Table 7 Mapping of engagement findings and previous research to steps 1–4 of BCW [25], and resulting recommendations
Behaviour Change Wheel step | Summary of outcome | Details of outcome and rationale |
|---|---|---|
1) Understand the behaviour | One target behaviour developed | - Who? People with dementia and supporters |
 - What do they need to do? Carry out the activities that they planned in the first or second PRIDE sessions (e.g. attending a group or completing a jigsaw) | ||
 - When? In the four weeks between each of the three sessions | ||
 - Where? Participants’ home or in community  • With whom? The provider, supporter and other people | ||
Two COM-B domains were identified as frequent barriers:  - Physical opportunity  - Psychological capability | - Physical opportunity (e.g. money and time to do the activity, accessible locations and resources to prompt activities) | |
 - Psychological capability (e.g. knowledge and skills about how to do the activities and how to organise and carry out activities) | ||
2) Identify intervention functions and policy categories | Three intervention functions were identified: - Education - Training - Enablement | • Education (to support engagement with PRIDE) |
 - Participants and supporters in the interviews reported not always knowing or remembering what activities they had chosen to work on during the session | ||
 • Training (to support engagement with PRIDE) | ||
 - Training interventions may be acceptable, effective and safe for people with dementia [59] | ||
 - Findings showed that participants reported not always knowing what to do to put their plans into practice | ||
 - PRIDE is already lengthy (three one hour sessions)- so would need to be easily implemented | ||
 • Enablement (to support engagement with PRIDE) | ||
 - Previous research suggests enablement empowers people with dementia to make decisions and encourages them to have a go at activities [60] | ||
 - People with dementia and supporters spoke about importance of social support provided by provider, supporters and other people | ||
One policy category was relevant | Service provision | |
3) Identify intervention content (BCTs) | Five BCTs were identified: - Social support (unspecified) (BCT 3.1) - Social support (practical) (BCT 3.2) - Instruction on how to perform the behaviour (BCT 4.1) - Prompts and cues (BCT 7.1) - Behavioural practice and rehearsal (BCT 8.1) | • Social support (unspecified) (BCT 3.1) |
 - Research suggests social support (unspecified) contributed towards an improvement in physical activity for people with dementia [61] | ||
 - Interview findings suggest that social support from the provider facilitated engagement with PRIDE | ||
 • Social support (practical) (BCT 3.2)  - Research suggests subtle practical support (E.g. helping the person form strategies to do their activities) helps maintain independence and make decisions [60] | ||
 - Interview findings highlighted practical support from many different people facilitated engagement with PRIDE | ||
 • Instruction on how to perform the behaviour (BCT 4.1) | ||
 - Research suggests that exercise classes, which include instructions, facilitate engagement with physical activity for people living in residential homes [62] | ||
 - Interview findings indicated that a lack of knowledge about how to do activities made it difficult for some participants to put their plans into practice | ||
 • Prompts and cues (BCT 7.1)  - Research suggests that prompting the person with dementia improves engagement with interventions or activities [63,64,65,66,67,68] | ||
 - Prompts would be acceptable as participants spoke about importance of reminders and recommended using sticky notes to highlight relevant sections of the manual or provide summaries between sessions | ||
 • Behavioural practice and rehearsal (BCT 8.1) | ||
 - Previous research indicated that exercise classes, which include practice facilitated engagement with physical activity for people with dementia living in residential homes [62] | ||
 - Participants spoke about wanting to engage in activities they were familiar with | ||
4) Mode of delivery | Three types of mode were identified as suitable to deliver the four BCTs: - Human interactions (face-to-face) - Human interactions (remote) - Printed materials | - The BCTs: Social support (practical)Â (BCT 3.2) and Behavioural practice and rehearsal(BCT 8.1)Â could be delivered face-to-face by the provider during the PRIDE sessions |
 - Social support (unspecified)(BCT 3.1) could be delivered over the phone between sessions | ||
 - The BCTs: Instruction on how to perform the behaviour (BCT 4.1), and Prompts and cues (BCT 7.1) could be delivered through the provision of printed materials | ||
 - Findings from the interviews indicated that this would be acceptable to people with dementia and supporters | ||
 - Participants reported that a summary sheet may be helpful, during the interviews. | ||
 - The delivery of these BCTs would require minimal additional resources. | ||
5) Resulting recommendations | Four recommendations were developed: 1) Give participants a session summary document 2) Give participants clear instructions detailing how to do their chosen activities 3) Ensure that there is time within the PRIDE session to practice the chosen activity where possible 4) Provide regular compulsory telephone support from provider | 1) • Give participants a session summary document |
 - Aims to prompt enactment and increase understanding | ||
 - Targets education using BCT 7.1  - Delivered through printed materials - summary document provided to the participants after each session - can be placed on fridge door/in homes somewhere visible. Facilitates involvement of supporters | ||
2) • Give participants clear instructions detailing how to do their chosen activities | ||
 - Aims to prompt enactment, and increase understanding and develop skills | ||
 - Targets training using BCT 4.1 | ||
 - Delivered through printed materials - clear step-by-step instructions would be given at the end of each session. Instructions would be created by providers in the session and would require additional time | ||
3) • Ensure that there is time within the PRIDE session to practice the chosen activity where possible | ||
 - Aims to increase skills and accessibility of activities | ||
 - Targets training and enablement using BCTs 8.1 and 3.2 | ||
 - Delivered face-to-face - participants could practice in session with support from provider or where not feasible the provider could arrange for the supporter to help the person the first time they do it | ||
4) • Provide regular compulsory telephone support from provider  - Aims to prompt enactment and increase understanding  - Targets enablement using BCT 3.1 | ||
 - Delivered over the phone between sessions to remind of activity and answer any questions they have |