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This study explores the mechanisms of action of the e-coachER intervention using measures of the behaviour change processes integral to the intervention\u2019s logic model.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Four hundred fifty adults with obesity, diabetes, hypertension, osteoarthritis or history of depression referred to an ERS were recruited in Plymouth, Birmingham and Glasgow. The e-coachER intervention comprising 7-Steps to Health was aligned with Self-Determination Theory and mapped against evidence-based behaviour change techniques (BCTs). Participants completed questionnaires at 0, 4, and 12\u00a0months to assess PA and self-reported offline engagement with core BCTs in day-to-day life (including action planning and self-monitoring) and beliefs relating to PA (including perceived importance, confidence, competence, autonomy and support). We compared groups at 4 and 12\u00a0months, controlling for baseline measures and other covariates. Mediation analysis using the product of coefficients method was used to determine if changes in process variables mediated intervention effects on moderate to vigorous physical activity (MVPA) recorded by accelerometer and self-report at 4- and 12-months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The internal reliability (Cronbach\u2019s alpha) for all multi-item scales was\u2009&gt;\u20090.77. At 4-months, those randomised to e-coachER reported higher levels of PA beliefs relating to importance (1.01, 95% confidence interval (CI): 0.42 to 1.61, <jats:italic>p\u2009=<\/jats:italic>\u20090.001), confidence (1.28, 95% CI: 0.57 to 1.98, <jats:italic>p\u2009&lt;<\/jats:italic>\u20090.001), competence (1.61, 95% CI: .68 to 2.54, <jats:italic>p\u2009=<\/jats:italic>\u20090.001), availability of support (0.77, 95% CI: 0.07 to 1.48, <jats:italic>p\u2009=<\/jats:italic>\u20090.031), use of action planning (1.54, 95% CI: 0.23 to 2.85, <jats:italic>p\u2009=<\/jats:italic>\u20090.021) and use of self-monitoring (0.76, 95% CI: 0.19 to 1.32, <jats:italic>p\u2009=<\/jats:italic>\u20090.009) compared to ERS alone. There were no intervention effects on autonomous beliefs or perceived frequency of support, compared to ERS alone. At the 12-month follow-up, participants belief in the importance of PA was the only process measure to remain significantly higher in the e-coachER group when compared to ERS alone (0.75, 95% CI: 0.05 to 1.45). Intervention effects on perceived importance (2.52, 95% CI: 0.45 to 5.39), action planning (1.56, 95% CI: 0.10 to 3.54) and self-monitoring (1.92, 95% CI: 0.21 to 4.33) at 4-months significantly mediated change in accelerometer measured MVPA at 12-months (recorded in\u2009\u2265\u200910-min bouts).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>e-coachER led to some short-term changes in most process outcomes. Some of these processes also appeared to mediate e-coachER effects on changes in accelerometer measured MVPA. Further work should be carried out to understand how best to design and implement theoretically underpinned web-based physical activity promotion interventions within ERS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ISRCTN, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN15644451\">ISRCTN15644451<\/jats:ext-link>. Registered 12 February 2015.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12966-022-01360-7","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T23:04:02Z","timestamp":1664492642000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A process evaluation, with mediation analysis, of a web-based intervention to augment primary care exercise referral schemes: the e-coachER randomised controlled trial"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4774-9054","authenticated-orcid":false,"given":"Jeffrey","family":"Lambert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Streeter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Greaves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy M.","family":"Ingram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Dean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Jolly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanette","family":"Mutrie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod S.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Yardley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Price","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"1360_CR1","unstructured":"Department of Health. 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Br J Soc Psychol. 2006;45(1):87\u2013106.","journal-title":"Br J Soc Psychol"}],"container-title":["International Journal of Behavioral Nutrition and Physical Activity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12966-022-01360-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12966-022-01360-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12966-022-01360-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T10:06:44Z","timestamp":1664532404000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijbnpa.biomedcentral.com\/articles\/10.1186\/s12966-022-01360-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,29]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["1360"],"URL":"https:\/\/doi.org\/10.1186\/s12966-022-01360-7","relation":{},"ISSN":["1479-5868"],"issn-type":[{"value":"1479-5868","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,29]]},"assertion":[{"value":"10 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in accordance with the Declaration of Helsinki and was approved by the National Research Ethics Committee North West\u2014Preston (15\/NW\/0347). Informed consent to participate in the study was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"No individual patient data has been reported.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare support from National Institute for Health Research (NIHR), Health Technology Assessment grant 13\/20\/25 for the submitted work. KJ declares that she is partly funded by NIHR ARC West Midlands and is a subpanel chair of the NIHR Programme Grants for Applied Health Research. NM declares grants from NIHR during the conduct of the study and personal fees for work in relation to UK physical guidelines revision outside the submitted work. LP reports: grants from Living Streets Charity, personal fees from NIHR, personal fees from NIHR PHR, personal fees from NIHR PHR rapid response, grants from Wellcome Trust seed corn (internal funding) outside the submitted work; the physical activity group in Sport and Health Sciences at the University of Exeter has a collaboration with Activinsights (the manufacturer of the physical activity monitor) to provide study design advice and data analysis\u2014the analysis of the physical activity data in the present study was not undertaken as part of this service. SD position is supported by NIHR Applied Research Collaboration, South West (PenARC). LY is partly supported by the NIHR Southampton Biomedical Research Centre. CG was supported in part by a NIHR Career Development Fellowship (CDF-2012\u201305-259). All other authors have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and have no other relationships or activities that could appear to have influenced the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"128"}}