Table 2

The e-coachER sequential process and objectives mapped against behaviour change techniques, and explanation of the implementation strategy

Sequential processPerformance objectivesBehaviour change techniques30Implementation strategy
Welcome pack, pedometer and Introduction to web-based support for self-directed physical activityTo introduce the user to the philosophy of the website to become personal coach.
Build on personal support provided by ERS using web-based platform.
Support those who do not want to/cannot engage with ERS personnel.
Support achievement of personal goals for physical activity to enhance health.
10. Self-monitoringExplain philosophy of using website to become own personal coach.
Links provided to local services and other self-help resources to highlight patient autonomy and choice.
Offers e-coachER facilitator to help with using technology. Provide link to IT support from LifeGuide team.
Step 1: thinking about the benefits of physical activityElevate importance of physical activity.82. Information about health consequences
83. Information about emotional consequences
Quiz to engage participants using positive framing.
Provide evidence of multiple benefits of physical activity, especially for relevant health condition(s).
Elicit and address concerns about physical activity, describing support given as part of ERS and by website.
Step 2: support to get activeTo encourage user to access and create social support networks.
To encourage user to take advantage of ERS and face-to-face support offered.
1. Social support (practical)
2. Social support (emotional)
3. Social support (unspecified)
Explain how to make the most out of the ERS support to learn how to become own personal trainer in future.
Explain how user can create a personal ‘physical activity challenge’ and share it with family, friends, peers and exercise and health professionals. The patient may be encouraged to tell others about how e-coachER has been used to support behaviour change.
Suggest ways of involving family or friends in long-term support for continued physical activity.
Link to online sources of local support (eg, local walking or jogging group, or British Trust for Conservation Volunteers).
How to use website to send personalised email/text reminders, motivational messages to self.
Draw on positive normative beliefs; identify benefits of social interaction (companionship). Sharing personal physical activity challenge with others, involve friends and family, online local support links.
Identify benefits of informational support (from ERS) in addition to emotional support from family and friends.
Step 3: counting your stepsTo encourage and support the user to monitor step counts using a pedometer over a week.
Emphasise personal experimentation.
10. Self-monitoring of behaviourProvide guidance on how to count steps/use pedometer.
Provide guidance on how steps can be implemented into lifestyle.
Encourage self-monitoring using diary.
Step 4: making your step plansTo set explicit step count goals for the following week.66. Goal setting (behaviour)Give rationale and evidence for goal-setting for graded increase in physical activity.
User sets specific, achievable goals for next week (eg, sessions completed, step count using the supplied pedometers).
Links provided to local services and other resources.
Step 5: making your activity plansTo encourage and support the user to identify behavioural goals (types of activities).68. Action planningUser selects walking or ‘other physical activities’ (which includes options for facility-based activity with practitioner support within ERS).
Present options for facility and lifestyle-based activity.
Sets specific, achievable goals for next week with a particular focus on avoiding days with less activity by planning walking or other activities.
Keeping a physical activity diary.
Weekly goal and physical activity reviewTo promote adherence and graded increase in physical activity by providing tailored feedback and advice based on self-reported goal progress.66. Goal setting behaviour
68. Action planning
69. Review behaviour goals
User records extent to which goals achieved in previous week, gets progress graph and personalised feedback.
Praise for any goal achievement, encouragement to set a more challenging goal if not yet meeting target physical activity criteria.
Encouragement where goals not attained, with links to webpages to assist with increasing motivation or confidence, selecting different activities or goals, making better plans, accessing support, overcoming setbacks (with links to relevant sessions below).
Each session completed ends with new links to reputable information and resources (eg, NHS choices, condition-specific physical activity advice websites).
Help user plan gradual increases in physical activity.
Step 6: finding ways to achieve your plansTo help the user harness their environment to provide support for physical activity.
Identifying personal motivations, building confidence.
30. Restructuring the physical environment
31. Restructuring the social environment
32. Avoidance/reducing exposure to cues for behaviour
Make plan to use environment to automatically support physical activity (eg, fitness equipment in living room, route to work/shops that involves more physical activity, committing self to specific routine).
Advise user on how to use website to send personalised email/text reminders, motivational messages.
Overcoming barriers in work, leisure, home and travel. Building self-efficacy.
Using smart phone apps for mobile support (eg, PowerTracker (c), MyFitnessPal (c)).
Invite user to identify personal motivations for becoming more active.
Motivational messages (text and/or emails)To provide reminders of user’s personal reasons (not necessarily health reasons) for becoming more active.15. Prompts/cuesInvite user to write motivational message to be sent weekly or monthly detailing their own motivations for becoming more active.
Step 7: dealing with setbacksTo provide strategies for overcoming relapse in levels of physical activity.5. Reduce negative emotionsIdentify possible causes of relapse (eg, illness, holidays, change in work hours, new caring responsibilities) and plan ways to overcome barriers.
Challenging catastrophic negative thoughts about lapses from intended physical activity.
How to learn from a lapse and plan to avoid or overcome in future.
Provide salient role models of people overcoming barriers to successfully engage with physical activity.
  • ERS, exercise referral scheme.