Using the behaviour change wheel to co-design an intervention targeting sedentary behaviour in individuals with spinal cord injury

Objective There is a lack of interventions targeting sedentary behaviour in individuals with spinal cord injury. Interventions designed for non-disabled individuals are unlikely to be generalisable to wheelchair-users with paraplegia, necessitating a tailored approach. This study aimed to co-design an intervention targeting sedentary behaviour using the Behaviour Change Wheel for manual wheelchair-users with paraplegia. Design An iterative co-design workshop approach was employed following the Behaviour Change Wheel. Initial workshops focused on identifying barriers and facilitators to reducing and breaking up sedentary behaviour and possible solutions to address these. These solutions were mapped to intervention functions and behaviour change techniques, leading to the identification of intervention components. The intervention components were then assessed and iterated in follow-up workshops. Data were analysed using the framework method. Setting Online video calls or in-person at a University campus or hospital setting. Participants Ten individuals with paraplegia, 13 healthcare professionals and four community caregivers. Results A multi-component intervention was co-designed and includes (1) a wearable activity tracker to provide sedentary behaviour reminders and feedback on physical activity, (2) an educational booklet about sedentary behaviour, (3) goal setting, (4) one-to-one motivational support sessions, (5) a peer support group, and (6) activity tools, including a hand cycle and exercise bands. Conclusions A novel intervention targeting sedentary behaviour was developed for individuals with paraplegia, which now requires evaluation. The combination of co-design with the Behaviour Change Wheel likely optimises the intervention's effectiveness and acceptability, and offers a replicable, theory-driven approach for future intervention development.