Ford, Kerrin (2025) An Examination of Multi-Level Factors That Influence the Integration of Physical Activity into Psychological Treatment. PhD thesis, Victoria University.

Abstract

Physical activity is increasingly recognised as an evidence-based intervention for mental health conditions, yet its integration into routine psychological treatment is limited. This thesis examines the integration of physical activity within psychological treatment in Australian services, using a multi-study mixed-methods design. Guided by the Theory of Planned Behaviour (TPB) and the Behaviour Change Wheel (BCW), including the Capability, Opportunity, Motivation - Behaviour (COM-B) model at its core, the research adopts a mixed-methods design to examine multi-level influences across community (Study 1), client (Study 2), and clinician (Study 3) perspectives. Study 1, a cross-sectional survey of 211 Australian adults, examined predictors of intention to engage in physical activity when it is introduced and supported by a psychologist as part of mental health care. Attitudes toward physical activity emerged as the strongest predictor of intention, and psychologists were perceived as credible and appropriate agents to deliver such guidance. These findings highlight community support for psychologists to incorporate physical activity within mental health treatment. Study 2 involved semi-structured interviews with 13 young people who had participated in a physical activity intervention delivered through a clinical trial within a youth mental health service. Reflexive thematic analysis identified six themes: therapeutic benefits and meaningful gains, capability and motivation, interpersonal support, barriers to engagement, strategies for engagement, and therapeutic integration. Participants described both facilitators and challenges to engaging in physical activity, highlighting the role of psychologists in supporting behaviour change through therapeutic techniques and integration within psychological treatment. Study 3 used focus groups with 10 registered psychologists. Analysed using reflexive thematic analysis, and identified six themes: Professional Identity and Scope; Therapeutic Integration of Physical Activity; Client-Centred Therapeutic Approach; Barriers to Implementation; Facilitators to Implementation; and Professional Advocacy and Growth. Psychologists described both individual-level influences (such as confidence and knowledge) and broader contextual barriers (including time, training, and organisational culture) as relevant to delivering physical activity as part of treatment. Together, these findings, synthesised through the Behaviour Change Wheel, offer a theoretically grounded explanation for the implementation gap in integrating physical activity into psychological practice and identify key leverage points for practice, policy, and workforce development. This thesis contributes new knowledge by clarifying the behavioural, relational, and systemic conditions that shape psychologists’ capacity to support physical activity within therapy. By establishing how psychologists can use their behaviour change expertise to support physical activity in mental health care, this thesis contributes to advancing the integration of evidence-based interventions within routine psychological treatment. It also offers practical guidance for embedding behaviour change strategies in routine sessions and could inform policy directions, such as expanding training frameworks and funding models to enable integration within mental health services.

Search Google Scholar

Repository staff login