Group or individual Lifestyle-integrated Functional Exercise (LiFE)? A qualitative analysis of acceptability

Abstract

Background: The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE.Methods: Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90 – 100 minutes duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.Results: In both formats, participants (N=30, 22 women, ngLiFE=15, nLiFE=15, mean age 78.5±6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.Conclusion: This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.Trial registration: ClinicalTrials.gov, NCT03462654. Registered on March 12, 2018. https://clinicaltrials.gov/ct2/show/NCT03462654.

Willingness to pay for a group and an individual version of the Lifestyle-integrated Functional Exercise program from a participant perspective

“…Other factors that can be hypothesized to determine WTP could be the individually perceived relevance (e.g. individually perceived risk of falling) and perceived effectiveness of the intervention, the presence of other health conditions whose treatment may be given a higher priority, or the relationship with the trainer [14]. It is also not clear whether participants factored the cost of providing the intervention, and thus the additional effort required for home visits in LiFE, into their willingness to pay, which may explain the difference in WTP between program versions [20].…”

“…Those people, based on individual preferences, may still opt for the individual program despite being more costly. For example, some people may prefer individual supervision and learning the program in their own home where the activities could be adapted to the individual conditions and are therefore more easy to integrate into everyday life, whereas for others the social aspects of a group program (e.g., motivation through peer support) may be more important [13,14]. Moreover, the individual approach in LiFE could be more suitable for people for whom participation in group programs would be difficult, for example, because of physical and transport limitations.…”

“…A detailed description of the interventions (including a TIDieR checklist) can be found in the study protocol [10]. The development of the conceptual gLiFE framework and a content analysis as well as a qualitative analysis of the acceptance of the two program versions were published separately [13][14][15].…”

“…When it comes to individual preferences and perceived benefits beyond clinical effectiveness, one could assume that the WTP of such a program differs by mode of administration. For example, gLiFE may be perceived as more valuable since it involves a social component (e.g., increased motivation through peer support) or, on the other hand, LiFE might be preferred as the individual training in the participant's home may be perceived as an advantage for implementing the LiFE activities into daily routines [13,14].…”

The Lifestyle-integrated Functional Exercise (LiFE) program and its modifications: a narrative review

“…The results showed positive group experiences and participants implemented 75% of the activities learned during gLiFE sessions, which is comparable to the adherence rate reported for LiFE (76%). Reicherzer et al (2021) conducted a qualitative focus group analysis that showed a high acceptance rate of gLiFE among 30 participants. gLiFE participants' attitude and motivation to participate was positively associated with learning in a group.…”