Engagement, acceptability, usability and satisfaction with Active for Life, a computer-tailored web-based physical activity intervention using Fitbits in older adults.

BACKGROUND: Preliminary evidence suggests that web-based physical activity interventions with tailored advice and Fitbit integration are effective and may be well suited to older adults. Therefore, this study aimed to examine the engagement, acceptability, usability, and satisfaction with 'Active for Life,' a web-based physical activity intervention providing computer-tailored physical activity advice to older adults. METHODS: Inactive older adults (n = 243) were randomly assigned into 3 groups: 1) tailoring + Fitbit, 2) tailoring only, or 3) a wait-list control. The tailoring + Fitbit group and the tailoring-only group received 6 modules of computer-tailored physical activity advice over 12 weeks. The advice was informed by objective Fitbit data in the tailoring + Fitbit group and self-reported physical activity in the tailoring-only group. This study examined the engagement, acceptability, usability, and satisfaction of Active for Life in intervention participants (tailoring + Fitbit n = 78, tailoring only n = 96). Wait-list participants were not included. Engagement (Module completion, time on site) were objectively recorded through the intervention website. Acceptability (7-point Likert scale), usability (System Usability Scale), and satisfaction (open-ended questions) were assessed using an online survey at post intervention. ANOVA and Chi square analyses were conducted to compare outcomes between intervention groups and content analysis was used to analyse program satisfaction. RESULTS: At post-intervention (week 12), study attrition was 28% (22/78) in the Fitbit + tailoring group and 39% (37/96) in the tailoring-only group. Engagement and acceptability were good in both groups, however there were no group differences (module completions: tailoring + Fitbit: 4.72 ± 2.04, Tailoring-only: 4.23 ± 2.25 out of 6 modules, p = .14, time on site: tailoring + Fitbit: 103.46 ± 70.63, Tailoring-only: 96.90 ± 76.37 min in total, p = .56, and acceptability of the advice: tailoring + Fitbit: 5.62 ± 0.89, Tailoring-only: 5.75 ± 0.75 out of 7, p = .41). Intervention usability was modest but significantly higher in the tailoring + Fitbit group (tailoring + Fitbit: 64.55 ± 13.59, Tailoring-only: 57.04 ± 2.58 out of 100, p = .003). Participants reported that Active for Life helped motivate them, held them accountable, improved their awareness of how active they were and helped them to become more active. Conversely, many participants felt as though they would prefer personal contact, more detailed tailoring and more survey response options. CONCLUSIONS: This study supports web-based physical activity interventions with computer-tailored advice and Fitbit integration as engaging and acceptable in older adults. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12618000646246. Registered April 23 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374901.

The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial.

BACKGROUND: Physical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. OBJECTIVE: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. METHODS: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants' Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)-measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. RESULTS: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI -24% to 40%) or the tailoring-only group (-4%, 95% CI -24% to 30%); however, a significant decline was seen in the control group (-35%, 95% CI -52% to -11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). CONCLUSIONS: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246.

International allied health student placements: A meta-synthesis.

BACKGROUND: Increasingly universities are offering international student placements as part of the global internationalisation movement. This review sought to synthesize the findings of studies to further understand the learning outcomes described by allied health students. AIMS/OBJECTIVES: To contribute to the understanding of the learning outcomes described by allied health students who have undertaken an international placement. METHODS: A qualitative meta-synthesis was conducted. From six databases, twenty-one studies were identified and critically appraised. Data were meta-aggregated, integrated and interpreted to develop new themes, with the experiences of over 259 allied health students synthesized. RESULTS: Themes include: the intertwined personal and professional development experienced by the students; confidence and independence, relationship building, insight into culture, service provision and differences in socio-economic and political contexts. CONCLUSION: Universities offering students international placements provide their students with opportunities to achieve unique learning outcomes with significant personal and professional transformational development that cannot be replicated by local placements.

Using social return on investment analysis to calculate the social impact of modified vehicles for people with disability.

INTRODUCTION: Returning to driving is often a goal for people with acquired disabilities. Vehicle modifications make it possible for people with both acquired and lifelong disabilities to drive yet can be costly. There has been no financial evaluation of vehicle modifications in Australia or internationally. METHODS: A social return on investment analysis of vehicle modifications was undertaken. Primary data were collected via qualitative interviews with consumers and other stakeholders (e.g. driver-trained occupational therapists, rehabilitation physicians, driving instructors, vehicle modifiers) (n = 23). Secondary data were collected from literature searches and used to identify suitable financial proxies and make estimations of the proportion of drivers with vehicle modifications experiencing each outcome. A co-investment model was adopted to estimate social return on investment and payback period for funder and consumer. Five scenarios were developed to illustrate social return for low-cost modifications (Scenario 1) through to high-cost modifications (Scenario 5). RESULTS: Social return on investment ratios was positive for funder and consumer investment in all five scenarios. Social return on investment calculations based on co-investment ranged from $17.32 for every $1 invested (Scenario 1) to $2.78 for every $1 invested (Scenario 5). Consumers' payback periods were between 5.4 and 7.1 months, and funders between 3.5 weeks and 2 years 8.4 months. CONCLUSION: Vehicle modifications represent sound investments for both funders and consumers. Given the short payback periods, funders should reconsider age restrictions on vehicles considered suitable for modifications, especially for low- to medium-cost modifications.

Modified motor vehicles: the experiences of drivers with disabilities.

Purpose: Driving is often a rehabilitation goal of people with acquired disability, and vehicle modifications are typically required to facilitate this outcome. Though there have been several survey studies on vehicle modifications for people with disability, there has been no qualitative work on understanding people with disabilities' experiences of being a modified vehicle driver.Method: An interpretative phenomenological approach was used to understand the lived experiences of drivers with disability. Semi-structured interviews were conducted (n = 8) with drivers who used a variety of vehicle modifications from simple to highly complex. Using NVivo, Stage 1 of the coding involved case by case analysis and Stage 2 cross case analysis to identify themes that best captured drivers' experiences.Results: Four core themes were identified: knowing vs. challenging limitations, making complex driving considerations, considering undesired alternative transportation options, and responding emotionally to temporary vehicle loss. The Person-Environment-Occupation model was used as an orientating framework to discuss findings.Conclusions: This explorative small scale study highlights that less than full utilisation of modified vehicles is not a result of driver choice, but rather a complex interface between drivers' physical and psychological limitations, and physical environments that do not support the needs of drivers with disability.Implications for RehabilitationThe development of resources that identify environmental factors in public spaces (e.g., number and location of parking for people with disability, steps, slopes, ticket machines and their height and location) could support the driving choices of people with disabilities.It is important to assess psychological limitations of driving as well as physical limitations.Driving goals and driving capacity across different locations requires periodic review post-rehabilitation.More advocacy for improving community accessibility is required.

Efficacy of a computer-tailored web-based physical activity intervention using Fitbits for older adults: a randomised controlled trial protocol.

INTRODUCTION: Physical activity is an integral part of healthy ageing, yet the majority of older adults 65+ years are not sufficiently active. Web-based physical activity interventions hold much promise to reach older adults. Preliminary evidence suggests that web-based interventions with tailored advice and Fitbits may be well suited for older adults. METHODS AND ANALYSIS: This study aims to test the effectiveness of 'Active for Life', a 12-week computer-tailored web-based physical activity intervention using Fitbits for older adults. We will recruit 300 participants who will be randomly assigned to one of three trial arms: (1) web-based physical activity intervention with tailored advice only, (2) web-based physical activity intervention with tailored advice and Fitbit or (3) a wait-list control. The primary outcome, objective moderate to vigorous physical activity (MVPA) and secondary outcomes of objective sedentary behaviour, objective sleep, quality of life, social support, physical function and satisfaction with life will be assessed at baseline and week 12. The secondary outcomes of self-reported physical activity, sitting time and sleep will be assessed at baseline, week 6, 12 and 24. Website usability and participant satisfaction will be assessed at week 12 and website usage and intervention fidelity will be assessed from week 1 to 24. Intention-to-treat linear mixed model analyses will be used to test for group (tailoring only, tailoring +Fitbit, control) differences on changes in the main outcome, MVPA and secondary outcomes. Generalised linear models will be used to compare intervention groups (tailoring only, tailoring +Fitbit) on website usability, participant satisfaction, website usage and intervention fidelity. ETHICS AND DISSEMINATION: The study has received ethics approval from the Central Queensland University Human Research Ethics Committee (H16/12-321). Study outcomes will be disseminated through peer-reviewed publications and academic conferences and used to inform improvements and dissemination of a tailored, web-based physical activity intervention for adults 65+ years. TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry Number: ACTRN12618000646246.

Valuing the impact of health and social care programs using social return on investment analysis: how have academics advanced the methodology? A systematic review.

OBJECTIVES: To identify how social return on investment (SROI) analysis-traditionally used by business consultants-has been interpreted, used and innovated by academics in the health and social care sector and to assess the quality of peer-reviewed SROI studies in this sector. DESIGN: Systematic review. SETTINGS: Community and residential settings. PARTICIPANTS: A wide range of demographic groups and age groups. RESULTS: The following databases were searched: Web of Science, Scopus, CINAHL, Econlit, Medline, PsychINFO, Embase, Emerald, Social Care Online and the National Institute for Health and Care Excellence. Limited uptake of SROI methodology by academics was found in the health and social care sector. From 868 papers screened, 8 studies met the criteria for inclusion in this systematic review. Study quality was found to be highly variable, ranging from 38% to 90% based on scores from a purpose-designed quality assessment tool. In general, relatively high consistency and clarity was observed in the reporting of the research question, reasons for using this methodology and justifying the need for the study. However, weaknesses were observed in other areas including justifying stakeholders, reporting sample sizes, undertaking sensitivity analysis and reporting unexpected or negative outcomes. Most papers cited links to additional materials to aid in reporting. There was little evidence that academics had innovated or advanced the methodology beyond that outlined in a much-cited SROI guide. CONCLUSION: Academics have thus far been slow to adopt SROI methodology in the evaluation of health and social care interventions, and there is little evidence of innovation and development of the methodology. The word count requirements of peer-reviewed journals may make it difficult for authors to be fully transparent about the details of their studies, potentially impacting the quality of reporting in those studies published in these journals. PROSPERO REGISTRATION NUMBER: CRD42018080195.

Valuing the impact of health and social care programmes using social return on investment analysis: how have academics advanced the methodology? A protocol for a systematic review of peer-reviewed literature.

INTRODUCTION: Unlike other forms of evaluation, social return on investment (SROI) methodology offers a way of placing values on personal, social and community outcomes, not just economic outcomes. Developed in 2000, there have been calls for greater academic involvement in development of SROI, which to date has been more typically implemented in-house or by consultants. This protocol describes a systematic review of SROI analysis conducted on health and social care programmes which represent a significant sector of social enterprise internationally. The aims of the systematic review are to (1) identify the extent to which academics have adopted SROI methodology, (2) how academics have interpreted, used and developed SROI methodology and (3) to assess the quality of studies published under peer review. METHODS AND ANALYSIS: The systematic review will include peer-reviewed studies since 2000 published in English. Search terms will be 'social return on investment' or 'SROI'. Health and social care interventions will be identified in the initial screening given the proliferation of possible key words in these areas. Databases to be searched include Web of Science, Scopus, Medline, Social Care Online and National Institute for Health and Care Excellence. Two reviewers will independently conduct initial screening based on titles and abstracts against the inclusion criteria. Data extracted will include date of intervention, country, study design, aim of intervention/programme, participants and setting, health and social care measures used, and SROI ratio. The quality of studies will be assessed by two reviewers using a SROI quality framework designed for the purpose of this study. ETHICS AND DISSEMINATION: The systematic review will review existing published academic literature; as such, ethics approval is not required for this study. A paper of the systematic review will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018080195.

Simulated versus traditional occupational therapy placements: A randomised controlled trial.

BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). METHODS: A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP. RESULTS: Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). CONCLUSION: Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

Implementation of Dialectical Behavior Therapy in Residential Treatment Programs: A Process Evaluation Model for a Community-Based Agency.

Dialectical behavior therapy (DBT) can be challenging to implement in community-based settings. Little guidance is available on models to evaluate the effectiveness or sustainability of training and implementation efforts. Residential programs have much to gain from introduction of evidence-based practices, but present their own challenges in implementation. This paper presents a low-cost process evaluation model to assess DBT training piloted in residential programs. The model targets staff and organizational factors associated with successful implementation of evidence-based practices and matches data collection to the four stages of the DBT training model. The strengths and limitations of the evaluation model are discussed.

Mapping an Australian Occupational Therapy curriculum: Linking intended learning outcomes with entry-level competency standards.

BACKGROUND: Curriculum mapping involves systematic charting of programme content against professional competencies. This process can reveal strengths, gaps and redundancies within educational programmes. METHODS: Curriculum mapping occurred using intended learning (ILOs) as documented in individual courses and linking them to units and elements within the occupational therapy minimum competency standards (ACSOT) and Miller's Framework of competency. Five occupational therapy academics and two impartial research assistants identified links between ILOs and units and elements of the ACSOT. Analysis of each course in the curriculum was completed by two reviewers. A systematic protocol was developed that enabled a transparent process and resolution of discrepancies between reviewers. RESULTS: There were many links (47% of total) between the documented curriculum and ACSOT Unit 1 Professional attitudes and behaviours. The other six units of the ACSOT had between 5% (Unit 7) and 16% links (Unit 3). No links were made between ILOs and the elements of evaluation (4.4), cessation (3.7) and quality assurance of services (7.3). Difficulties mapping ILOs to units and elements revealed inconsistencies in specificity and language in the ILOs and also ambiguities and gaps within the standards themselves. Mapping against Miller's framework showed a steady increase in performance expectations of students across the four years levels. CONCLUSION: Curriculum mapping is recommended for critical reflection about content of occupational therapy programmes and to review pedagogical approaches. This process revealed strengths and weaknesses of the occupational therapy curriculum being mapped but also revealed insight into the current ACSOT that may inform future iterations.

Partnership, inclusion and innovation in occupational therapy: Essential or optional ingredients to flourish in a changing environment?

BACKGROUND/AIM: Historically occupational therapy has evidenced a tenacity to adjust and adapt to societal changes. Currently in Australia we are in the midst of significant change in health, disability and aged care service delivery alongside increasing numbers of new graduates seeking employment. Both of these changes create challenges and opportunities for the profession. How the profession adjusts to new service delivery models and supports new graduates in this changing work environment will influence our future. METHODS: Using examples from practice the paper explores ways in which partnership, inclusion and innovation can be effective in a changing environment. RESULTS: Doing effective partnership takes time, energy and a shared commitment of all involved and often requires negotiations and compromise. Inclusion can be tricky and requires vigilance and ongoing reflection on actions to determine if the outcomes are what was intended. Innovation can play two roles; it can be used to conserve current practice in new ways or it can offer agency to disrupt and redefine practice. CONCLUSION: The way in which the profession chooses to enact partnerships and inclusion will play a vital role in shaping the future. Similarly the space and support made for conservative or disruptive innovation will determine how we choose to define ourselves going forward. Moreover, these choices and actions will govern how effective we are in navigating the changing environment and supporting new graduates transitioning into the profession.

Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial.

BACKGROUND: Clinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making. METHODS/DESIGN: This study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation. DISCUSSION: Use of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001339448 . Registered 26 September 2016.

Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review.

BACKGROUND: Allied health professionals working in rural areas face unique challenges, often with limited access to resources. Accessing continuing professional development is one of those challenges and is related to retention of workforce. Effectiveness of distance learning strategies for continuing professional development in rural allied healthcare workers has not been evaluated. METHODS: We searched 17 databases and the grey literature up to September 2016 following the PRISMA guidelines. Any primary studies were included that focussed on allied health and distance delivery regardless of education topic or study design. Two independent reviewers extracted data and critically appraised the selected studies. RESULTS: The search returned 5257 results. With removal of duplicate references, we reviewed 3964 article titles and abstracts; n = 206 appeared potentially eligible and were scrutinised via full text screening; n = 14 were included. Studies were published between 1997 and 2016, were of varied methodological quality and were predominantly from Australia, USA and Canada with a focus on satisfaction of learners with the delivery method or on measures of educational outcomes. Technologies used to deliver distance education included video conference, teleconference, web based platforms and virtual reality. Early papers tended to focus more on the technology characteristics than educational outcomes. Some studies compared technology based delivery to face to face modes and found satisfaction and learning outcomes to be on par. Only three studies reported on practice change following the educational intervention and, despite a suggestion there is a link between the constructs, none measured the relationship between access to continuing professional development and workforce retention. CONCLUSION: Technology based options of delivery have a high utility, however the complex inter-relatedness of time, use, travel, location, costs, interactivity, learning outcomes and educational design suggest a need for more sophisticated consideration by educational providers. TRIAL REGISTRATION: Registration with PROSPERO 30 June 2016: CRD42016041588 .

Leveraging Health IT to Reduce Disparities in Three Underserved Beacon Communities.

Using health information technology (IT) can potentially address health disparities by increasing access to care, delivering higher-quality care, improving patient-provider communication, and enhancing patient safety. It describes challenges encountered by three underserved Beacon Communities that implemented health IT interventions, including inadequate connectivity infrastructure, technical support, expertise, and financial resources; provider shortages and staff turnover; and equipment theft.

Previously inactive rural adults' experiences of commencing and maintaining a walking routine following participation in a walking intervention.

OBJECTIVE: This study aimed to richly describe previously inactive Riverland adults' experiences of commencing and maintaining a walking routine following participation in a walking intervention. DESIGN: Qualitative description using semi-structured in-depth interviews and thematic analysis. SETTING: Riverland, South Australia. PARTICIPANTS: Nine adults (four men and five women) aged between 40 and 65 years. INTERVENTION: Six-week walking intervention included issuing of pedometers, setting goals, completing logs and weekly emails to remind participants to wear their pedometers, recording of steps and provision of strategies for increasing daily steps. MAIN OUTCOME MEASURES: Rich description of participants' experiences represented by four themes and a number of subthemes, supported by direct quotes. RESULTS: Four themes: taking care of me through my walk, pedometers and accountability as motivators, fitting walking in and commencing and maintaining a walking routine. CONCLUSIONS: The participants' experience of commencing a walking routine differed from maintaining a walking routine. Future attempts to support maintenance of a walking routine may be strengthened through identifying and including ways to provide accountability for walking to others beyond the intervention as well as strategies that support the integration of walking into every activity. Furthermore, future walking interventions should enable participants to tailor their walks to their own preferences and mental health benefits of walking should be promoted at least as much as the physical benefits.