligible o he p esen in e iew s udy. Budge a y cons ain s limi ed he sample o 25 pa icipan s (23% o he eligible sample), a sample size likely o cap u e a su icien a ie y o expe iences o add ess ou esea ch ques ion. 9 While we aimed o in e iew a oughly equal numbe o pa icipan s om each condi ion, ime and s udy pe sonnel cons ain s necessi a ed i s -come, i s -se ed ec ui men un il ou a ge sample (N=25) was eached. None o hose who esponded o he ec ui men in i a ion d opped ou be o e he in e iew. PATHS ial ec ui men was ini ia ed la e a he ou h hospi al, so ou sample size was eached be o e pa icipan s a he ou h hospi al became eligible. Thus, ou pa icipan s we e d awn om only h ee PATHS hospi al si es. The i s au ho (D.K.) conduc ed all in e iews in 2018, ace- o- ace wi h indi idual pa icipan s and alone in a quie space wi hin pa icipa ing hospi als, in on o a compu e showing hei pe - sonal in e en ion dashboa d as an in e iew p omp . D.K. is a emale, pos doc o al psychology esea che wi h ex ensi e expe ience in quali- a i e in e iewing and analysis, employed as a Resea ch Fellow du ing da a collec ion. D.K. had me pa icipan s in-pe son on ou p io occa- sions o p o ide and collec ac i i y moni o s o da a collec ion pu - poses (see Kwasnicka e al. 7 ), so pa icipan s we e amilia wi h he in e iewe . In e en ion ecipien s we e in e iewed 3 mon hs a e ac i e in e en ion ceased, and con ol pa icipan s 3 mon hs pos - baseline. In e iew ques ions we e designed o cap u e e lec ions on physical ac i i y and alloca ed ea men , and ou domains unde pin- ning long- e m beha iou change (i.e., knowledge, conscious mo i a ion, sel - egula o y abili ies and habi s 10 ). The in e iew guide is p o ided as Suppo ing In o ma ion Ma e ial S1. Each pa icipan ecei ed an AUD20 shopping ouche . E hical app o al was ob ained om he hos uni e si y (Cu in Uni e si y E hics Commi ee HR20/2016) and all pa icipa ing hospi als' e hics commi ees (Hollywood P i a e Hospi al E hics Commi ee HPH443; King Edwa d Memo ial Hospi al E hics Commi ee 2016034EW; S . John o God Hospi al E hics Commi ee 1008). All pa - icipan s ga e ull in o med consen . 2.3 |T ea men As he PATHS ial an ac oss only ou hospi als, hospi al-le el (i.e., clus e ) andomisa ion was deemed un easible, so PATHS ial pa - icipan s we e andomly alloca ed indi idually o he ou condi ions. Con ol pa icipan s ecei ed (I) educa ion only (non- ailo ed). In e en- ion pa icipan s ecei ed: (II) educa ion and ailo ed in e en ion com- ponen s a ge ing knowledge and conscious mo i a ion (‘mo i a ion’ condi ion); (III) educa ion and ailo ed componen s a ge ing knowledge, mo i a ion, and sel - egula o y skills (‘sel - egula ion’condi ion) o (IV) educa ion and ailo ed componen s a ge ing knowledge, mo i a- ion, sel - egula ion and p omo ing beha iou al au oma ici y (‘habi ’ condi ion 11 ). A desc ip ion o hypo hesised mechanisms and pe - condi ion beha iou change echniques is a ailable elsewhe e. 7 In e en ion pa icipan s ecei ed six ailo ed in e en ion sessions o nigh ly, adminis e ed ia a web-based pla o m, supplemen ed by SMS messages elaying key in o ma ion. Du ing each session, pa icipan s we e asked ques ions abou hei physical ac i i y, hei cogni ions (e.g., mo i a ion o be ac i e) and beha iou s, which allowed ‘i - hen’algo i hms o p o ide pe sonally- ailo ed in o ma ion. Feedback was ailo ed o mul iple ac o s concu en ly as app op ia e in each condi ion; o example, pa icipan s in he ‘sel - egu- la ion’condi ion epo ed minimal physical ac i i y, a lack o mo i a ion bu high sel - egula o y capabili y ecei ed ad ice aimed a inc easing mo i a ion. Con ol pa icipan s ecei ed access o a s a ic websi e wi h basic, ac ual ac i i y in o ma ion, bu no online sessions o SMS messages. 2.4 |Analysis Ve ba im in e iew ansc ip s o audio eco dings we e analysed using induc i e codebook hema ic analysis, om a ealis epis emological pe - spec i e. 12 The aim o he analysis was o cons uc hemes speaking o one o mo e o ou in e en ion design assump ions. Howe e , da a coding d ew a en ion o addi ional implici assump ions we had made, and challenges o hem, which we had no explici ly ecognised. Th ee au ho s (D.K., S.P. and B.G.) independen ly ead and induc- i ely coded i e ansc ip s, gene a ing lis s o ini ial codes and po en ial clus e ing o codes in o highe -le el hemes. Discussions be ween h ee analys s (D.K., S.P. and B.G.) induc i ely gene a ed a hema ic coding amewo k, which was subsequen ly applied and e ined (by S.P. and D.K.) o he emaining ansc ip s. The c edibili y o la e da a in e p e a- ions was ensu ed using a ‘c i ical iend’app oach, 13 whe eby i e a i e collabo a i e discussions we e held be ween S.P., D.K. and B.G. un il he hemes e iewed and named by S.P. and D.K. we e deemed by all h ee au ho s o be alid and cohe en da a ep esen a ions. Themes a e epo ed as opic summa ies. 14 2.4.1 | Re lexi i y D.K., S.P. and B.G. a e heal h psychology esea che s. D.K. and B.G. we e in ol ed in de eloping he in e en ion and designing he PATHS ial. S.P. was ec ui ed o he esea ch eam a e da a collec- ion, o gain he pe spec i e o an analys no p e iously in ol ed in he PATHS ial. 3|RESULTS 3.1 |Pa icipan cha ac e is ics Pa icipan s we e 25 heal h ca e p o essionals (mean age 52.04 yea s, SD 7.23; 23 emale, 2 male; Table 1), comp ising 16 ull- ime and 9 pa - ime wo ke s. Se en we e om he con ol condi ion, six om he mo i a ion in e en ion condi ion, i e om he sel - egula ion condi ion, and se en om he habi condi ion. Ten pa icipan s wo ked in public and 15 in p i a e hospi als. Mos wo ked in clinical posi ions KWASNICKA ET AL.3 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License TABLE 1 T ea men condi ion and pa icipan s' pe sonal cha ac e is ics (N=25). No. Condi ion and hospi al Age and gende Ma i al s a us Heigh , weigh , e hnici y Educa ion A wo k days pe week A wo k o al hou s pe week ( o al nigh hou s) Absence sick days in he las 6 mon hs Wo k ype and posi ion To al amily income 1 Mo i a ion, 3 46, F Ma ied 166 cm, 67 kg, Whi e Le el 5 5 38 (0) 2 Clinical nu se educa o , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 2 Sel - egula ion, 3 55, F Ma ied 168 cm, 69 kg, Whi e Le el 6 5 50 (0) 1 Clinical nu se manage , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 3 Sel - egula ion, 3 51, F Ma ied 176 cm, 72 kg, Whi e Le el 8 5 38 (0) 1 Clinical nu se manage , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 4 Con ol, 3 53, F Ma ied 163 cm, 92 kg, Whi e Le el 7 4 40 (0) 2 Regis e ed nu se, ull- ime shi wo ke $2000–$2499 pe week ($100 000–$129 999 pe yea ) 5 Habi , 3 43, F Ma ied 162 cm, 75 kg, Whi e Le el 8 5 36 (0) 7 Regis e ed nu se, ull- ime shi wo ke $2000–$2499 pe week ($100 000–$129 999 pe yea ) 6 Con ol, 3 61, M Ma ied 179 cm, 106 kg, Whi e Le el 1 5 38 (0) 1 O he , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 7 Mo i a ion, 3 52, F Ma ied 162 cm, 68 kg, Whi e Le el 6 5 38 (0) 3 Clinical nu se specialis o consul an , ull- ime shi wo ke $1500–$1999 pe week ($78 000–$99 999 pe yea ) 8 Con ol, 3 54, F Ma ied 173 cm, 75 kg, Whi e Le el 5 4 32 (0) 1 Regis e ed nu se, pa - ime shi wo ke $2000–$2499 pe week ($100 000–$129 999 pe yea ) 9 Sel - egula ion, 2 61, F Ma ied 162 cm, 73 kg, Whi e Le el 8 4 25 (0) 2 Clinical nu se educa o , pa - ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 10 Sel - egula ion, 3 56, F Ma ied 158 cm, 72 kg, Whi e Le el 6 4 32 (0) 2 Midwi e, pa - ime non-shi wo ke $1500–$1999 pe week ($78 000–$99 999 pe yea ) 11 Mo i a ion, 3 36, F Di o ced 172 cm, 70 kg, Whi e Le el 8 5 38 (10) 5 Clinical nu se, ull- ime shi wo ke $1500–$1999 pe week ($78 000–$99 999 pe yea ) 12 Habi , 3 40, F Ma ied 165 cm, 67 kg, Whi e Le el 5 4 28 (0) 2 Nu se, pa - ime shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 13 Con ol, 2 47, F Ma ied 167 cm, 73 kg, Whi e Le el 9 5 36 (0) 1 O he , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 14 Habi , 2 59, F Ma ied 165 cm, 67 kg, Whi e Le el 7 5 39 (0) 0 Clinical nu se educa o , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 15 Habi , 2 61, F Single/ne e ma ied 154 cm, 62 kg, Whi e Le el 9 4 32 (0) 1 O he , pa - ime non-shi wo ke $1500–$1999 pe week ($78 000–$99 999 pe yea ) 16 Sel - egula ion, 3 59, F Ma ied 163 cm, 68 kg, Whi e Le el 8 5 36 (0) 4 Clinical nu se manage , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 17 Mo i a ion, 1 53, F Ma ied 160 cm, 69 kg, o he Le el 2 3 24 (5) 0 Pa ien ca e assis an , pa - ime shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 18 Mo i a ion, 2 65, F Di o ced 165 cm, 96 kg, Whi e Le el 7 5 40 (0) 0 Clinical nu se educa o , ull- ime non-shi wo ke $1500–$1999 pe week ($78 000–$99 999 pe yea ) 4KWASNICKA ET AL. 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License TABLE 1 (Con inued) No. Condi ion and hospi al Age and gende Ma i al s a us Heigh , weigh , e hnici y Educa ion A wo k days pe week A wo k o al hou s pe week ( o al nigh hou s) Absence sick days in he las 6 mon hs Wo k ype and posi ion To al amily income 19 Con ol, 2 59, F Ma ied 165 cm, 65 kg, Whi e Le el 9 4 30 (0) 2 Midwi e, pa - ime shi wo ke $1000–$1499 pe week ($52 000–$77 999 pe yea ) 20 Habi , 2 53, F Ma ied 169 cm, 65 kg, o he Le el 9 5 40 (0) 1 Clinical nu se educa o , ull- ime non-shi wo ke $2000–$2499 pe week ($100 000–$129 999 pe yea ) 21 Habi , 2 43, F Ma ied 167 cm, 67 kg, Whi e Le el 8 4 30 (0) 2 Midwi e, pa - ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 22 Con ol, 1 56, M De ac o/ cohabi ing 171 cm, 83 kg, Whi e Le el 8 3 36 (0) 3 Clinical nu se, ull- ime shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 23 Mo i a ion, 2 59, F Ma ied 182 cm, 70 kg, Whi e Le el 7 5 40 (0) 40 Clinical nu se manage , ull- ime non-shi wo ke $2500–o mo e pe week ($130 000 o mo e pe yea ) 24 Con ol, 2 53, F Ma ied 157 cm, 63 kg, Whi e Le el 7 4 26 (0) 0 O he , pa - ime non-shi wo ke $800–$999 pe week ($41 600–$51 999 pe yea ) 25 Habi , 1 51, F Di o ced 163 cm, 86 kg, Whi e Le el 7 5 45 (0) 0 Clinical nu se manage , ull- ime non-shi wo ke $1500–$1999 pe week ($78 000–$99 999 pe yea ) No e: Hospi al codes a e: 1—p i a e, 2—public, 3—p i a e hospi al. Educa ion le els (in line wi h Aus alian educa ion sys em): Le el 1—Ce i ica e I; Le el 2—Ce i ica e II; Le el 5—Diploma; Le el 6—Associa e deg ee/Ad anced diploma; Le el 7—Bachelo deg ee; Le el 8—G adua e diploma/ce i ica e o Bachelo honou s deg ee; Le el 9—Mas e 's deg ee (ex ended/cou sewo k/ esea ch). Abb e ia ions: F, emale; M, male; weigh , weigh a baseline in kg. KWASNICKA ET AL.5 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License and had a o al weekly amily income o AUD2,000–2499 (AUD100,000–129 999/yea ) and abo e. Pa icipan s we e mos commonly ma ied (n=20), Whi e (n=23), wi h child en (on a e age, 2; M=2.28, SD =1.27), and highe o ad anced educa ion (associa e deg ee/ad anced diploma o highe ; n=20). 4|THEMES 4.1 |Theme 1: Heal h ca e p o essionals' pe cei ed ole in changing pa ien s' heal h beha iou s We assumed ha by imp o ing heal h ca e p o essionals' physical ac i - i y, pa icipan s would be be e able o encou age pa ien s o be ac i e. Al hough suppo ed by some (‘you a e seen as a ole model, so you [assume] ha ha ole model would be a heal hy pe son as well’; Pa icipan 15 [P15], ‘o he ’p o essional), o he s el i was no hei own p o es- sional esponsibili y o change pa ien s' beha iou , no o ‘lead by exam- ple’. Some el i was o he specialis s' du y o suppo beha iou change: [We] nu ses can say, “You should be mobilising mo e”, […] bu in e ms o p o essional esponsibili y, i 's ac ually he physio he apis ha guides he pa ien 's exe cise (P25, nu se). Se e al pa icipan s did no wan o discuss heal h beha iou wi h pa ien s, because hey we e no pe sonally ac i e, o we e li ing o e - weigh , so ea ed being seen o be hypoc i ical (‘i 's ha d o hold he highe g ound i you a e inac i e o don' look heal hy you sel ’; P13, ‘o he ’p o essional). A key pe cei ed ba ie o p o iding li es yle ad ice was ha con- sul a ions we e oo b ie o o e meaning ul oppo uni ies: I you' e go someone smoking 60 ciga e es a day and a bo le o wine e e y nigh , you need mo e han jus a 10-minu e cha o con e ha pa ien in o ha ing a heal hie li es yle (P21, midwi e). Ano he pe cei ed ba ie was a lack o aining o p o iding meaning ul heal h beha iou ad ice (‘we' e no all quali ied in he spe- ci ics o i , […] o mo e in-dep h [heal hy ea ing] in o ma ion you would be e e ing o a die ician who's expe ienced in ha ega d’; P3, clinical nu se manage ). Some el hei ole should solely be o signpos pa ien s o mo e app op ia e specialis s. 4.2 |Theme 2: Wo k- ela ed ba ie s o physical ac i i y in e en ion adhe ence We assumed pa icipan s would adhe e o ou in e en ion, ye many men ioned se e al wo k- ela ed ba ie s o physical ac i i y. Fo example, one pa icipan el ha s ess, lack o ime, and a eeling o a igue om s anding all day p ohibi ed leisu e ime physical ac i i y (‘by he ime you ge ou o he e you' e so men ally exhaus ed, and physi- cally’; P14, clinical nu se educa o ). Simila ly, some pa icipan s epo ed ha , al hough hey app ecia ed he bene i s o physical ac i i y, physical a igue p e en ed hem om being ac i e ou side o wo k: I you become a igued hen you can' ac ually ge you sel back on ack. Fa igue is de ini ely a downwa d spi al (P19, midwi e). Mos pa icipan s ound i di icul o conside ini ia ing o main aining an exe cise ou ine while wo king an unp edic able sched- ule (‘you can' ge a se shi […] [on] mos o he wa ds, you' e go o be p epa ed o wo k any ime, 24/7, so you can' commi ’; P11, clinical nu se). O he s desc ibed o e lapping amily and wo k commi men s, men al and physical p essu es, and low mo i a ion: E e y hing ha I do is b ain-s ain […] i 's jus abou ying o mo i a e mysel a bi mo e [ o be ac i e] …you always ha e some hing [else] o do (P13, ‘o he ’ p o essional). 4.3 |Theme 3: Heal h ca e p o essionals' use o beha iou change echniques Se e al pa icipan s epo ed spon aneously adop ing beha iou change echniques no ecommended wi hin hei alloca ed condi ion. Fo example, some con ol pa icipan s epo ed buying exe cise aids, moni o ing hei beha iou (i.e., sel - egula ion), o adop ing con ex - speci ic ac i i y pa e ns conduci e o habi : I' e ins i u ed a p og am whe e each nigh , a e I' e had my dinne …I go o abou a 50-minu e walk and I'll basically go om pa k o pa k […] I keep a no e o my ime (P6, ‘o he ’p o essional; con ol condi ion). O he s epo ed ha s udy measu emen p ocedu es s imula ed inc eased ac i i y (‘I wo e he [ac i i y moni o ] o he i s week and I upped my exe cise … ha kind o go me ocused’; P2, clinical nu se manage ; ‘sel - egula ion’in e en ion condi ion). These insigh s made us awa e, on e lec ion, ha we made an addi ional assump ion when designing he in e en ion— ha is, ha heal h ca e p o es- sionals would use only he BCTs p o ided wi hin hei alloca ed in e en ion—which did no hold. 4.4 |Theme 4: Con amina ion be ween g oups Con a y o ou ins uc ions, pa icipan s epo ed sha ing con en wi h hei colleagues. Gi en ha pa icipan s we e indi idually an- domised, his in oduced con amina ion be ween pa icipan s and condi ions wi hin hospi als. This aised ou awa eness o a u he , 6KWASNICKA ET AL. 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License implici assump ion unde pinning ou in e en ion and ial design mo e b oadly: ha pa icipan s would wi hhold de ails o hei alloca ed in e en ion om hei co-wo ke s. Fo some pa icipan s, discussing hei in e en ion esul ed in he pe cep ion ha o he s had ecei ed a supe io in e en ion: I said o one o my colleagues, ‘Come on, join his p og am’. She was e y keen and she only wo ks pa - ime and she exe cises all he ime. She said, ‘Open you lock hings’ [in e en ion sessions ha unlocked o nigh ly] and I'm like, ‘Wha lock hings?’So, I'd go on he websi e and she's showing me, ‘Look, I' e opened his’. I'm like, ‘Idon' ha e hose’(P4, egis e ed nu se; con ol condi ion). Some pa icipan s ound he ins uc ion no o discuss he in e - en ion wi h o he s limi ing, as hey would ha e p e e ed o pa ici- pa e alongside o he s, o in o ma ion-sha ing, suppo and mo i a ion: No knowing who else is on i , i didn' gi e me he oppo uni y o discuss i wi h anyone else, which I hink could ha e helped mo i a e me (P23, clinical nu se manage ; ‘mo i a ion’condi ion). Pa icipan s who became awa e hey did no ecei e a ailo ed e sion o he in e en ion we e epo edly disappoin ed wi h he p og am and suppo p o ided, which limi ed en husiasm and in e en ion engagemen . A g oup ha was [only eading] jou nal a icles [con ol g oup] el eally duped ha hey didn' ge wha we [in e en ion g oup] go , and hen hey go eally na ky, and hen hey we e like, ‘Why should I do his?’(P5, egis e ed nu se; ‘habi ’condi ion). 4.5 |Theme 5: Pe cep ions o ailo ing Mos pa icipan s pe cei ed pe sonally- ailo ed in o ma ion o be gene ic and insu icien ly indi idualised. Some sugges ed ha con en should ha e been ailo ed o, o ins ance, shi ypes, o con ex ual ba ie s o exe cise among heal h ca e p o essionals. Mos pa ici- pan s iden i ied ha eedback was au oma ically gene a ed by an algo i hm (‘i 's doing i s bes as a compu e , as a so wa e p og am’; P20, clinical nu se educa o ). Pe haps because o he appa en lack o human in ol emen in he ailo ing p ocess, some el us a ed by insensi i e, impe sonal eedback: I ook when we said wha ou goals a e and hen inpu ha in o ma ion in o he commen s. Bu …when i old me I'd pu on weigh [I el ] disappoin ed. [The eedback said] i looks like you' e pu on weigh du ing his [pe iod] and I [ hough ] yes, no kidding! [laughs] (P12, nu se). In hindsigh , we ealised we had made an addi ional assump ion: pa icipan s would ecognise ha he con en was ailo ed o hem. This assump ion was no suppo ed. 5|DISCUSSION We assumed ha heal h ca e p o essionals would eel esponsible o acili a ing heal h beha iou in pa ien s. Ye , al hough some pa ici- pan s sha ed his iew, o he s did no see p o iding beha iou guid- ance o pa ien s as hei p o essional esponsibili y. While his may pa ly e lec a lack o awa eness o policies ha u ge heal h ca e p o- essionals o ‘make e e y con ac [wi h pa ien s] coun ’, 15 e en hose awa e o such policies may ail o seize beha iou discussion oppo u- ni ies because hey do no eel i is app op ia e o gi e such guid- ance. 16 Indeed, while mos o ou pa icipan s pe cei ed hemsel es as po en ial ole models (see oo Joyn e al. 17 ), hey el o he special- is s we e be e quali ied, o had mo e ime, o ad ise pa ien s. Ou esul s sugges ha , e en i in e en ions success ully change heal h ca e p o essionals' own heal h beha iou , his will no necessa ily ansla e in o be e suppo o pa ien s' heal h beha iou change. This poin s o a disconnec be ween he public heal h policymake s who ha e sough o imp o e pa ien heal h indi ec ly, by p omo ing heal h among p o essionals (e.g., NHS England 18 ), and he g ound- le el expe iences o heal h p o essionals. Public heal h migh bene i om g ea e in ol emen o heal h p o essionals in policy design. Ou s udy sugges ed ha wo k- ela ed ba ie s limi ed adhe ence o ou heal h p omo ion in e en ion, and o inc easing leisu e ime physical ac i i y mo e b oadly, among heal h ca e p o essionals. P e i- ous s udies ha e demons a ed ha heal h ca e p o essionals a e less likely o engage in leisu e ime ac i i ies han he gene al popula- ion. 19 Ou indings sugges ha among Aus alian heal h ca e p o es- sionals, s ess, a igue, long hou s, wo kload, and unp edic able shi wo k wi h limi ed au onomy o e wo k schedules may explain his lack o engagemen . The oo causes o such p essu es may need o be add essed o pe mi g ea e up ake o physical ac i i y and o he heal h beha iou s. In ol ing heal h ca e p o essionals as co-design pa ne s migh imp o e he accep abili y and e ec i eness o beha - iou change in e en ions o heal h p o essionals. 20 Ano he assump ion unde lying ou in e en ion, which only came o ou awa eness du ing da a analysis, was ha ou pa icipan s would use only echniques deli e ed o hem as pa o hei alloca ed ea men . Ye , mos pa icipan s epo ed adop ing addi ional beha - iou change s a egies. We also ound po en ial con amina ion among ou sample, because indi idually andomised pa icipan s epo edly discussed and sha ed in e en ion con en wi h o he s. Con amina ion ob usca es a emp s o assess he con ibu ion o alloca ed ea - men s o beha iou change. 21 P ocess e alua ions o beha iou al in e en ions should sys ema ically assess whe he pa icipan s adop ed s a egies o he han hose ecommended. Pa icipan s el ha ou ailo ing me hods we e no as sophis i- ca ed as we had assumed. Tailo ed in e en ions should p o ide in o - ma ion ele an o he ecipien and hei si ua ion, o ensu e such KWASNICKA ET AL.7 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License in o ma ion is expe ienced as pe sonally ele an and, consequen ly, ead and applied. 22 Heal h p omo ion p og ams o heal h ca e p o es- sionals should be e accoun o shi ype and o he con ex -speci ic physical ac i i y ba ie s. Au oma ed ailo ing should ideally be complemen ed by a mode a o -led p og am, o ensu e ailo ed mes- sages eel pe sonable. Limi a ions mus be acknowledged. Ou pa icipan s we e p e- dominan ly Whi e, highly educa ed, and emale. This pa ly e lec s he demog aphy o Aus alia, whose ci izens a e ypically o Eu opean ances y, 23 and dispa i ies wi hin he Aus alian heal h ca e wo k- o ce, which consis s o almos h ee imes as many emales as males. 24 None heless, ou ocus on Whi e, educa ed emales likely o e looked impo an expe iences and na a i es om o he demo- g aphics, including Abo iginal and To es S ai Islande people, who a e less likely o mee physical ac i i y guidelines han non-Indigenous Aus alians. 25 I is pa icula ly impo an , gi en he Aus alian go e n- men 's plan o build a mo e inclusi e and ep esen a i e heal h wo k o ce, 26 ha u u e s udies o PA p omo ion among heal h ca e p o essionals ec ui om a b oade ange o demog aphic g oups. In addi ion, we did no ga he in o ma ion on he disciplines o ields in which pa icipan s wo ked, o hei yea s o expe ience, which may ha e impac ed hei ime, a ailabili y and engagemen wi h he in e - en ion, and he ex en o which hey alued physical ac i i y. 6|CONCLUSION We assumed ha p o iding heal h ca e p o essionals wi h ailo ed physical ac i i y guidance would change hei beha iou and ansla e in o pa ien bene i . Ye , many ci ed mul iple wo k- ela ed ba ie s ha limi ed hei adhe ence o ou ac i i y in e en ion, and many pa icipan s did no iew i as hei esponsibili y o change pa ien s' heal h beha iou . We encou age in e en ion de elope s o engage heal h ca e p o essionals as co-designe s and he eby inco po a e hei alues and expec a ions in o he design and implemen a ion o ailo ed beha iou change in e en ions o his popula ion. ACKNOWLEDGEMENTS The au ho s hank P o . Mi ch Duncan, The Uni e si y o Newcas le, Aus alia, NHMRC Ca ee De elopmen Fellow who suppo ed he PATHS s udy eam in he de elopmen o he in e en ion, quan i a- i e da a p ocessing and quan i a i e da a analysis. The au ho s also hank Jona han Dong and Anna Michalska o hei con ibu ion o in e en ion deli e y. This s udy was unded by Cu in Uni e si y, Cen al Queensland Uni e si y, and a g an om he Heal h Collabo- a i e Resea ch Ne wo k (HCRN) Aus alia. S . John o God Subiaco Hospi al p o ided addi ional unds o employ a Resea ch Nu se. P o . Vandelano e holds a Fu u e Fellowship unded by he Aus alian Resea ch Council (FT210100234). D . Camille E. Sho (APP1090517) held a ellowship unded by he Na ional Heal h and Medical Resea ch Council o Aus alia. P o . Hagge holds a Finnish Dis inguished P o- esso Fellowship unded by TEKES and he Finnish Academy. CONFLICT OF INTEREST STATEMENT The au ho s decla e no con lic o in e es . DATA AVAILABILITY STATEMENT The da a ha suppo he indings o his s udy a e a ailable on eques om he co esponding au ho . The da a a e no publicly a ailable due o p i acy o e hical es ic ions. ETHICS STATEMENT E hical app o al and in o med pa icipan consen we e gi en o his s udy, e hics commi ees ha app o ed he s udy and e e ence num- be s a e: Hollywood P i a e Hospi al E hics Commi ee (HPH443); King Edwa d Memo ial Hospi al E hics Commi ee App o al (2016034EW); S John o God Hospi al (Subiaco and Mu doch) E hics Commi ee (1008); and Cu in Uni e si y E hics Commi ee (HR20/2016). ORCID Dominika Kwasnicka h ps://o cid.o g/0000-0002-5961-837X Sebas ian Po ho h ps://o cid.o g/0000-0003-4580-8532 Ma in S. Hagge h ps://o cid.o g/0000-0002-2685-1546 Co neel Vandelano e h ps://o cid.o g/0000-0002-4445-8094 Amanda Reba h ps://o cid.o g/0000-0003-3164-993X Camille E. Sho h ps://o cid.o g/0000-0002-4177-4251 Benjamin Ga dne h ps://o cid.o g/0000-0003-1223-5934 ENDNOTE 1 A manusc ip desc ibing p ima y analyses o hese da a is in p epa a ion. REFERENCES 1. Pend i h C, P opp R, Kesha jee L, Ande son J, I e s N, Hillie LM. Inc easing he p o ision o physical ac i i y ad ice by heal hca e p o- essionals. Coch ane Da abase Sys Re . 2017;2017(3):CD012585. 2. Rose S, Poyn e P, Ande son J, Noa S, Coniglia o J. Physician weigh loss ad ice and pa ien weigh loss beha io change: a li e a u e e iew and me a-analysis o su ey da a. In J Obes. 2013;37(1):118–28. 3. Binks H, Vincen GE, I win C, Heidke P, Vandelano e C, Williams S, e al. Associa ions be ween sleep and li es yle beha iou s among Aus alian nu sing s uden s: a c oss-sec ional s udy. Collegian. 2021; 28:97–105. 4. Kelly M, Wills J, Sykes S. Do nu ses' pe sonal heal h beha iou s impac on hei heal h p omo ion p ac ice? A sys ema ic e iew. In J Nu s S ud. 2017;76:62–77. 5. Fie S, No man IJ, While AE. The ela ionship be ween physicians' and nu ses' pe sonal physical ac i i y habi s and hei heal h-p omo ion p ac ice: a sys ema ic e iew. Heal h Educ J. 2013;72(1):102–19. 6. McDowell N, McKenna J, Naylo P-J. Fac o s ha in luence p ac ice nu ses o p omo e physical ac i i y. B J Spo s Med. 1997;31: 308–13. 7. Kwasnicka D, Vandelano e C, Reba A, Ga dne B, Sho C, Duncan M, e al. Compa ing mo i a ional, sel - egula o y and habi ual p ocesses in a compu e - ailo ed physical ac i i y in e en ion in hos- pi al employees-p o ocol o he PATHS andomised con olled ial. BMC Public Heal h. 2017;17(1):518. 8. Kwasnicka D, Domb owski SU, Whi e M, Snieho a FF. Da a-p omp ed in e iews: using indi idual ecological da a o s imu- la e na a i es and explo e meanings. Heal h Psychol. 2015;34(12): 1191–4. 8KWASNICKA ET AL. 22011617, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/hpja.784 by Uni e si y O Jy äskylä Lib a y, Wiley Online Lib a y on [07/08/2023]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License