Descriptive contents analysis of ParticiPAte CP: a participation-focused intervention to promote physical activity participation in children with cerebral palsy

Abstract

Purpose

ParticiPAte CP is a participation-focused therapy intervention that is effective to increase perceived performance of physical activity (PA) participation goals in children with cerebral palsy (CP). We aimed to characterise the contents of ParticiPAte CP using validated behaviour change frameworks.

Materials and methods

Data came from physiotherapist treatment notes and were used to specify: (1) physiotherapist-perceived barriers to behaviour change (using the International Classification of Functioning, Disability and Health Framework [ICF] and Theoretical Domains Framework), intervention content (Behaviour Change Technique Taxonomy v1), intervention functions (Behaviour Change Wheel) and mechanisms of action (Capability, Opportunity, Motivation – Behaviour model).

Results

Physiotherapist-perceived barriers to participation were identified in all ICF and Theoretical Domains Framework domains. ParticiPAte CP consisted of 32 behaviour change techniques, delivered via six intervention functions of the Behaviour Change Wheel, especially enablement. All six possible mechanisms of action were identified according to the Capability, Opportunity, Motivation – Behaviour model. These were targeted most frequently through Theoretical Domains Framework domains social influences, environmental context and resources, intentions, skills, knowledge, and beliefs about capabilities.

Conclusions

The content of a PA intervention for children with CP can be specified according to behaviour change frameworks. ParticiPAte CP was complex, with multiple targets, constituent behaviour change techniques and mechanisms of action. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615001064594.

Implications for rehabilitation

• Providing social support to families through practical actions such as motivating conversation, providing information, linking families to community services and participating in activities with children to support their self-efficacy may be a defining feature of effective participation-focused therapies.

• If children with cerebral palsy (CP) and their families nominate goals for increased frequency of attendance or improved involvement in physical activities (PAs), therapists must identify all important barriers to participation, including behavioural barriers that may be thought of less often (e.g. emotions, beliefs, optimism etc.).

• Promoting PA participation in children with CP may require a complex or multi-faceted therapy intervention that supports not only physical capability, but also enhances the social and physical opportunity for participation to take place and promotes the psychological capability and motivation for PA of children and families.

• Therapists or researchers may consider using the Behaviour Change Wheel to prospectively design their own health behaviour intervention for children with CP.

Keywords:

• Complex intervention
• behaviour change technique
• theoretical domains framework
• participation-based therapy
• motivational interviewing
• implementation science
• self-determination theory

Declaration of interest statement

The authors report no conflicts of interest.

Data availability statement

A de-identified dataset can be provided upon written request to the corresponding author.

Additional information

Funding

This research was supported by a Project Grant awarded by the Research Foundation, Cerebral Palsy Alliance (PG 3915), an Australian Government Research Training Program Scholarship (SR), Merchant Charitable Foundation via the Children's Hospital Foundation (Donation ID: 10415), National Health and Medical Research Council of Australia (NHMRC) Career Development Fellowship (LS: 1160694) and NHMRC Centre of Research Excellence and NHMRC Research Fellowship (RB: 1116442, 1195602).