A PhD Confirmation seminar: Physical activity decreases pain and increases physical function for people with osteoarthritis (OA), however most people with OA do not meet recommended physical activity guidelines. If there are clear benefits to engaging in physical activity, then why aren’t more people in this population motivated to be active? Existing models of behavior change for physical activity for people with OA commonly focus on barriers and facilitators that require deliberate reasoning, however, recent findings suggest that non-conscious processes also drive health behavior. In this dissertation, I use the reflective-impulsive model to explore the relationship between implicit and explicit processes of behavior to broaden our understanding of motivation for physical activity for people with OA. I use a systematic approach to develop a protocol for a pilot randomized controlled trial that uses financial incentives as a behavior change technique to increase and sustain physical activity levels of adults with lower limb osteoarthritis.

1. Using financial
incentives to
increase and
sustain physical
activity for adults
with lower limb
osteoarthritis
My-Linh Nguyen
Luong, MSPH
9 April 2018
PhD
Confirmation
Seminar
1

2. Acknowledgement of
Country
2

3. Have you been physically active lately?
3
Defined as: 150 minutes of moderate-intensity aerobic physical
activity or 75 minutes of vigorous-intensity aerobic physical activity
throughout the week in bouts of at least 10 minutes duration

4. Have you been physically active lately?
4

5. Have you been physically active lately?
5

6. Have you been physically active lately?
6

7. Why were you or were you not successful in being
physically active or maintaining activity levels over the
course of time?
7

8. ISLAGIATT* principle of
intervention design
*It Sounded Like A Good Idea At The Time
8A term coined by Martin Eccles, Emeritus Professor of Clinical Effectiveness, Institute for Health and Society, Newcastle University

9. ISLAGIATT* principle of
intervention design
*It Sounded Like A Good Idea At The Time
9A term coined by Martin Eccles, Emeritus Professor of Clinical Effectiveness, Institute for Health and Society, Newcastle University

10. 10
Behavioral
Problem
Intervention

11. 11
Behavioral
Problem
Intervention
Understanding
the behavior(s)
we are trying to
change

12. A systematic approach to intervention development
is more comprehensive and robust than a non-
systematic approach
Behavioral
Problem
Intervention
12
Understanding
the behavior(s)
we are trying to
change
Theory
Behavioral analysis | Inclusion of participants |
Selection of techniques | Tailoring

13. A systematic approach to intervention development
is more comprehensive and robust than a non-
systematic approach
Behavioral
Problem
Intervention
13
Understanding
the behavior(s)
we are trying to
change
Theory
Evidence
Selection of behavior | Effectiveness of technique

14. A systematic approach to intervention development
is more comprehensive and robust than a non-
systematic approach
Behavioral
Problem
Intervention
14
Understanding
the behavior(s)
we are trying to
change
Theory
Evidence
Practical Issues
Feasibility | Acceptability

15. Steps for
developing a
theory-
informed
implementatio
n intervention
(Campbell et al., 2000; UK
Medical Research Council,
2000, 2008; Craig et al., 2008;
French et al., 2012)
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
15
Theory
Evidence
Practical Issues

16. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 1. Introduction
16

17. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 2. Applying the COM-B model to physical
activity for people with lower limb osteoarthritis: a
literature review
Chapter 3. Exploring non-conscious processes and
physical activity for people with osteoarthritis using
the Reflective-Impulsive Model
17

18. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 4 . Financial Incentives as a behavior change
technique to increase physical activity for adults: a
systematic review protocol
18

19. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 4. Financial Incentives as a behavior change
technique to increase physical activity for adults: a
systematic review protocol
Chapter 5. Financial incentives as a behavior change
technique to increase physical activity for adults: a
systematic review and meta-analysis
19

20. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 4. Financial Incentives as a behavior change
technique to increase physical activity for adults: a
systematic review protocol
Chapter 5. Financial incentives as a behavior change
technique to increase physical activity for adults: a
systematic review and meta-analysis
Chapter 6. Investigating subject preferences and traits
to guide development of an intervention that uses
financial incentives to promote physical activity OA: a
discrete choice experiment
20

21. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 7. A pilot randomized controlled trial to
increase physical activity for people with
osteoarthritis: a protocol
21

22. Steps for
developing a
theory-informed
implementation
intervention
Step 4 How can behavior change be measured and understood?
Step 3
Which intervention components (behavior change techniques
and mode(s) of delivery) could overcome the modifiable
barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and enablers
need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 1. Introduction
Chapter 2. Applying COM-B to physical activity for
people w/ osteoarthritis: a literature review
Chapter 3. Exploring non-conscious processes and
physical activity for people with osteoarthritis using
the Reflective-Impulsive Model
Chapter 4. Financial Incentives as a behavior change
technique to increase physical activity for adults: a SR
protocol
Chapter 5. Financial Incentives as a behavior change
technique to increase physical activity for adults: a SR
& MA
Chapter 6. Investigating subject preferences & traits to
guide development of an intervention that uses
financial incentives to promote physical activity OA: a
discrete choice experiment
Chapter 7. A pilot randomized controlled trial to
increase physical activity for people with osteoarthritis:
a protocol
22

23. Develop a protocol for a
theory-informed
intervention that uses
financial incentives to
increase and sustain
physical activity for adults
with lower limb
osteoarthritis
Overall aim
of the
dissertation
23

24. Steps for
developing a
theory-
informed
implementatio
n intervention
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 1. Introduction
24

25. 25
Step 1
Identifying the problem: Who
needs to do what, differently?
Chapter 1.
Introduction

26. 26

27. Moderate, regular physical activity has health benefits, but
the physical activity levels are less than the optimal World
Health Organization recommended level
27
77%
23%
Adults Meeting Recommended Physical Activity Guidelines
Meeting the guidelines
Not meeting the
guidelines

28. Moderate, regular physical activity has health benefits, but
the physical activity levels are less than the optimal World
Health Organization recommended level
66%
33%
High income countries: Adults Meeting Recommended Physical Activity
Guidelines
Meeting the guidelines
Not meeting the
guidelines
28

29. Moderate, regular physical activity has health benefits, but
the physical activity levels are less than the optimal World
Health Organization recommended level
40%
60%
Australian Adults Meeting Recommended Physical Activity Guidelines
Meeting the guidelines
Not meeting the
guidelines
29

30. Physical activity is universally recommended for people
with osteoarthritis, regardless of disease severity
30
2008 Physical Activity Guidelines
for Americans
• 150 minutes of moderate-
intensity aerobic activity
• 75 minutes of vigorous-
intensity activity
• Or a combination of both

31. Physical activity is universally recommended for people
with osteoarthritis, regardless of disease severity
31

32. Physical activity is universally recommended for people
with osteoarthritis, regardless of disease severity
32

33. Physical activity is universally recommended for people
with osteoarthritis, regardless of disease severity
33

34. Physical activity is universally recommended for people
with osteoarthritis, regardless of disease severity
34

35. Physical activity is universally recommended for people
with osteoarthritis, regardless of disease severity
35

36. • Functional performance (Dunlop et
al., 2011; Chmelo et al., 2013)
• Delay of onset of physical limitation
(Egan & Mentes, 2010)
• Weight loss (Pelligrini et al., 2016)
• Reduction in pain severity (Geneen
et al., 2017)
• Improved quality of life (Geneen et
al., 2017)
• Improved fitness, muscle strength
and joint function
• Better management of other
chronic conditions
36
Physical activity has a number of
health benefits for people with OA
Physical Activity
Healthbenefits

37. Yet, the majority of people w/OA don’t
meet these guidelines
37
77%
23%
Adults Meeting
Recommended Physical
Activity Guidelines in
66%
33%
High income countries: Adults
Meeting Recommended
Physical Activity Guidelines
How many people with OA
fail to meet physical activity
guidelines?
a) 0-25%
b) 26-50%
c) 51-75%
d) 75%+

38. Yet, the majority of people w/ OA don’t
meet these guidelines
38
77%
23%
Adults Meeting
Recommended Physical
Activity Guidelines in
66%
33%
High income countries: Adults
Meeting Recommended
Physical Activity Guidelines
How many people with OA
fail to meet physical activity
guidelines?
a) 0-25%
b) 26-50%
c) 51-75%
d) 75%+87%

39. 39
Step 1
Identifying the problem: Who
needs to do what, differently?
Chapter 1.
Introduction
Given the health benefits, the
few adverse effects affiliated
with physical activity, and the
low percentage of adults with
osteoarthritis meeting physical
activity guidelines, it is of
public health significance to
develop an intervention that
increases and sustains
physical activity levels of
people with lower limb
osteoarthritis

40. Steps for
developing a
theory-
informed
implementatio
n intervention
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 2. Applying the COM-B model to
physical activity for people with lower limb
osteoarthritis: a literature review
Chapter 3. Exploring non-conscious processes
and physical activity for people with
osteoarthritis using the Reflective-Impulsive
Model
40

41. Step 2
Assessing the problem: Using
a theoretical framework, which
barriers and enablers need to
be addressed?
41
Chapter 2. Applying
the COM-B to
physical activity for
people with
osteoarthritis: a
literature review

42. Current physical activity interventions may not
promote long-term physical activity behavior
change for people with osteoarthritis
42
12
months
3-6 months
-3
months
Short-term Medium-term Long-term
Williamson et al.,
2013
Lower limb OA
Combined Subj + Obj:
Significant improvement
Subj: Positive but not
significant
Marley et al., 2017
Musculoskeletal
pain: OA subgroup
Subj: No effect
Obj: Positive but not
significant
Subj: Moderate ES and
statistically significant
Obj: Negative
Subj: Small ES and
statistically
significant
Obj: Positive but not
significant

43. 43
Capability
Psychological/physical
Behavior
Opportunity
Physical/Social
Motivation
Automatic/Reflective
COM-B Model.
Michie, Atkins, West, 2014
Why the COM-B?
1. Comprehensive behavioral
analysis
2. Starting point for intervention
design w/ direct link to
intervention function

44. 44
Capability
Psychological/physical
Behavior
Opportunity
Physical/Social
Motivation
Automatic/Reflective

45. 45
Behavior Change Wheel
Michie, Stralen, West 2014
Image courtesy of Julie Dirksen

46. 46
Step 2
Assessing the problem: Using
a theoretical framework, which
barriers and enablers need to
be addressed?
Chapter 3. Exploring
nonconscious
processes and
physical activity for
people with
osteoarthritis

47. Dual process models
System 1/Automatic
• Fast, automatic in that
it requires no cognitive
resources and effort
• Impulsive
• Non-conscious
• Stimulus driven
• Associative
System 2/Reflective
• Slower, effortful
reflective in a way that
is comprises controlled
reasoning
• Conscious
• Goal-directed
• Logical, rational
47
95% 5%

48. Dual process models: Reflective-
Impulsive Model (Strack & Deutsch, 2004)
Impulsive system:
clusters of associative
representations
Reflective System
Examples of
measures:
• Beliefs about facts
& values
• Intentions to
exercise
• Outcome
expectancies
48

49. Dual process models: Reflective-
Impulsive Model (Strack & Deutsch, 2004)
Impulsive system:
clusters of associative
representations
Examples of
measures:
• Automatic
evaluation
• Habit
• Approach-
avoidance
tendencies
Reflective System
Examples of
measures:
• Beliefs about facts
& values
• Intentions to
exercise
• Outcome
expectancies
49

50. Dual process models: Reflective-
Impulsive Model (Strack & Deutsch, 2004)
Impulsive system:
clusters of associative
representations
Examples of
measures:
• Automatic
evaluation
• Habit
• Approach-
avoidance
tendencies
Reflective System
Examples of
measures:
• Beliefs about facts
& values
• Intentions to
exercise
• Outcome
expectancies
50
Automatic evaluation: strength of
association and a positive or negative
attribute (e.g. pleasantness)
Habit strength: actions initiated
automatically by environmental cues,
impulsively triggered
Approach-avoidance tendencies: automatic
responses cued by automatic evaluations,
habit

51. 51

52. 52
Automatic evaluations for PA: runningpleasant,
physical activityfun, vs. exercisetiring, physical
activitypainful
Habit strength: Monday & Wednesday—run club—
pub runs
note context dependent (living in CH v. living in AU)
Approach-avoidance tendencies: Approach tendency
for physical activity, Avoidance tendency for
sedentary behavior

53. • Consistent evidence to support this relationship
• Primarily focused on young adults, healthy populations
53
Non-conscious
processes
Physical Activity
Sedentary
Behavior

54. Participants: ages 45+ who meet the NICE clinical classification
consistent with diagnosis of OA, English-speaking recruited to
participate voluntarily in an online survey (June-September: ~200
participants)
IV: Non-conscious processes: Automatic evaluations (IAT), Habit
strength (SRBAI), Approach-avoidance tendencies (AAT)
DV: Self-reported Physical activity (IPAQ) at 7 day follow-up
Hierarchical multiple regression: (1) Controlling for: Sociodemographic
characteristics (2) Main effect predictors (3) Reflective processes-
intention and strength of intention, reflective measures (4) Interaction
of Pain as moderator
54
Non-conscious
processes
Physical Activity

55. Steps for
developing a
theory-
informed
implementatio
n intervention
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 4. Financial Incentives as a behavior
change technique to increase physical activity
for adults: a systematic review protocol
Chapter 5. Financial incentives as a behavior
change technique to increase physical activity
for adults: a systematic review and meta-
analysis
55

56. 56
Step 3
Forming possible solutions:
Which intervention
components (behaviour
change techniques and
mode(s) of delivery) could
overcome the modifiable
barriers and enhance the
enablers?
Chapter 4. Financial
incentives as a
behavior change
technique to
increase physical
activity for adults: a
systematic review
protocol

57. 57
Behavior Change Wheel
Michie, Stralen, West 2014
Image courtesy of Julie Dirksen

58. Incentivization for physical activity
• Michie et al: defines an incentive as a motivating reward
provided contingently on behavioral performance
• Reflective motivation: Incentive can be linked with self-
regulation of behavior
• Automatic motivation: Incentive can operates on System 1
processing due to cognitive biases e.g. present bias
• Primary objective of systematic review: Evaluate the effect of
financial incentives on physical activity participation in adults
58

59. PICO for Systematic Review using Methodological
Expectations of Cochrane Intervention Reviews (MECIR)
are methodological standards
• Population: Adults 18+, with or without health conditions
• Intervention: A financial incentive with the purpose of
encouraging participation in physical activity
• Comparison: Any comparison group provided the only
difference is the specific financial incentive
• Outcomes: Any physical activity outcome, defined using WHO
definition
• Limited to: RCTs, English-language
59

60. Previous studies (4)
• No prior registered protocol
• Specific physical activity
outcomes
• Exclusion of penalties
• Increase in the number of
studies using SRs
• Limited search strategy
• Lacked Risk of Bias
assessment
60

61. Published 2018 Jan
61

62. 62
Step 3
Forming possible solutions:
Which intervention
components (behaviour
change techniques and
mode(s) of delivery) could
overcome the modifiable
barriers and enhance the
enablers?
Chapter 5: Financial
incentives as a
behavior change
technique to increase
physical activity for
adults: a systematic
review and meta-
analysis

63. 63

64. We found three times the
number of studies as the most
recent systematic review by
Barte & Wendel-Vos, 2017!
64

65. Steps for
developing a
theory-
informed
implementatio
n intervention
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 4. Financial Incentives as a behavior
change technique to increase physical activity
for adults: a systematic review protocol
Chapter 5. Financial incentives as a behavior
change technique to increase physical activity
for adults: a systematic review and meta-
analysis
Chapter 6. Investigating subject preferences
and traits to guide development of an
intervention that uses financial incentives to
promote physical activity OA: a discrete choice
experiment
65

66. 66
Step 3
Forming possible solutions:
Which intervention
components (behaviour
change techniques and
mode(s) of delivery) could
overcome the modifiable
barriers and enhance the
enablers?
Chapter 6: Investigating
subject preferences &
traits to guide the
development of an
intervention that uses
financial incentives to
promote physical
activity OA: a discrete
choice experiment

67. DCE can be used
to:
• Identify a
promising
physical activity
intervention for
RCT
• Test the effects
when incentives
and/or enrolment
fees are offered
to generate
prediction of
program uptake
67

68. Example development of DCE for physical
activity interventions for people
w/osteoarthritis attributes & levels
• Pinto D, Danilovich
MK, Hansen P, Finn
DJ, Chang RW,
Holl JL, Heinemann
AW, Bockenholt U.
Qualitative
Development of a
Discrete Choice
Experiment for
Physical Activity
Interventions to
Improve Knee
Osteoarthritis.
Archives of physical
medicine and
rehabilitation. 2017
Jun 1;98(6):1210-6.
68
Time per physical activity occasion
≥90min 45–89min 10–44min
Physical activity effort
High: you cannot say more than
a few words without pausing for
breath
Medium: you can talk, but
cannot sing during the activity
Low: you can sing during the
activity
Monthly cost, including equipment or coaching
$80 per month $50 per month $20 per month
Convenience: how well the activity fits into your schedule
With difficulty, and large need for
modification
With some need for modification With ease, and minimal need for
modification
Enjoyment
High: you are happy and very
engaged in the activity
Moderate: you are somewhat
engaged in activity
Low: you are bored and not
engaged in activity
Benefits for my health
Large relief in discomfort, large
increase in strength and ability
to move
Moderate relief in discomfort,
moderate increase in strength
and ability to move
Small relief in discomfort, small
increase in strength and ability
to move

69. Potential ideas
• Include financial
incentive
component (based
on previous SR
findings)
• Measure traits like
impulsivity,
socioeconomic
status, approach-
avoidance
tendencies for
physical activity,
present bias/time
• preferences—
payment at start of
intervention (lose)
vs payment at
conclusion
ointervention (6
weeks)
69
Time per physical activity occasion
≥90min 45–89min 10–44min
Physical activity effort
High: you cannot say more than
a few words without pausing for
breath
Medium: you can talk, but
cannot sing during the activity
Low: you can sing during the
activity
Monthly cost, including equipment or coaching
$80 per month $50 per month $20 per month
Convenience: how well the activity fits into your schedule
With difficulty, and large need for
modification
With some need for modification With ease, and minimal need for
modification
Enjoyment
High: you are happy and very
engaged in the activity
Moderate: you are somewhat
engaged in activity
Low: you are bored and not
engaged in activity
Benefits for my health
Large relief in discomfort, large
increase in strength and ability
to move
Moderate relief in discomfort,
moderate increase in strength
and ability to move
Small relief in discomfort, small
increase in strength and ability
to move

70. Applications of the DCE
• Population: DCE data collected via an online panel
representative of the Australian population w/ OA (approx. 750
w/ OA) + CHESM recruitment (200)
• Outcome: ID of promising interventions to include in RCT
• Low-cost and efficient manner for estimating the effect of
different types of magnitudes/attributes of incentives
• Measuring traits can help with tailoring an intervention, highlight
individuals who should be targeted by the intervention
70

71. Steps for
developing a
theory-
informed
implementatio
n intervention
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 7. A pilot randomized controlled trial to
increase physical activity for people with
osteoarthritis: a protocol
71

72. 72
Step 3
Forming possible solutions:
Which intervention
components (behaviour
change techniques and
mode(s) of delivery) could
overcome the modifiable
barriers and enhance the
enablers?
Chapter 7. A pilot
randomized
controlled trial to
increase physical
activity for people
with osteoarthritis:
a protocol
Step 4
Evaluating the selected
intervention: How can behaviour
change be measured and
understood?

73. Can the key components of a full-scale
study be implemented as planned, or will
some modification(s) need to be made?
73

74. • Proposed protocol for pilot
trial will include
• Clearly defined aims
• Feasibility objectives
• Analytic plans
• Explicit definitions of what
constitutes success
74

75. Thabane et al. categories of outcomes
to include
Process: the feasibility of the research processes (e.g. recruitment
rates per week/month)
Resources: the amount of time and resources of research process
(e.g. length of time to fill out the study forms)
Management: potential human and data management challenges
(e.g. what challenges do study personnel have?)
Scientific: the variance of effect, fidelity, treatment safety (e.g. are
there any adverse effects to participating in the study)
75

76. Implementation outcomes to consider
• Acceptability: Extent to which stakeholders perceive the
treatment to be agreeable or satisfactory
• Appropriateness: The perceived fit of the treatment for a
consumer and/or perceived fit of the treatment to address a
particular issue or problem
• Cost: Financial impact of an implementation of the treatment
76

77. Steps for
developing a
theory-
informed
implementatio
n intervention
Step 4 How can behavior change be measured and
understood?
Step 3
Which intervention components (behavior change
techniques and mode(s) of delivery) could overcome
the modifiable barriers and enhance the enablers?
Step 2 Using a theoretical framework, which barriers and
enablers need to be addressed?
Step 1 Who needs to do what, differently?
Chapter 1. Introduction
Chapter 2. Applying COM-B to physical activity for
people w/ osteoarthritis: a literature review
Chapter 3. Exploring non-conscious processes
and physical activity for people with osteoarthritis
using the Reflective-Impulsive Model
Chapter 4. Financial Incentives as a behavior
change technique to increase physical activity for
adults: a SR protocol
Chapter 5. Financial Incentives as a behavior
change technique to increase physical activity for
adults: a SR & MA
Chapter 6. Investigating subject preferences &
traits to guide development of an intervention that
uses financial incentives to promote physical
activity OA: a discrete choice experiment
Chapter 7. A pilot randomized controlled trial to
increase physical activity for people with
osteoarthritis: a protocol
77

78. Develop a protocol for a
theory-informed
intervention that uses
financial incentives to
increase and sustain
physical activity for adults
with lower limb
osteoarthritis
Overall aim
of the
dissertation
78

79. Big picture
79
Chapter 1. Introduction
To be updated over the course of the dissertation
Chapter 2. Applying COM-B to physical activity for people w/
osteoarthritis: a literature review To be updated over the course of the dissertation
Chapter 3. Exploring non-conscious processes and physical
activity for people with osteoarthritis using the Reflective-
Impulsive Model
Ethics: April
Practical logistics: June
Launch of survey: June-September
Published manuscript: early 2019
Chapter 4. Financial Incentives as a behavior change technique
to increase physical activity for adults: a SR protocol
Publication January 2018
Chapter 5. Financial Incentives as a behavior change technique
to increase physical activity for adults: a SR & MA
Intended completion May 2018
Chapter 6. Investigating subject preferences & traits to guide
development of an intervention that uses financial incentives to
promote physical activity OA: a discrete choice experiment
Methods & Stat plan: March-July 2018
Ethics: July 2018
Launch survey: October 2018-February 2010
Published manuscript: late 2019
Chapter 7. A pilot randomized controlled trial to increase
physical activity for people with osteoarthritis: a protocol TBD: Intended completion of protocol: February
2020

80. Relevance & Significance of study
• Uses a comprehensive systematic approach to behavioral
analysis and intervention development to improve the activity
levels of people with lower limb OA
• Exploration of non-conscious processes and physical activity in
the OA population is of clinical relevance
• Combines knowledge across several disciplines
• Promotes transparent and open science methods
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81. Acknowledgements
Supervisory committee
Prof Kim L. Bennell
Prof Rana S. Hinman
Prof Anthony Harris, Monash University
Dr. Michelle Hall
Dr. Amanda Rebar, Central Queensland
University
Advisory committee
Dr. Kade Paterson
Dr. Thorlene Egerton
Funding
Melbourne Research Scholarship (MRS)
Australian Government Research Training
Program (RTP) Scholarship
National Health & Medical Research Council
Centre of Research Excellence (#1079078)
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82. Thank you!
• Questions?
Follow up with me via:
email:mylinhl@student.unimelb.edu.au
twitter: mylinhluong
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