Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 11, 2020
Date Accepted: Apr 30, 2021
Older adults’ experiences of behavior change support in a digital fall prevention exercise program: A qualitative study framed by the Self-determination theory
ABSTRACT
Background:
Exercise is an effective intervention to prevent falls in older adults, however, long-term adherence is often poor. To increase adherence, an added support for behavior change has been advocated. However, consistence in reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistence in studies using behavior change techniques within the Self-determination theory.
Objective:
The study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed and digital falls prevention exercise program comprising behavior change support, the Safe-Step program, which was developed in co-creation with intended users.
Methods:
The qualitative study design was based on open-ended responses to questionnaires, individual-, and focus group interviews. A deductive qualitative content analysis was applied using the Classification system of Motivation and Behavior Change Techniques as an analytical matrix, followed by an inductive analysis. The 26 participants took part in a feasibility study, and exercised in their homes with the Safe Step-program for 4 months.
Results:
In deductive analysis expressions of support for all three basic psychological needs were shown, which related to 11 of the 21 motivation and behavior change techniques in the classification. The inductive analysis indicated that autonomy - to be in control- was valued and enabled individual adaptations according to different rationales for realizing exercise. However, the experience of autonomy was also two sided, and depended on the participants’ competence in exercise and technology. The clarity of the program and the exercise videos was seen as key for support in performance and competent choices. Although, augmented techniques for social support was requested, support through relatedness was found within the program.
Conclusions:
In this study, the Safe Step-program supported the establishment of new exercise routines, as well as, the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix is presented. Clinical Trial: ClinicalTrials.gov: NCT02916849
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