title: A systematic framework for resource use measurement in the economic evaluation of individual-level physical activity and sedentary behaviour interventions
Creators: name: Cochrane, M
Publisher: name: Liverpool John Moores University
Year: 2020

description: There is an increasing demand for economic evidence on physical activity (PA) and sedentary behaviour (SB) interventions which can prevent noncommunicable disease (NCD). Trials assessing the impact of PA and SB interventions rarely collect and present economic data alongside their effectiveness results. The overarching aim of this PhD was to develop a multidisciplinary and pragmatic framework to support researchers carrying out trial-based economic evaluations of individual-level PA and SB interventions. The nature of this PhD project presented me with the opportunity to train in a new discipline, health economics, and draw on my existing discipline-specific knowledge in anthropology and public health in order to make an interdisciplinary contribution to the field of public health economics applied to trials. In particular, my knowledge in anthropology, the study of human society and its complexity, supported my documentation of the complexity involved in developing and implementing a standardised pragmatic framework to the multidisciplinary field of economic evaluation in PA and SB. Complexity is reported throughout this thesis in the form of reflection boxes. The purpose of the reflections were to: (1) describe in detail the actions I took to develop a framework; and (2) explain why I believed these actions were fit for purpose. For the latter, I reflect on my prior knowledge in public health and anthropology, as well as on the complex detailed observations I made and informal multidisciplinary conversations I had during this PhD. In order to design an initial framework and to test the practicability of it, I carried out three key studies. Study one was a systematic review which aimed to identify how authors of existing economic evaluations of individual-level PA and SB interventions have addressed key methodological challenges associated with the conduct of economic evaluations in public health. In summary, the review showed that there are marked methodological differences in existing studies. Nevertheless, good quality methods were identified and drawn on in order to develop the initial framework. The initial framework comprised of 16 items along with guidance on how these items could be applied in the context of PA and SB. Study two involved applying the initial framework to a ‘real world’ PA trial and reflecting on its practicability. Study three was carried out concurrently with study two and involved applying the initial framework to a ‘real world’ SB trial, also to see how the framework performed in practice. Narrative synthesis methods were used to bring together the key learnings and reflections from studies 1-3. The narrative synthesis shed light on how my interdisciplinary knowledge and experience could improve the procedures for identifying and measuring resource use within PA and SB trials. My revised systematic framework incorporates existing tools from the multiple research fields in which PA and SB cut across, namely public health, exercise science, behavioural science, anthropology and trial methodology. The final framework, presented in the form of a standard operating procedure (SOP), is recommended for use in trial units to support early career health economists to make and communicate decisions around the measurement of resource use in complex individual-level PA and SB trials.