A Self-Determination Theory Approach to Embedding Physical Activity Behaviour Change in Cardiac & Pulmonary Rehabilitation: Intervention Development and Optimisation


Student thesis: Doctoral Thesis


Every year in the UK, 82,000 people die from heart disease, and approximately 25,000 will die from Chronic Obstructive Pulmonary Disease. Clearly, combatting the burden of cardiac and respiratory disease is a considerable public health concern. Individuals who participate in cardiac rehabilitation or pulmonary rehabilitation enjoy a better quality of life and a reduced risk of secondary cardiac events or acute exacerbations of COPD relative to those who do not complete cardiac or pulmonary rehabilitation.
Although only 15% of cardiac rehabilitation services have access to a psychologist, behaviour change is highlighted as a core component of an effective programme, and to date has been poorly integrated into chronic disease interventions. This PhD thesis describes the development of a physical activity behaviour change intervention, informed by self-determination theory that will operate within an existing cardiac and rehabilitation programme. The intervention aims to increase the ability of healthcare professionals to deliver behaviour change interventions within their current practice.
This thesis contains several key components. Firstly, a literature review was conducted, covering a number of topics that are central to the thesis, such as physical activity, behaviour change, intervention development, current arguments within applied health research, an analysis of relevant health policy, and self-determination theory, which served as the theoretical framework of the thesis. Second, a systematic review was used to understand the development process underpinning interventions using self-determination theory to affect uptake and adherence to physical activity amongst clinical populations. Third, a qualitative needs analysis was conducted with healthcare professionals and patients to explore factors influencing programme uptake and adherence, behaviour change, and how self-determination theory could explain these phenomena. A development phase was used to triangulate the findings of the three previous steps, with a commentary provided to explain how the intervention’s logic model and course materials were developed.
The Theory Coding Scheme was used to demonstrate that the intervention is strongly theory-based. The intervention was then delivered to healthcare professionals to assess its prospective acceptability and elucidate how it could be improved. This study revealed that healthcare professionals perceived the intervention to be highly acceptable: it filled a significant knowledge gap, clearly aligned with their current practice, and did not constitute a significant additional burden within their standard clinical practice.
This thesis addresses gaps in knowledge regarding how behaviour change interventions can be co-developed alongside healthcare professionals, how such interventions can be incorporated into standard clinical practice, and how healthcare professionals can be supported to deliver behaviour change interventions. Recommendations and implications for future research and practice are also reported.
Date of Award15 Jul 2021
Original languageEnglish
Awarding Institution
  • Edge Hill University
SupervisorANDREW LEVY (Director of Studies), ADRIAN MIDGLEY (Supervisor) & Bashir Matata (Supervisor)


  • Cardiac Rehabilitation
  • Behaviour Change
  • Health Psychology
  • Intervention Development
  • Self-Determination Theory
  • Motivation
  • Pulmonary Rehabilitation
  • Medical Education
  • Physical Activity

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