JMIR Publications

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