Getting women active using the COM-B model and the Behaviour Change Wheel

Physical inactivity negatively impacts physical and mental health, whilst physical activity (PA) protects against almost all non-communicable diseases. Women are less active than men and face more barriers to PA, so PA interventions for women provide a cost-effective public health solution. In this thesis, a 4-week pilot PA intervention for women was co-designed with target end-users, using the Theoretical Domains Framework (TDF), the COM-B model and the Behaviour Change Wheel. The TDF was considered incomplete for categorising PA determinants, so an additional domain (‘biomechanical capability’) has been proposed. Qualitative evidence syntheses revealed women’s barriers to PA to be gender-centric, with PA determined by factors related to SES, culture, body image and motherhood. Many women prefer single sex spaces for PA, which can be difficult to achieve in line with the religious teachings of Islam, within Western society. During focus groups, women from the East Midlands appeared capable of and motivated to be active but described limited opportunity for PA. Two co-design workshops supported development of a pilot intervention design that included hybrid (online and in-person) circuit classes, daily PA challenges and goal-setting support/education. The intervention could tentatively be described as effective, eliciting best results for women who were ‘fairly active’ at baseline. Women considered the intervention acceptable and feasible but those who were inactive at baseline seemed more likely to withdraw/not participate and less likely to maintain increased PA at follow-up, whilst those who engaged in co-design appeared more likely to engage. Exploration of reasons for dropout revealed that temporary reductions in capability or opportunity (usually elicited by short-term injury or adverse personal circumstances) frequently created permanent reductions in motivation. Although women’s PA promotion can be ethically complex, self-compassion coaching might provide one ethical intervention option to increase the likelihood of women maintaining PA long-term, by addressing the characteristically female experience of guilt.