Currently submitted to: JMIR Formative Research
Date Submitted: Dec 12, 2025
Open Peer Review Period: Dec 15, 2025 - Feb 9, 2026
(closed for review but you can still tweet)
NOTE: This is an unreviewed Preprint
Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).
Peer review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.
Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).
Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.
Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.
Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Systematic development and description of a behaviour change intervention to support general practitioners’ very brief physical activity advice for patients with coronary heart disease: formative research from the OptiCor study
ABSTRACT
Background:
Despite strong evidence supporting the benefits of regular physical activity (PA) for managing coronary heart disease (CHD), PA advice remains infrequent in general practice. Barriers include general practitioners’ (GPs’) limited familiarity with current PA guidelines and their application to CHD patients, insufficient skills for delivering brief advice, and time constraints. In Germany, no structured, theory-informed training exists to support GPs in delivering brief PA advice in routine CHD care.
Objective:
This study aimed to systematically develop a theory-based behaviour change intervention to strengthen GPs’ competencies in delivering brief PA advice to patients with CHD in routine primary care.
Methods:
Guided by the Behaviour Change Wheel, we conducted a multi-method formative research study to develop the training intervention. Preceding studies, including a cross-sectional survey, interviews, and focus groups with GPs and patients, were synthesised to identify needs, barriers, and preferences related to PA advice. These findings were mapped onto the COM-B model components (capability, opportunity, motivation – behaviour) to identify determinants of GP behaviour, and further specified using the Theoretical Domains Framework (TDF). Intervention components were described using the Behaviour Change Technique (BCT) Taxonomy, and GPs were involved throughout the development process to ensure practical relevance, feasibility, and acceptability.
Results:
The primary result of this study is a fully developed intervention: a bespoke, structured, 3.5-hour, small-group training for GPs focusing on the very brief 3As method (ask, advise, assist) for PA advice. The training comprises theoretical modules on PA and CHD, guided self-reflection and group discussions to explore personal practice and barriers, moderated role-plays with professional actors, and experiential learning using PA stimuli. Practical materials (e.g., handouts, digital resources) support skill acquisition, and short on-demand good practice videos are provided. The training is delivered by an experienced GP-researcher tandem, with full content documented in a comprehensive trainer manual to enable standardised replication.
Conclusions:
This formative research resulted in the first structured, theory-based GP training in Germany designed to strengthen brief PA advice in routine care of patients with CHD. By integrating the COM-B model and TDF framework, the intervention explicitly targets behavioural determinants of GP advising behaviour, while the use of the BCT Taxonomy enhances transparency and reproducibility. The intervention is currently being evaluated for its effects on GP behaviour in an ongoing trial, and a pilot of the evaluation study has recently been completed. Clinical Trial: Not applicable
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.