The Development, Implementation, and Evaluation of a Community-Based Intervention to Increase Levels of Physical Activity Among Military Veterans that are Wounded, Injured, and/or Sick
Military veterans that are wounded, injured, and/or sick (WIS) face significant physical, mental, and social challenges following discharge from their military service; often leading to mental health issues and suicidal ideation. The principal aim of the research reported in this thesis was to develop a better understanding of physical activity behaviour among veterans that are WIS, and provide practical recommendations by which it can be increased, through the development, implementation, and evaluation of a community-based physical activity intervention. To achieve this, the United Kingdom Medical Research Council (UKMRC) Complex Intervention Development and Evaluation Guidance and the Behaviour Change Wheel (BCW) were utilised as guiding frameworks. An evidence base was established related to the likely effects of a physical activity intervention through a systematic review, which identified a number of positive psychosocial effects for the target population. Following the identification of the evidence-base, the BCW was used to inform two separate, yet related studies. Firstly, a qualitative semi-structured interview methodology explored the perceived barriers to, and benefits of physical activity among a sample of veterans that are WIS (N=9). A range of perceived barriers and benefits were identified in this study. In particular, physical capability, psychological capability, physical opportunity, and reflective motivation were prominent barriers to physical activity engagement. The second study was designed to overcome the limitations of the first study by developing and distributing a questionnaire based upon the themes identified in the first, qualitative study, to a larger sample of veterans that are WIS (N= 105). In contrast to the findings of the qualitative study, quantitative statistical analyses revealed that physical activity self-efficacy was the key barrier to physical activity engagement. Based on these findings, a walking group intervention was designed to overcome low physical activity self-efficacy barriers while providing an environment where physical activity self-efficacy could be developed. Unfortunately, despite the researcher’s best efforts in planning and preparation, the intervention did not commence due to the COVID-19 public health crisis. However, the intervention design was evaluated for acceptability and feasibility and found to be highly acceptable among participants who had expressed interest in participating in the walking group intervention (N=10). These findings were compared to a similar acceptability and feasibility evaluation of an existing group-based exercise intervention (N=5) which led to the refinement of the walking group intervention and the development of eight recommendations for future practice and intervention design. The findings stemming from research reported within this thesis provided several novel contributions to knowledge. Most notably, the research is the first to apply the UKMRC guidance and BCW in relation to a physical activity intervention aimed at military veterans that are WIS. In combination with knowledge from the wider literature, research findings reported in this thesis can help inform the design of future physical activity interventions, leading to increased physical activity behaviour among veterans that are WIS.