Developing Behaviour Change Interventions to Increase Levels of Physical Activity in Patients with Chronic Kidney Disease

This thesis aimed to develop an evidence based, theory driven behaviour change intervention to increase levels of physical activity (PA) in patients with chronic kidney disease (CKD). Using mixed-methods the following studies were conducted: Cross-sectional study of self-reported PA levels and PA correlates: Survey of 1015 patients indicated a high prevalence of PA insufficiency (85.3%), but a readiness to change. Regression modelling indicated self-efficacy, physical function, older age and sex as independent predictors of PA. Observational study of walking and survival: Walking behaviours were shown through Cox proportional hazard modelling to be independently associated with mortality in a 44-month median follow-up of 437 persons and 89 deaths. Qualitative study exploring patient factors influencing exercise: Factors influencing exercise were captured via focus groups and semi-structured interviews with 36 patients. Analysed thematically findings were conceptualised within a social cognitive perspective and included: personal influences (co-morbidities, symptom burden, ageing, fear, previous experiences, and internal drive); behavioural influences (health and wellbeing, maintaining normality, and enjoyment); and environmental influences (organisation, physical, and social). Findings highlighted PA and disease information needs, and modifiable psychological targets for intervention. Person-Based Approach to the development of a PA intervention: Expert consultations (n=9), examination of theory and evidence, observations of patient education programmes; Public Patient Involvement (n=9) to establish intervention guiding principles; user testing with patients (n=14) to refine the Physical Activity Changing Together (PACT) intervention, a structured group-based PA education programme. PACT feasibility study: Recruitment, retention and engagement/acceptability were assessed using mixed methods in a 12-week study. Post intervention step counts indicated a mean increase of 2127 steps/day from baseline. PACT was feasible to implement, acceptable to patients and warrants further testing. Original contributions to knowledge include: confirming a link between walking and health; identifying factors that influence PA; and the development/evaluation of a CKD specific PA intervention; all which can be framed within the Behavioural Epidemiology Framework.