Table 1

Behavioural strategies used in the RecoverEsupport intervention29

Strategy (from Wang et al)	Strategy description (from Wang et al)	How strategy is operationalised in ‘RecoverEsupport’
Strategies to support intervention engagement
Prompts/cues	Introduce or define environmental or social stimulus with the purpose of prompting or cueing the behaviour. The prompt or cue would normally occur at the time or place of performance.	Surgeon’s ‘prescription letter’—intervention participants will receive a letter from their surgeon prescribing the RecoverEsupport Programme to prompt patients to access the website and increase engagement. Patient prompts—patients will receive a series of personalised automated reminders to prompt them to access the website (pre surgery and post surgery) and complete daily diaries (in hospital). Clinician alerts—When patient responses in the ‘daily diary’ indicate non-adherence to the ERAS recommendations, or when patients flag they are distressed, the website will send an email alert to the CRC liaison nurse to follow-up with the patient within the day. Patient questions—‘my questions’—at the end of each website module, patients are asked if they have questions for their clinical team. Patients can record and save their questions centrally within the website and email a copy to themself and/or the CRC liaison nurse. Patients are encouraged to print and/or bring their list of questions to medical appointments. Postdischarge care—at discharge, patients, their support person (if applicable) and their GP will be emailed a list of common side effects/complications following colorectal surgery and how to manage them. The patient will also receive an SMS reminder to make a follow-up appointment with their GP 2 weeks after discharge. Provision of device—to increase website engagement during the inpatient stay, we will provide a tablet to intervention patients without access to a smartphone or tablet or laptop during their hospital stay.
Social support	Advise on, arrange or provide social support (eg, from friends, relatives, colleagues, ‘buddies’ or staff)	Support person involvement: The support person can access the website independently of or together with the patient. GP involvement: On discharge, a standard information sheet detailing the general care needs for patients with CRC is emailed to the patient’s GP. (The patient and support person are also emailed a copy).
Strategies to motivate behaviour change
Credible source	Present verbal or visual communication from a credible source in favour of or against the behaviour	Information is communicated via videos presented by the clinical team who will be providing care to the patient, including a surgeon, anaesthetist, and stoma nurse. There are also a series of videos of patients with CRC talking first-hand about their experiences.
Framing/reframing	Suggest the deliberate adoption of a new perspective on behaviour (eg, its purpose) in order to change cognitions or emotions about performing the behaviour	The website encourages patients to see themselves as active participants in their own recovery, to empower them to take control of their recovery. Patients are asked to reflect on their motivation for accessing the intervention and optimising their recovery.
Information about health consequences	Provide information (eg, written, verbal, visual) about health consequences of performing the behaviour	Text and videos are included within the website outlining the rationale for undertaking the behaviours specified in the ERAS recommendations, and the benefits of adherence and the consequences of non-adherence are explained, for example, if you remain on opioids, your bowel will take longer to start working again.
Strategies to enact behaviour change
Self-monitoring of behaviour	Establish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategy	Daily diary: Each day in the hospital post surgery, the patient is prompted by SMS/email to use the website to monitor and record their behaviours that support recovery (eg, moving, eating, drinking, breathing exercises and minimising opioids).
Feedback on behaviour	Monitor and provide informative or evaluative feedback on the performance of the behaviour	Daily diary: The website provides automated and tailored feedback on patient behaviour (eg, mobilisation) based on patient self-monitoring data (see above). Non-adherence to ERAS recommendations will trigger an alert to the CRC liaison nurse so that they can follow-up with the patient (ie, if they are not getting up and moving) and attempts to address barriers. Interactive quizzes: Brief self-assessment tools (with real-time feedback) will be included in each module to ensure patients understand: What the key patient-led ERAS recommendations are (eg, opioid minimisation post surgery). Why they are important to their recovery (eg, quickens return to normal bowel function and defecation). What they can do (eg, take all non-opioid analgesia according to the prescribed schedule).
Instruction and demonstration of how to perform the behaviour	Advise how to perform the behaviour (including the provision of an observable sample of the performance of the behaviour)	Patients are provided with text, videos and diagrams explaining step-by-step how to undertake specific behaviours. Specifically, diagrams and videos are included on the website to demonstrate: The target behaviours, for example, breathing exercises. What to expect at each stage of the patient journey, for example, what patients will see, hear and feel as they are taken into the operating theatre.

CRC, colorectal cancer; ERAS, Enhanced Recovery After Surgery; GP, general practitioner.