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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 hospi al employees - p o ocol o he PATHS
andomised con olled ial
Kwasnicka, Dominika; Vandelano e, Co neel; Reba , Amanda; Ga dne , Benjamin;
Sho , Camille; Duncan, Mi ch; C ook, Dawn; Hagge , Ma in
Kwasnicka, D., Vandelano e, C., Reba , A., Ga dne , B., Sho , C., Duncan, M., C ook,
D., & Hagge , M. (2017). 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 hospi al employees
- p o ocol o he PATHS andomised con olled ial. BMC Public Heal h, 17, A icle
518. h ps://doi.o g/10.1186/s12889-017-4415-4
2017
STUDY PROTOCOL Open Access
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
hospi al employees - p o ocol o he
PATHS andomised con olled ial
Dominika Kwasnicka
1,2
, Co neel Vandelano e
1,2*
, Amanda Reba
1,2
, Benjamin Ga dne
3
, Camille Sho
4
,
Mi ch Duncan
5
, Dawn C ook
6
and Ma in S. Hagge
1,2,7
Abs ac
Backg ound: Mos people do no engage in su icien physical ac i i y o con e heal h bene i s and o educe isk
o ch onic disease. Heal hca e p o essionals equen ly p o ide guidance on physical ac i i y, bu o en do no mee
guideline le els o physical ac i i y hemsel es. The main objec i e o his s udy is o de elop and es he e icacy
o a ailo ed in e en ion o inc ease heal hca e p o essionals’physical ac i i y pa icipa ion and quali y o li e, and
o educe wo k- ela ed s ess and absen eeism. This is he i s s udy o compa e he addi i e e ec s o h ee o ms
o a ailo ed in e en ion using di e en echniques om beha iou al heo y, which di e acco ding o hei ocus
on mo i a ional, sel - egula o y and/o habi ual p ocesses.
Me hods/Design: Heal hca e p o essionals (N= 192) will be ec ui ed om ou hospi als in Pe h, Wes e n
Aus alia, ia email lis s, lea le s, and pos e s o pa icipa e in he ou g oup andomised con olled ial. Pa icipan s
will be andomised o one o ou condi ions: (1) educa ion only (non- ailo ed in o ma ion only), (2) educa ion plus
in e en ion componen s o enhance mo i a ion, (3) educa ion plus componen s o enhance mo i a ion and
sel - egula ion, and (4) educa ion plus componen s o enhance mo i a ion, sel - egula ion and habi o ma ion. All
in e en ion g oups will ecei e a compu e - ailo ed in e en ion adminis e ed ia a web-based pla o m and will
ecei e suppo ing ex -messages con aining ailo ed in o ma ion, p omp s and eedback ele an o each condi ion.
All ou comes will be assessed a baseline, and a 3-mon h ollow-up. The p ima y ou come assessed in his s udy is
physical ac i i y measu ed using ac i i y moni o s. Seconda y ou comes include: quali y o li e, s ess, anxie y, sleep,
and absen eeism. Websi e engagemen , e en ion, p e e ences and in e en ion ideli y will also be e alua ed as well
as po en ial media o s and mode a o s o in e en ion e ec .
(Con inued on nex page)
* Co espondence: [email p o ec ed]
1
Heal h Psychology & Beha iou al Medicine, School o Psychology and
Speech Pa hology, Facul y o Heal h Sciences, Cu in Uni e si y, Pe h,
Aus alia
2
Physical Ac i i y Resea ch G oup, School o Heal h, Medical and Applied
Sciences, Cen al Queensland Uni e si y, Rockhamp on, QLD, Aus alia
Full lis o au ho in o ma ion is a ailable a he end o he a icle
© The Au ho (s). 2017 Open Access This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion 4.0
In e na ional License (h p://c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and
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he C ea i e Commons license, and indica e i changes we e made. The C ea i e Commons Public Domain Dedica ion wai e
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Kwasnicka e al. BMC Public Heal h (2017) 17:518
DOI 10.1186/s12889-017-4415-4
(Con inued om p e ious page)
Discussion: This is he i s s udy o examine a ailo ed, echnology-suppo ed in e en ion aiming o inc ease physical
ac i i y in heal hca e p o essionals. The s udy will e alua e whe he including addi ional heo y-based beha iou
change echniques aimed a p omo ing mo i a ion, sel - egula ion and habi will lead o inc eased physical ac i i y
pa icipa ion ela i e o in o ma ion alone. The online pla o m de eloped in his s udy has po en ial o deli e e icien ,
scalable and pe sonally- ele an in e en ion ha can be ansla ed o o he occupa ional se ings.
T ial egis a ion: Aus alian New-Zealand Clinical T ial Regis y: ACTRN12616000462482, submi ed 29/03/2016,
p ospec i ely egis e ed 8/04/2016.
Keywo ds: Compu e - ailo ing, Beha iou change, Beha iou main enance, Habi , Heal hca e p o essionals, Physical
ac i i y, Web-based, Randomised con olled ial
Backg ound
Physical inac i i y is ela ed o inc eased isk o a
numbe o ch onic diseases (e.g., ca dio ascula disease,
Type 2 diabe es, ce ain ypes o cance , obesi y) [1, 2].
Engaging in egula physical ac i i y is ela ed o educed
isk o ch onic diseases [2]. In addi ion, posi i e ou -
comes o physical ac i i y include imp o ed quali y o
li e, be e sleep, and educed s ess [3, 4]. Wo ld Heal h
O ganisa ion physical ac i i y guidelines o adul s o
gain heal h bene i s is o unde ake a leas 150 min o
mode a e in ensi y physical ac i i y pe week (e.g.,
walking, cycling), o a leas 75 min o igo ous in en-
si y physical ac i i y pe week (e.g., unning, playing
oo ball) [5]. Globally, 1 in 4 adul s does no mee hese
ecommenda ions [5].
Heal hca e p o essionals ha e a key ole o play in he
p omo ion o physical ac i i y [6]; howe e hey o en do
no mee guideline le els o physical ac i i y hemsel es.
Fo ins ance a s udy ocussing on nu ses’physical ac i i y
(N= 325) indica ed ha mo e han hal o he assessed
sample did no mee guideline le els o physical ac i i y
[7]. Those who we e less ac i e we e also mo e likely o
epo poo gene al heal h and wo se sleep pa e ns han
hei ac i e coun e pa s. Despi e signi ican heal h educa-
ion among heal h ca e p o essionals, i appea s ha he
heal h knowledge o en does no ansla e in o hei own
heal h beha iou s [7–9].
In addi ion, he e is a ela ionship be ween pe sonal
physical ac i i y beha iou s o heal hca e p o essionals
and hei heal h-p omo ion p ac ice. A sys ema ic e iew
[10] o c oss-sec ional s udies (N= 13) in es iga ing his
ela ionship ound ha a highe pe sonal physical ac i -
i y le el in heal hca e p o essionals was associa ed wi h
highe physical ac i i y-p omo ing p ac ices in mos
s udies. Heal h p o essionals wi h posi i e a i udes
owa ds physical ac i i y we e also mo e likely o
p omo e physical ac i i y o hei pa ien s.
Heal hca e p o essionals o en exhibi unheal hy li e-
s yle beha iou s wi h wo k- ela ed s ess iden i ied as
he mos equen ly-ci ed eason [11]. P o essionals epo
ha hospi als a e a highly s ess ul wo k en i onmen , and
i egula shi wo k o en places an addi ional s ain on
he hospi al employees [12]. Sleep pa e ns and sleep
quali y among heal hca e p o essionals we e insu icien
o good heal h [13] and physical ac i i y is a ecognised
means o imp o e sleep quali y [14]. In addi ion, nu ses a e
p one o su e lowe back pain [15] and physical ac i i y is
ecommended o his occupa ional g oup o managing
back pain. As such, he e is s ong a ionale o p omo ing
physical ac i i y among heal hca e p o essionals.
The wo kplace is epo ed as a sui able en i onmen
o making changes in he physical ac i i y and imp o ing
heal h o employees [16]. Inc eased pa icipa ion in phys-
ical ac i i y in heal hca e p o essionals can be p omo ed
using beha iou al in e en ions which u ilise pe suasi e
s a egies and echniques o encou age indi iduals o
change hei beha iou (e.g., goal se ing, planning, p o-
iding social suppo ) [17, 18]. Such in e en ions ha e
been shown o be e ec i e in p omo ing inc eased up ake
and main enance o physical ac i i y, including in he
wo kplace [19–21], hence hey may be sui able o p o-
mo ing physical ac i i y o heal hca e p o essionals.
O he han iden i ying he impo ance o con ex in he
deli e y o in e en ions, such as he occupa ional se ing
o heal hca e wo ke s, i is also impo an o look a he
means by which in e en ions may be deli e ed o em-
ployees in his con ex [22]. Recen ly compu e - ailo ing
has been used o deli e beha iou al in e en ions in
heal h con ex s and i has ecei ed inc eased a en ion as
a means o e ec i ely deli e pe sonalised in e en ions o
a wide audience a a ela i ely low cos [23]. These in e -
en ions p o ide use s wi h indi idualised eedback based
on hei demog aphic p o ile and p e e ences. Use s a e
p omp ed o p o ide in o ma ion salien o he in e en-
ion (using an online ques ionnai e) and a e subsequen ly
p o ided wi h ailo ed eedback including in o ma ion on
beha iou change ma ched o hei equi emen s and
consis en wi h hei esponses. P e-de ined algo i hms
gene a e ailo ed con en o he use based on use -
p o ided in o ma ion and he ele an beha iou
change con en ha is s o ed in a da abase including all
possible esponse op ions [24].
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 2 o 16
Web-based in e en ions ha e a numbe o ad an ages
o e ace- o- ace in e en ions: hey ha e wide each,
compa a i ely low cos o implemen a ion and deli e y,
and lexibili y o in e en ion use a imes and loca ion
con enien o he use [25, 26]. Tailo ing web-based
in e en ions also ca ies dis inc ad an ages o e non-
ailo ed app oaches: pa icipan s a e p esen ed only wi h
ele an and pe sonalised in o ma ion, and non- ele an
in o ma ion can be omi ed. This in u n may inc ease
engagemen and pe suasion [27, 28]. In compu e -
ailo ed in e en ions, less in o ma ion is p esen ed o
he use s and mo e a en ion is di ec ed o he ele an
in e en ion con en . In addi ion, consis en wi h he
elabo a ion likelihood model o pe suasion [29], in o -
ma ion in he in e en ion is mo e likely o be hough -
ully a ended o when i is pe sonally ele an and when
eade s a e mo i a ed. The e o e, ailo ed in e en ions
a e mo e likely o be a ended o and should lead o
longe las ing beha iou al change.
In addi ion o compu e ailo ing, he e is also a g owing
li e a u e suppo ing he use o sho message se ice
(SMS) o ‘ ex ’messaging o p omo e heal h beha iou .
Resea ch has demons a ed ha deli e ing heal h beha -
iou messages ia ex messaging can p omo e heal h
beha iou change in nume ous con ex s, including phys-
ical ac i i y [30]. Tex messaging has also been used in
conjunc ion wi h web-based in e en ions o imp o e
heal h beha iou and o enhance hei e ec i eness. A
sys ema ic e iew epo ed ha he e ec i eness o web-
based in e en ions can be enhanced by he inclusion o
SMS as a means o emind pa icipan s o in e en ion
con en o o augmen i [31]. The e o e, adop ion o web-
based ailo ed in e en ions o p omo e physical ac i i y
augmen ed wi h ex messaging, may be a use ul, cos -
e ec i e means o p omo e physical ac i i y o heal hca e
p o essionals.
In he con ex o physical ac i i y p omo ion,
compu e - ailo ed beha iou al in e en ions ha e been
epo ed as e ec i e [26, 32]; howe e u he in es iga-
ion o he mechanisms is needed in e ms o e alua ing
hese in e en ions and hei e ec i eness ac oss mul-
iple con ex s. In es iga ing he mechanisms ha can
imp o e he e ec i eness o compu e - ailo ed in e en-
ions is c ucial. The e o e, s udies ha isola e speci ic
beha iou change echniques (BCTs) wi hin in e en ion
condi ions using ac o ial designs will p o ide obus
e idence o es ing he impac o speci ic BCTs [18].
This means ha knowledge o he speci ic indi idual
componen s ha a e mos likely o change beha iou
will be iden i ied.
Theo ies o beha iou change and main enance
Heal h beha iou change in e en ions a e usually unde -
pinned by psychological heo ies o beha iou change and
main enance. Many such heo ies ha e ocused on
mo i a ion and in en ions o explain and change beha -
iou (e.g., he Theo y o Planned Beha iou ) [33]. These
heo ies iew lack o engagemen in heal h beha iou s
(e.g., physical ac i i y) as p ima ily a p oblem wi h
mo i a ion, such ha inc easing mo i a ion will di ec ly
lead o inc eases in beha iou al pa icipa ion. The he-
o ies also assume ha mo i a ion is a unc ion o an
indi iduals’explici , consciously-held belie s abou he
beha iou [33]. Howe e , heo ies o oli ion [34] indi-
ca e ha mo i a ion is a necessa y bu insu icien con-
di ion o beha iou al enac men and sugges s ha
oli ional s a egies (e.g., planning) ha ope a e in a
pos -decisional manne (i.e. a e in en ions ha e been
o med) lead o he e ec i e execu ion o in en ions in o
ac ion because hey enable an indi idual o mo e e ec -
i ely ecall hei in ended beha iou ia p omp s o cues
ha ha e been linked o he desi ed beha iou [35].
Dual p ocess heo ies o e a b oade pe spec i e ha
in eg a es mo i a ional and oli ional p ocesses, bu also
ecognises ha beha iou may also be in luenced by
mo e implici , non-conscious p ocesses [36–39]. Dual
p ocess heo ies p opose ha heal h beha iou s a e
enac ed h ough wo p ocesses – he conscious, delib-
e a i e p ocesses such as hose desc ibed in mo i a ional
and oli ional heo ies, as well as non-conscious p o-
cesses ha occu au oma ically, ou side an indi idual’s
delibe a ion. The implici p ocesses e lec ini ia ing o
engaging in ac ions wi h e y li le delibe a i e, ea-
soned, and conscious decision making p ocesses ou -
lined in adi ional mo i a ional heo ies. Beha iou s
ha may ini ially be con olled h ough delibe a i e,
mo i a ional pa hways beha iou s can, h ough a habi -
o ma ion p ocess become con olled by au oma ic p o-
cesses [40]. Habi o ma ion likely occu s h ough
lea ning o con ex -beha iou associa ions ia con ex -
dependen epe i ion o he beha iou usually in he
p esence o some ewa ding con ingency [41]. In some
cases, he beha iou is enac ed because epe i ion and
expe ience has led he beha iou o occu wi hou he
need o any conscious con ol, as such he beha iou
is classed as ‘habi ual’[42, 43].
Resea che s applying hese heo ies o p edic and
change beha iou ha e iden i ied s a egies and ech-
niques o p omo e he de elopmen o habi s [40]. These
echniques should be sepa able and able o be isola ed
om echniques ha p omo e, o example, inc eased
beha iou al engagemen ia he mo i a ional and ol-
i ional pa hways iden i ied in dual p ocess heo ies. As a
consequence, ac o ial- ype designs should be able o
demons a e he unique e ec s o echniques ela ed o
mo i a ion and oli ion and echniques ela ed o habi
p omo ion on heal h beha io change. Such designs may
also pe mi demons a ion o whe he he addi ion o
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 3 o 16
componen s a ge ing speci ic p ocesses (e.g., mo i a ional,
oli ional, habi ual) may lead o inc emen al changes in
beha iou ela i e o each se o echniques alone.
The p esen s udy
The e is a need o cos -e ec i e, e icacious beha iou al
in e en ions o inc ease physical ac i i y in heal hca e
p o essionals [13]. Resea ch has sugges ed ha heo y-
based in e en ions adop ing mul iple BCTs a e e ec i e
in inc easing physical ac i i y beha iou [31]. Recen
esea ch e o s ha e ocused on linking BCTs wi h
unde lying heo e ical mechanisms o ac ion [44]. How-
e e , ew s udies ha e sys ema ically examined he e icacy
o speci ic g oups o BCTs ha a e hough o ope a e
h ough one o he h ee speci ied p ocesses (mo i a ional,
oli ional, and habi - o ming) and assessed hei inde-
penden and addi i e e ec s on beha iou change. The
pu pose o he cu en s udy, he Physical Ac i i y
Tailo ed in e en ion in Hospi al S a (PATHS)s udy,is
o e alua e he e icacy o a compu e - ailo ed in e en-
ion o inc ease physical ac i i y and quali y o li e, and
dec ease wo k- ela ed s ess and absen eeism, in hospi al
heal hca e wo ke s. The in e en ion will examine he
addi i e e ec s o g oups o BCTs de i ed om heo ies o
mo i a ion, oli ion, and habi on physical ac i i y beha -
io change. The esea ch is unique as i will p o ide he
i s e idence o he e icacy o echniques de i ed om
hese h ee heo e ical app oaches applied in a wo kplace
con ex . The s udy will adop a andomised con olled
design o es and compa e he e ec s o h ee dis inc
g oups o BCTs de i ed om heo y and ocusing di e en
p ocesses o beha iou changes on s udy ou comes:
mo i a ion, sel - egula ion, and habi o ma ion.
Speci ically, he in e en ion will include mo i a ional
echniques o inc ease mo i a ion and sel -e icacy o
engage in physical ac i i y, sel - egula o y echniques o
inc ease capabili y and skills o ini ia e and egula e
beha iou change, and habi -based echniques o inc ease
he au oma ic, non-conscious endencies o engage in
physical ac i i y on p esen a ion o con ex ual and ime-
ele an cues. Th ee in e en ion condi ions a e p oposed,
each de ined by he se s o BCTs in an addi i e design: (1)
mo i a ional BCTs; (2) mo i a ional plus sel - egula o y
BCTs; and (3) mo i a ional plus sel - egula o y and
habi o ma ion BCTs. The in e en ion g oups will be
compa ed o a con ol condi ion ha will ecei e basic
non- ailo ed in o ma ion abou physical ac i i y.
Me hods
Pa icipan s
Full- and pa - ime hospi al s a including midwi es,
clinical nu se manage s, clinical nu ses, egis e ed nu ses,
en olled nu ses, and pa ien ca e assis an s will be eligible
o pa icipa e in he PATHS s udy. Pa icipan s will be
ec ui ed om hospi als in Pe h, Wes e n Aus alia. S a
wo king in shi and non-shi pa e ns will be eligible o
pa icipa e. No es ic ions will be placed on he ype o
con ac and numbe o hou s wo ked. Pa icipan s a e
eligible i hey ail o mee he ecommended weekly le el
o 150 min o mode a e in ensi y physical ac i i y because
he in e en ion is designed o people who ail o mee
his le el.
Indi iduals who sel - epo a physical condi ion o
impai men p e en ing hem om being physically ac i e
will be excluded om he s udy. They will be sc eened
using he Physical Ac i i y Readiness Ques ionnai e
(PAR-Q) p io o s udy consen [45]. Howe e , indi iduals
who a e no eligible o pa icipa e in he s udy based on
PAR-Q measu es can s ill consul hei GP o ob ain
app o al. Hospi al employees who do no ha e a mobile
phone ha allows hem o ecei e ex messages, who do
no ha e access o in e ne on hei mobile phone, com-
pu e o able ou side o wo k, who a e al eady mee ing
weekly ecommended le els o physical ac i i y o a e cu -
en ly pa icipa ing in ano he physical ac i i y p og am
(e.g., a s uc u ed weigh loss p og am, egula mee ings
wi h pe sonal aine o coach) will be excluded.
Rec ui men
Pa icipan s will be ec ui ed om di e en hospi al
wa ds ia email messages and p in ed le e s ha will be
sen o all po en ially eligible employees, accompanied
by a desc ip ion o he s udy and i s equi emen s and
in i ing hem o ake pa . S udy pos e s and lea le s
ad e ising he s udy will be placed h oughou hospi al
p emises. Membe s o he PATHS eam will also isi
each wa d o p omo e he s udy, alongside wa d man-
age s. The p omo ional ma e ials will ad e ise he
s udy as esea ch in es iga ing he de elopmen o a
web-based ool o imp o e employees’physical ac i i y,
wellbeing and heal h. Rec ui men ma e ials (including
pos e s, lea le s, emails, and p in ed le e s) will di ec
in e es ed s a o he p ojec websi e, which will p o-
ide s udy in o ma ion and will allow hem o assess
eligibili y and egis e o pa icipa e. A o mal s a e-
men o consen will be signed in pe son a he i s
mee ing wi h he s udy esea che .
S udy design
The PATHS s udy is a p agma ic ou -g oup in e en ion
ial adop ing a andomised con ol design wi h assess-
men s o p ima y and seconda y ou comes a baseline
and 3-mon h ollow-up ime poin s (see Fig. 1). We
chose andomisa ion o indi iduals wi hin hospi als
( a he han andomisa ion o hospi als o wa ds) because
indi idual andomisa ion was mo e e icien and mo e
easible wi h con inuous ec ui men o he pa icipan s;
p og am was deli e ed o indi iduals a he han g oups
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 4 o 16

so con amina ion ac oss in e en ion g oups was no con-
side ed a majo isk [46]. The p ojec comp ises h ee
in e en ion condi ions and a no in e en ion condi ion,
in which pa icipan s ecei e in o ma ion abou he s udy
only. This will se e as a con ol condi ion. Each condi ion
includes a g oup o heo y-based BCTs designed o es
he addi i e e ec s o he speci ic BCT g oups on s udy
ou comes:
1. Con ol condi ion –p o ision o in o ma ion abou
physical ac i i y only
2. Mo i a ion condi ion –p o ision o in o ma ion
+ mo i a ional BCTs
3. Sel - egula ion condi ion –p o ision o
in o ma ion + mo i a ional BCTs + sel - egula o y
BCTs
4. Habi condi ion –p o ision o in o ma ion +
mo i a ional BCTs + sel - egula o y BCTs + habi
o ma ion BCTs
P ocedu e
A e sc eening, eligible pa icipan s will be con ac ed by
a s udy esea che who will a ange a one-on-one
mee ing (Figu e 1, CONSORT low diag am). Du ing he
mee ing, he pa icipan will ecei e a de ailed explan-
a ion o he s udy, and i s equi emen s and expec a ions
om he esea che . They will also be p o ided wi h an
in o ma ion shee p o iding he same in o ma ion and
ou lining hei igh s o con iden iali y and o wi hd aw
om he s udy a any s age wi hou consequence. Once he
pa icipan has had he oppo uni y o con i m hei unde -
s anding o he p ojec and ha e any ques ions answe ed,
hey will be asked o sign an in o med consen o m.
A s udy esea che will se up and ini ia e a GENEAc i
ac i i y moni o [47] o each pa icipan , including p o-
g amming he pa icipan ’s code numbe , da e o bi h,
heigh , and handedness. Each moni o will be p o-
g ammed o s a collec ing da a om se up. S udy
pa icipan s will be equi ed o wea he moni o on
hei non-dominan uppe a m and will be p o ided
wi h de ailed ins uc ions on how o wea he de ice.
Pa icipan s will be ins uc ed o wea i con inuously
h oughou day and nigh o one week a e he i s
mee ing.
Eigh days la e , pa icipan s will mee wi h he
esea che again o e u n he ac i i y moni o . The s udy
acili a o will check i su icien da a ha e been collec ed
by he de ice (i.e., a leas i e days o wea wi h a mini-
mum 16 h wea pe day) [48]. I he pa icipan ails o
wea he ac i i y moni o o he minimum ime speci-
ied, hey will be asked o wea i again o ano he
se en days. A his second mee ing, pa icipan s will
Fig. 1 CONSORT low diag am [91]
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 5 o 16
also be asked o comple e web-based baseline ques ion-
nai es using a p o ided able (Time 1).
A e he second mee ing, pa icipan s will be
emailed a pe sonalised login/passwo d, and link o
he websi e so hey a e able o login o he web-
based PATHS s udy pla o m used o deli e he
ailo ed in e en ion messages. Pa icipan s will be
au oma ically andomly alloca ed online in an equal
a io o one o he ou possible s udy condi ions; a
block andomisa ion will be used wi h block size o
16. I alloca ed o one o he h ee in e en ion condi ions,
hey will be able o comple e he i s in e en ion
session on he websi e immedia ely a e comple ing
he baseline assessmen s. I alloca ed o he con ol
condi ion, hey will ecei e an email di ec ing hem
o he Lib a y si e o physical ac i i y ele an in o -
ma ion. The Lib a y is a sub-sec ion o he websi e
wi h non- ailo ed e idence-based in o ma ion abou
physical ac i i y,
Ac oss all condi ions, pa icipan s will be encou -
aged o use and in e ac wi h he web-based PATHS
pla o m o h ee consecu i e mon hs, comple ing
sessions e e y o nigh . A he end o mon h h ee,
pa icipan s will mee wi h he esea che and will be
p o ided wi h a GENEAc i ac i i y moni o o be
wo n o one week immedia ely pos -in e en ion o
assess physical ac i i y. Pa icipan s will mee wi h he e-
sea che again one week a e hey ecei ed he ac i i y
moni o o comple e he pos -in e en ion ques ionnai es
and e u n he ac i i y moni o (Time 2). All esea che s
collec ing he da a will be blinded o he alloca ion o
pa icipan s’s udy condi ion.
Following he h ee-mon h pe iod, pa icipan s will
be hanked o hei s udy con ibu ion ia pe sonal
email and ex message, and hei names will be au o-
ma ically en e ed in o a p ize d aw allowing hem o
win shopping ouche s o hei pa icipa ion ( ou
shopping ouche s, 20 AUD alue pe each hospi al).
Pa icipan s alloca ed o he con ol condi ion will
hen be gi en he oppo uni y o ecei e he con en
om one o he in e en ion condi ions so ha hey
a e no p e en ed om pa icipa ing in a po en ially
e ec i e in e en ion. They will ecei e login de ails,
passwo dandlink o heweb-based ailo edpla o m
p o iding hem wi h he op ion o engage in one o
he h ee in e en ion condi ions, chosen andomly. All
s udy pa icipan s will be old ha he e a e ou di e en
e sions o he same p og am ha di e in con en and
beha iou change echniques used. Pa icipan s will be
asked no o sha e o compa e in e en ion con en o
a oid s udy con amina ion among pa icipan s wo king
on he same wa d. They will be asked in he pos in e -
en ion e alua ion i hey adhe ed o he a o emen-
ioned ecommenda ion.
In e en ion con en
Con ol condi ion
Pa icipan s assigned o he con ol condi ion will be
p o ided wi h in o ma ion abou physical ac i i y ecom-
menda ions compiled in he Lib a y and will ha e he
oppo uni y o a e he con en ( anging om 0 s a s
[no in e es ing and no use ul] o 5 s a s [ e y in e es ing
and e y use ul]). The p esen a ion o de o he a icles
will mo e up o down on he lis based on he a ings
gi en by he pla o m use s, wi h he ones a ed he
highes displayed a he op o he page. The in o ma ion
will be ac ual and non-pe sonalised. BCTs used in he
con ol g oup a e: p o iding in o ma ion abou heal h
consequences [49], p o iding in o ma ion abou social
[50], en i onmen al [51] and emo ional consequences
[52]. Websi es ha p o ide in o ma ion only ha e no
been shown o ha e s ong e ec s on heal h beha iou
change [27] and is e ec i e as a con ol g oup in he
cu en s udy as i p o ides a con ol o in o ma ion
load and con ac wi h he s udy eam.
Mo i a ion condi ion
Pa icipan s assigned o he mo i a ion condi ion will
ecei e pe sonalised messages based on BCTs o p o-
mo e in en ion and sel -e icacy o engage in physical
ac i i y [53]. Speci ically, pa icipan s will be p o ided
wi h ad ice on how o wo k owa ds hei goals and o
main ain mo i a ion in he ace o ba ie s [54, 55].
Sel - egula ion condi ion
Pa icipan s assigned o he sel - egula ion condi ion will
ecei e he con en om he mo i a ion condi ion along
wi h con en p omo ing sel - egula ion. Speci ically, pa -
icipan s will be encou aged o se ou come-speci ic
goals [56] and o sel -moni o hei p og ess owa ds
hese goals by moni o ing how much ime hey spen
doing physical ac i i y. They will also be p omp ed o
o m ac ion and coping plans [57], speci ying when,
whe e and how hey will pe o m hei physical ac i -
i ies, and iden i ying ba ie s o hei physical ac i i y
pa icipa ion and how hey migh o e come hem.
Pa icipan s will be encou aged o speci ically ocus on
sel -moni o ing in high isk si ua ions [58], such as when
hey a e i ed o s essed and hei capaci y o sel -
egula ion is mos likely o be comp omised [59, 60].
Pa icipan s will also ecei e in o ma ion on managing
mul iple goals [61] and sel - egula ing he si ua ion when
compe ing ac i i ies a ise (e.g., he desi e o be ac i e and
heal hy con lic s wi h o he si ua ional op ions such as
wa ching TV and es ing).
Habi condi ion
Pa icipan s assigned o he habi condi ion will ecei e
he con en om he mo i a ion and sel - egula ion
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 6 o 16
condi ions along wi h con en p omo ing habi de elop-
men (e.g., ecognising p omp s o ac ion and lea ning o
ac upon hese p omp s). Pa icipan s will ecei e in o ma-
ion ele an o implemen a ion in en ions wi h con ex -
speci ic p omp s [62] (e.g., o ming simple p omp -
dependen plans o engage in physical ac i i y when he
p omp occu s). They will be asked o ecognise and iden-
i y si ua ional, con ex ual and ime-based cues ha can
p omp hem o be mo e ac i e. Pa icipan s will be
encou aged o de elop a habi o ins iga ing physical ac i -
i y wi hou ha ing o consciously emembe [63]. In o de
o do hings au oma ically beha iou al epe i ion o he
same ac i i y in he same con ex s will be encou aged; pa -
icipan s will ha e he choice o which con ex hey wish
o do he ac i i y.
In e en ion deli e y
The in e en ion will be deli e ed ia he PATHS web-
si e [64] (see Fig. 2 o sc eensho examples). Pa ici-
pan s in all condi ions will log-in o he web-based
in e en ion using hei email add ess and passwo d
c ea ed while going h ough he eligibili y assessmen
p ocess. Pa icipan s in all condi ions will ha e access o
he Lib a y in he o m o b ie clea -language desc ip-
ions o physical ac i i y ecommenda ions and in o ma-
ion on he impo ance o physical ac i i y. Gi en
esea ch demons a ing ha p o iding in o ma ion
abou heal h beha iou alone is no su icien o change
beha iou [65], bu also ecognising he need o p o ide
a a ionale o engaging in he websi e and o ensu e
ha in o ma ion is con olled ac oss condi ions, all
s udy pa icipan s will ha e access o he Lib a y.
All pa icipan s will also ha e access o F equen ly Asked
Ques ions page, a sub-sec ion o he websi e abou p ac i-
cali ies o i s use (e.g., how o change hei passwo d, basic
ea u es, ips on na iga ing h ough he websi e). This
sub-sec ion o he websi e has been designed based on
pilo ing p e ious simila websi e [66]. Pa icipan s will be
able o con ac an in e en ion acili a o i hey ha e any
addi ional ques ions abou pa icipa ing in he s udy.
The e will also be an Abou page a ailable –a sub-sec ion
o he websi e ha will (1) explain he easons why he
in e en ion was de eloped and (2) in oduce he PATHS
s udy esea ch eam o add c edibili y. A F equen ly Asked
Ques ions page and an Abou page, also de eloped om
p e ious in es iga ions pilo ing he pla o m, will be
sligh ly di e en o each in e en ion condi ion o
accoun o he di e ences be ween condi ions.
Pa icipan s alloca ed o he h ee in e en ion g oups
will ha e access o addi ional in e en ion ea u es. Each
o nigh , hey will be p omp ed ia email o access he
websi e and o answe sho online su eys and ecei e
ailo ed eedback based on he in o ma ion p o ided in
hei esponses. Depending on hei g oup alloca ion
(Tables 1 and 2), pa icipan s will ecei e eedback aimed
a p omo ing mo i a ion (mo i a ion g oup), mo i a ion
and sel - egula ion (sel - egula ion g oup), o mo i -
a ion, sel - egula ion and p omp s o ac ions (habi
g oup). In o ma ion pe inen o he pa icipan ’s condi-
ion will be deli e ed ia pe sonally- ailo ed messages
p esen ed as ex on a webpage accompanied by app op i-
a e pic u es and g aphs wi h ailo ed in o ma ion (e.g.,
g aphs showing pa icipan ’s change in physical ac i i y o
weigh h oughou he in e en ion). The in e en ion will
include six consecu i e sessions ha will be p esen ed
o nigh ly o h ee consecu i e mon hs.
Each o nigh , pa icipan s will be p o ided wi h a
new session including a ecap o he messages om he
p e ious wo weeks along wi h new pe sonally- ele an
con en and ailo ed eedback. I pa icipan s do no
comple e he session on ime, hey will be able o do so
when hey nex login. Each session will end wi h a pop-up
Fig. 2 PATHS s udy –in e en ion sc eensho s –con en examples
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 7 o 16
no i ica ion asking use s o use a s a a ing sys em
(Wha did you hink o his eedback? 0 o5s a s)anda
quali a i e eedback box o ecei e open-ended com-
men s ela ing o each session con en (Why did you
a e i his way? [op ional]).
Du ing each in e en ion session, pa icipan s will
ecei e pe sonally- ele an con en inco po a ing BCTs
ele an o hei alloca ed in e en ion condi ion (Table 2).
To gene a e he con en -speci ic in o ma ion, pa icipan s
will be asked abou hei physical ac i i y du ing he p e i-
ous week a he beginning o each in e en ion session
(including hei low, mode a e and high in ensi y physical
ac i i y, and esis ance aining, speci ying numbe and
leng h o sessions). They will also be asked ques ions
ega ding he psychological de e minan s o physical
ac i i y, physical esou ces, and social and en i onmen al
ac o s ele an o he condi ion o which hey a e
alloca ed. Fo example, du ing he session on goal se ing,
pa icipan s alloca ed o he Mo i a ion condi ion will
ecei e in o ma ion which p omp s hem o o m ac i i y
goals and o s ay mo i a ed o achie e hem. Pa icipan s
alloca ed o he Sel - egula ion condi ion will also ecei e
sugges ions how o moni o and sel - egula e owa ds he
goal (ac ion planning, coping planning). Pa icipan s
assigned o he Habi condi ion will also ecei e in o ma-
ion on he impo ance o epe i ion o he same ac i i y in
he same con ex o de elop habi s.
The pla o m uses i - hen algo i hms o p o ide ailo ed
eedback based on he pa icipan ’s esponses. The eed-
back will be d awn om a da abase o messages inco po -
a ing eedback combina ions ailo ed o he pa icipan ’s
condi ion and esponses o p omp s o in o ma ion on
he websi e. The pla o m will s o e pa icipan s’ e-
sponses o each session, pe mi ing ailo ing o he in e -
en ion o he esponses om he cu en session, as well
as o esponses om p e iously comple ed su eys. Fo
ins ance, g aphs displayed o he pa icipan s will include
changes in physical ac i i y h oughou he in e en ion.
In addi ion, all g oups, wi h he excep ion o he con-
ol g oup, will ecei e weekly ex messages sen a he
same ime each week o p o ide u he condi ion- and
session- ele an eedback based on hei mos ecen ly
comple ed session and including a sho summa y o key
poin s. The e will be h ee in oduc ion messages and
each session has wo session speci ic ex messages,
ollowed by a inal concluding message. Pa icipan s will
also ecei e egula o nigh ly eminde s o login o he
in e en ion websi e when a new session is a ailable sen
ia email. Up o h ee eminde s will be sen pe session
(one e e y ou days).
Measu es
Table 3 desc ibes measu es ha will be aken du ing he
s udy, speci ying he ype o ou come assessed, he
measu emen ool used, he numbe o ques ions
included, and he ime poin s when he measu es will be
adminis e ed.
Physical ac i i y
The p ima y ou come will be measu ed physical ac i i y
o e a one-week pe iod p io o he in e en ion (Time 1)
and o a u he week immedia ely pos -in e en ion a
he h ee-mon h ollow-up occasion (Time 2) using accel-
e ome e s (GENEAc i L d.) [47, 67]. Pa icipan s will be
asked o wea he uni con inuously o he se en day
pe iod on he non-dominan uppe a m o comply wi h
hospi al hygiene egula ions. The GENEAc i de ice is
wa e p oo and pa icipan s will be in o med ha hey
a e ee o choose whe he o wea i while swimming,
showe ing, o sleeping. Da a will be collec ed a 60 Hz
epoch equency. S ep coun s will be de i ed om he
accele a ion da a using open-sou ce mac os and hey will
be used as p oxy o physical ac i i y [47]. Pa icipan s will
be supplied wi h a band speci ically designed o as en he
moni o o he uppe a m.
Table 1 In e en ion con en o PATHS s udy -o e iew
Session numbe Mo i a ion condi ion Mo i a ion + sel - egula ion condi ion Mo i a ion + sel - egula ion + habi condi ion
1 Mo i a ion and sel -e icacy Mo i a ion, sel -e icacy and
sel -moni o ing
Mo i a ion, sel -e icacy, sel -moni o ing
and habi de elopmen
2 Goal se ing Goal se ing and ac ion planning Goal se ing, ac ion planning and o ming
posi i e habi s
3 Sel -e icacy, ba ie s iden i ica ion
and s aying mo i a ed when
acing ba ie s
Sel -e icacy, ba ie iden i ica ion
and s aying mo i a ed and
sel - egula ing when acing ba ie s
Sel -e icacy, ba ie s iden i ica ion and s aying
mo i a ed, sel - egula ing in ace o ba ie s and
ecognising cues o ac ion
4 Social suppo and mo i a ion Social suppo and mo i a ion, and
sel -moni o ing wi h o he s
Social suppo and mo i a ion, sel -moni o ing
and o ming ac i i y ou ines wi h o he s
5 Expe iencing ba ie s o being
ac i e and s aying mo i a ed
Expe iencing ba ie s o being ac i e
and s aying mo i a ed; elapse p e en ion
Expe iencing ba ie s o being ac i e and s aying
mo i a ed; easons o alling back in o bad habi s;
elapse p e en ion
6 Summa y: s aying mo i a ed Summa y: s aying mo i a ed and
sel - egula ing
Summa y: s aying mo i a ed, sel - egula ing and
main aining habi s
Kwasnicka e al. BMC Public Heal h (2017) 17:518 Page 8 o 16
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