Priority Setting of Physical Activity Barriers and Facilitators Among Individuals With Rheumatoid Arthritis: A Nominal Group Technique Study

Objective To (1) understand key physical activity (PA) determinants for individuals with rheumatoid arthritis (RA), and (2) map determinants using the Behavior Change Wheel (BCW) to guide theory-driven intervention development.

Methods A patient-centered nominal group technique (NGT) approach was used, with recruitment through purposive sampling from past research participants. After self-reporting demographics and PA, participants attended NGT sessions consisting of idea generation, sharing, and refinement through discussion. Researchers combined PA-determinant lists across sessions using content analysis. Using a survey, participants rated the importance of each determinant from 1 to 9. Theoretical mapping was completed with the most important 2 out of 3 determinants using the BCW.

Results Fourteen individuals participated across 3 sessions. The mean age was 58.1 (SD 13.4) years, with a mean 20.0 (SD 21.8) years with RA. Participants were 86% female, 79% White, and 86% had some university/college education. All participants were physically active, with a mean Godin Leisure-Time Exercise Questionnaire (GLTEQ) leisure score index of 43.3 (SD 18.4; < 14 = insufficiently active, 14-24 = moderately active, > 24 = active). The 22 PA barriers and 25 facilitators fell into 4 categories: personal, social, physical, and environmental. The top 3 barriers (importance: 7.1-7.4/9) were unpredictable fluctuations, fatigue, and lack of RA-specific PA knowledge. The top 3 facilitators (importance: 7.6-7.9/9) were motivation to maintain function, knowledge to tailor PA, and PA self-confidence. Theoretical mapping led to 3 capability-related, 6 opportunity-related, and 4 motivation-related determinants.

Conclusion Our study highlighted key PA determinants related to capability, opportunity, and motivation. Interventions may target skills (capability), social influences (opportunity), and beliefs about capabilities (motivation) to increase PA in individuals with RA.