The aim of the process evaluation was to (1) assess how acceptable and appropriate participants found the intervention and (2) identify psychosocial and environmental factors that may modify the effectiveness of the intervention. The study contained two components: (1) a survey by postal questionnaire, incorporating closed and open questions, and (2) a semistructured interview conducted individually face to face or over the telephone, depending on the preference of each participant.
Our methodological and theoretical approach is that adopted by Snape and Spencer,49characterised by a subtle realism, interpretivism and pragmatism: we understand our subject matter through participants’ contextually situated perspectives; we strive for neutrality and objectivity during data collection and analysis and we attempt to be as transparent as possible as we move beyond the data during interpretation to serve the needs of policy-makers.
Survey
Survey questionnaires were sent to participants before their 3-month research assessment and they were asked to completed the questionnaire before the assessment and return it in a sealed envelope. If the survey was not completed participants were asked if they would be willing to complete it at the 3-month research assessment, after which the participant sealed it in an envelope and handed it back to the RA. Because of delays in regulatory approvals, questionnaires were sent out from April 2010 only and thefirst 47 randomised participants were not invited to complete it.
The survey questionnaire asked participants about the type and location of physical activity that they had undertaken during the previous 3 months, reasons for staying physically active, factors that influenced their physical activity behaviour and social support from significant others. The versions of the
questionnaire sent to participants in the full and mini booster arms of the trial also contained questions on the intervention received. Participants were asked why they chose to participate; their preferred format for such an intervention; their expectations of the intervention and the extent to which these were met and whether they found the intervention easy, convenient, non-judgemental and non-confrontational. Participants were also asked their opinion about the amount of contact time with the project worker, the extent to which they felt encouraged to set their own goals for physical activity and the extent to which
they felt that the intervention had helped them to resolve their barriers to physical activity, expand their knowledge of physical activity, increase their awareness of local facilities and opportunities and increase their confidence to stay active. Finally, participants were asked whether they had become more physically active than they were before participating and what had helped them achieve this. The questionnaire sent to those in the full booster arm of the trial can be found inAppendix 4. The questionnaires distributed to the mini booster and control arms are available from the team on request.
In-depth interviews
Those receiving a booster intervention who also responded to the survey questionnaire (seeSurvey) were given the option of participating in an in-depth interview. Because of the poor response there was no scope for purposive sampling; as a result, we interviewed a sample comprising all of the 26 people who volunteered. We did not elicit reasons for declining a research interview. Three RAs performed the interviews: Andrew Hutchison PhD (male) and Kimberly Horspool MSc and Sue Kesterton MSc
(both female). KH and SK had both studied qualitative research techniques as part of their MSc but were novice interviewers. AH was more experienced having conducted a number of qualitative research interviews as part of his doctoral research. None of the interviewers delivered the intervention to the interviewees but interviewers may have been involved in collecting baseline data for the RCT component from some interviewees. Interviewees would have known that interviewers were on the research team and were from Sheffield Hallam University and may have associated them with exercise science and delivery of the intervention. The interviewers were asked to withhold their own opinions and to make it clear that this interview was separate from the intervention motivational interviews. Nofield notes were taken and no repeat interviews were undertaken.
Semistructured interviews lasted between 9 and 32 minutes (median 21 minutes) and were conducted over the telephone or face to face in a quiet room at a community venue, according to each participant’s choice. For most interviews no one was present except for the participant and the researcher. In one case a participant chose to conduct the interview on a mobile phone and, for part of the time, in a public place.
A topic guide was provided to interviewers (seeAppendix 5); this was not pilot tested. This guide included questions on participants’levels, choice and prioritisation of physical activity as well as the benefits and costs associated with staying physically active. It also included questions on participants’experiences of the booster sessions and why they had or had not helped them to stay active and why participants felt that the booster sessions were or were not a good way to give them the support that they needed.
Interviews were digitally recorded and transcribed verbatim. Transcripts were not returned to participants for comment or correction. Daniel Hind conducted the initial data analysis in NVivo version 10 (QSR International, Southport, UK) using a constant comparative method to identify themes. We used a ‘framework’approach to analysis in which a priori and emergent themes were identified using the following stages: familiarisation, identifying a thematic framework, indexing, mapping and interpretation (charting was not undertaken).50For instance, a theme of a priori interest was the perceived effectiveness of the booster sessions; subthemes within this category were derived inductively from familiarisation with the transcripts.50,51The results were used to explore insights into the mechanisms that may have
contributed towards the quantitativefindings and to identify any other emerging issues or factors that may have influenced the uptake of the boosters and which had not previously been documented.52Data saturation was achieved53with no substantively new themes emerging in the last 10 interview transcripts. Participants were not asked to provide feedback on the themes.
Having indexed transcripts using our own thematic framework, we undertook a rapid review of the literature tofind existing frameworks to evaluate dimensions of (1) prior conditions experienced by the participants; (2) barriers to and facilitators of adoption of new behaviours or technologies; and (3) the acceptability/appropriateness of the interventions. For prior conditions (seeChapter 4,Prior conditions) we used dimensions described by Rogers (p. 172).54We adopted, with modifications, the dimensions of the Motivators of and Barriers to Health-Smart Behaviors Inventory, developed by Tucker and colleagues55
(seeChapter 4,Barriers to physical activityandPhysical activity: motivators). Our dimensions of intervention acceptability are based on those described by Nastasi and Hitchcock56(seeChapter 4, Motivational interviewing: perceived effectiveness,Motivational interviewing: consistency with
perspectives or world views,Motivational interviewing: perceived feasibilityandMotivational interviewing: perceived importance).