A Systematic Review Approach Using the Behaviour Change Wheel, COM-B Behaviour Model and Theoretical Domains Framework to Evaluate Physical Activity Engagement in a University Setting

Abstract

Introduction: Physical activity has been recognised to offer health benefits and reduce the risks of developing chronic diseases such as diabetes, cardiovascular diseases, hypertension, cancer, depression, and atherosclerosis. However, even with the known health benefits of physical activity, over a quarter of adults globally are physically inactive, which is a serious public health concern and thus calls for concerted efforts to increase physical activity levels in diverse settings. A university is a unique setting in which to promote health enhancing behaviours, such as physical activity, because it offers opportunity to be active (e.g., in-built sports facilities), provides flexible working conditions to enable staff and students a reasonable level of autonomy in managing their individual time and endowed with highly educated and well-informed staff base, which has been previously shown to influence individuals’ engagement in physical activity. Therefore, the overall aim of the PhD research project was to understand the barriers and enablers to physical activity among university staff and students, design an intervention informed by this understanding and implement intervention to address these barriers, in order to create behaviours that lead to better engagement in physical activity. Methods: A mixed-methods experimental design was utilised throughout the research, incorporating both qualitative (group interviews) and quantitative (surveys) data collection. The four experimental studies that make up this programme of work were designed using established behaviour change models, i.e., the Behaviour Change Wheel (BCW), the Capability, Opportunity, Motivation-Behaviour (COM-B) model and/or the Theoretical Domains Framework (TDF). The qualitative data were analysed in Nvivo12 using deductive content analysis, while the qualitative data were analysed using SPSS Statistical software 26.0, with significance level set at 0.05. Results: Six prominent domains were identified as enablers and barriers to physical activity among university staff and students, i.e., knowledge; social influences; social/professional role and identity; environmental context and resources; beliefs about capabilities; and intentions (study 1). About 78.0% of the administrative staff and 67.0% of the PhD students were physically inactive, i.e., achieving less than 600 MET-minutes/week of moderate intensity physical activity. A multiple regression analysis showed that of the 14 domains of the TDF, the ‘physical skills’ domain (t 106 = 2.198, p=0.030) was the only significant predictor of physical inactivity among the administrative staff, while the ‘knowledge’ (t 99 = 2.018, p= 0.046) and ‘intentions’ (t 99 = 4.240, p=0.001) were the only predictors of physical inactivity amongst the PhD students (study 2). The administrative staff that were assigned to engage in supervised exercise sessions (experimental group) reported higher physical skills scores and overall physical activity levels compared to the control (study 3). The PhD students that were allocated to the education and intentions group, who received educational materials and asked to form implementation intentions of times, days and places they intend to carry out physical activity, reported higher overall physical activity levels compared to other treatment groups, i.e., intentions only, education only and control groups (study 4). Conclusion: This thesis contributes to the knowledge on adult’s physical activity by detailing the development, implementation, and assessment of a bespoke brief 4-week behaviour change intervention that effectively increased university administrative staff and PhD students’ total physical activity levels, as well as time spent in physical activity weekly. The university was established as a unique setting to promote health-enhancing behaviour such as promotion of physical activity. Therefore, theory-based interventions underpinned by the BCW, COM-B model and TDF may provide an effective strategy to improve university staff and students’ engagement in physical activity, as well as their overall wellbeing