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Table 6 Deductive content analysis and resulting themes

From: Pedometer use and self-determined motivation for walking in a cardiac telerehabilitation program: a qualitative study

Units of meaning Sub-themes Themes
Interview: patients Interview: health professionals Observations and Documents (notes from the PHR)
Autonomy
“Well, I don’t do it for the sake of others, only for my own sake. It’s the same about the goal of 10,000 steps, which I might not get to every single day, but then I get more another day” (ID5).
“When the weather was nice, I could easily walk the 10,000 steps. But, I would not have walked 10,000 steps on a rainy day [laughs]. I want to decide myself” (ID12).
“When the lawn needs mowing, then you feel motivated, not to be active, but to make the lawn look good” (ID8).
“I don’t need the pedometer anymore. I now know how many steps the normal working day provide, or my favourite walking trip. If I have been inactive, then I just walk 18 holes at the golf club” (ID5).
“The alternative was to exercise at the Healthcare centre, but I am not driving all that way for half an hour of exercise. You could just take a walk in the nature. It’s basically the pedometer that supports your exercise” (ID11).
You have to accept the patient’s choice At the same time you have to make sure that the patient understands the health related problems of their choice, and that the choice are made on the basis of knowledge (Nurse at Healthcare Centre 3). “In the middle of the living room there was a rowing machine, and during the first observation the patient expressed a wish for a more detailed personal plan for exercises improving strength beside her pedometer goals. She explained that this was because she wanted to exercise on her own” (Field note ID3).
“Morten, you are close to the 5000 steps per day, good ☺, are you ready to increase the amount of steps?” (PHRpatientID12).
Individual choice and decision for walking activity Independence from standardised rehabilitation
“When you have a pedometer, you look at it, how many steps have I walked now? Then we’ve gone for an evening walk. If you can’t see the results of what you do, that is, measuring the steps, then you have no opportunity to adjust” (ID10).
“Before [the pedometer] I wasn’t given any marker on how many steps to walk a day. I was just told to walk; now I walk longer distances about 7000 steps 8000 steps on one trip” (ID2).
“After all we use it a lot, I preach; you must reach those 10,000 steps a day, but we do have some citizens that … if they reach 5000 then I think it’s very well done, considering their physical level” (Physiotherapist at Healthcare Centre1).
“In worst case scenarios they only walked 2000 steps in a day. You have to be aware of their starting point when you plan their individual activity level” (Physiotherapist at Healthcare Centre4).
“I can see you are getting close to your goal of steps, should we try and raise the number of steps to 10,000?” (PHRpatientID2).
“Thanks for a nice talk on the phone today; I am pleased that you are feeling OK. The heart failure makes you ‘short of breath’ and I suggest that you take shorter but more frequent walks (PHRpatientID7).
“John experiences leg pain when walking [just a short distance]. We agreed to measure how far he can walk (numbers of steps). After that we will determine goals for daily steps” (PHRpatientID1).
”Thomas wants to loos weight by increasing physical activity through indoor bike riding and 5000 daily steps. Suggested that Thomas divides the walking trip into two. In a month’s time we will evaluate the achieved physical activity PHRpatientID11).
Tailor walking activity
Competence
“Unfortunately I forgot the pedometer this morning, and I went for a long walk, which unfortunately didn’t get registered” (ID2).
“I forgot my pedometer today, but I went for a shopping trip in Aalborg, and I think I walked about 7000 steps all together. I tell you: I was so tiered after that, I slept all evening” (PHR ID1).
It’s nice to see that I did actually walk many steps today.” ID1)
“Previously it seemed blurred, whereas now, with this [the pedometer], it is easier to keep track on their activity” (RN at Healthcare Centre3). Hi Mette [nurse at the hospital], the pedometer is really motivating. I wore it at the gym, I went there with my wife, and it gave me 2 – 3.000 steps at the cross trainer” (PHRpatientID12). Feedback on walking activity Conscious awareness of walking activity
“Especially when I think about it, in a way, I’ve got my life back so, if I just sat back, I wouldn’t have understood ‘the message’” (ID3).
“Purely for medical reasons, it is all about your health. It is all about health. I try to keep as healthy as possible, and it appears that, exercise makes a difference” (ID10).
“Walking is my work. I want to be in a good shape, because it’s good for me” (ID2).
“It’s form my own sake, and if some clever people tells me that 10000 steps per day is good for my, the it won’t be any good if I just walk 500 steps (ID 5)
Some of the patients don’t consider walking as a health related issue; they just consider walking as an act to get from one place to another. The pedometer changed that. (Nurse at Healthcare Centre 1) “Three months has passed by, and you have to live without telerehabilitation technologies. You have reached all your goals; you have lost 13 cm around your waist, and walk a lot of steps. You have said no to any additional rehabilitation sessions at the health care centre” (PHRpatientID11).
“A patient had the pedometer placed visibly at the shirt, expressing that it is an appropriate place for him, because it reminds him to walk and makes him aware of activity” (Field note ID11).
“Hi, Helle. It’s nice to see that you really focus on exercise and activity, and that you set yourself personal goals. Regarding strength exercise, I have some suggestions, but it is very important to listen to the signs from your body, like pain. You can make sit ups and by doing … etc. etc. If you have any questions don’t hesitate to contact me again. Yours sincerely, Peter Hansen, Physiotherapist, Aalborg University Hospital” (PHRpatientID3)
Knowledge leading to awareness of walking
Relatedness
“You lose face if the pedometer shows too few steps. I mean, you lose face if you don’t do what they [the health professionals] told you to do” (ID4).
It may not show too few steps … it would be embarrassing to wear a pedometer that only shows 200 steps. It has to be more, maybe not in one walk … but if you continue to walk, then the victory comes to you (ID4).
Of cause you listen to people [health professionals] who knows what they are talking about (ID1)
“For the patients, it’s the immediate result each evening. It’s like a close surveillance of activity, like a: ‘well done today, Peter’” (Physiotherapist at Healthcare Centre2). Hi Ib. How are you? Are you using the pedometer every day? There aren’t many steps uploaded to the PHR (PHRpatientID4).
Hi Hans.
I can see that you have been really active, that’s good☺. Enjoy the lovely weather today, maybe you feel like a long walk on the beach? (PHRpatientID5)
Hallo Mette [nurse at the hospital]. As you can see, I don’t walk much. I am extremely affected by the new drug. Immediately after intake, my pulse and blood pressure drops and I need to lie down. (PHRpatientID4)
It’s a safe feeling, that the nurse follows your rehabilitation status in the PHR. I haven’t reach my goals yet, but I am determined that I will (PHRpatientID9)
Feeling of being under surveillance, yet supported Interaction whit others in relation to walking activity
It’s my kids, my kids they are also active, and I want to be active together with them. They have been walking with me; they helped me to get started. And when you have the pedometer, then you look at it, ‘how many steps have I been walking?’, then we have been out for an evening walk. (ID3).
I just call my friend and ask her; ‘don’t you need some fresh air?’ It’s like; ‘two for the price of one’ because then we talk and talk, and suddenly, whiteout noticing, we have been walking a long trip (ID6).
His wife bought a pedometer herself, they compared, and talked about how many steps they had reached. I think that it was motivating for them, to see that the spouse feeling good. (Physiotherapist at Healthcare Centre3) I offered the patient rehabilitation gym at the healthcare centre, but he chose continues to exercise with his wife (PHRpatientID11). Support from next of kin