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Kananura RM, Birabwa C, Ssanyu JN, Kizito F, Kagaha A, Namutanba S, Kyangwa M, Kakaire O, Waiswa P. Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol. PLoS One 2024; 19:e0293351. [PMID: 38728317 PMCID: PMC11086862 DOI: 10.1371/journal.pone.0293351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/26/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?" METHODS We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why. DISCUSSION Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context. REGISTRATION This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).
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Affiliation(s)
- Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Birabwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Jacquellyn Nambi Ssanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Alexander Kagaha
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- Busoga Health Forum, Jinja, Uganda
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Mino E, Hanson CL, Naber I, Weissenfels A, McHale S, Saftig J, Klamroth S, Gelius P, Abu-Omar K, Whiting S, Wickramasinghe K, Galea G, Pfeifer K, Geidl W. A systematic review and narrative synthesis of physical activity referral schemes' components. Int J Behav Nutr Phys Act 2023; 20:140. [PMID: 38012688 PMCID: PMC10683187 DOI: 10.1186/s12966-023-01518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.
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Affiliation(s)
- Eriselda Mino
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany.
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Inga Naber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Anja Weissenfels
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Sheona McHale
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Jane Saftig
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Sarah Klamroth
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Stephen Whiting
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Kremlin Wickramasinghe
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Gauden Galea
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
| | - Wolfgang Geidl
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058, Erlangen, Germany
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Oster C, Skelton C, Leibbrandt R, Hines S, Bonevski B. Models of social prescribing to address non-medical needs in adults: a scoping review. BMC Health Serv Res 2023; 23:642. [PMID: 37316920 DOI: 10.1186/s12913-023-09650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The health and wellbeing consequences of social determinants of health and health behaviours are well established. This has led to a growing interest in social prescribing, which involves linking people to services and supports in the community and voluntary sectors to address non-medical needs. However, there is considerable variability in approaches to social prescribing with little guidance on how social prescribing could be developed to reflect local health systems and needs. The purpose of this scoping review was to describe the types of social prescribing models used to address non-medical needs to inform co-design and decision-making for social prescribing program developers. METHODS We searched Ovid MEDLINE(R), CINAHL, Web of Science, Scopus, National Institute for Health Research Clinical Research Network, Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registry Platform, and ProQuest - Dissertations and Theses for articles and grey literature describing social prescribing programs. Reference lists of literature reviews were also searched. The searches were conducted on 2 August 2021 and yielded 5383 results following removal of duplicates. RESULTS 148 documents describing 159 social prescribing programs were included in the review. We describe the contexts in which the programs were delivered, the program target groups and services/supports to which participants were referred, the staff involved in the programs, program funding, and the use of digital systems. CONCLUSIONS There is significant variability in social prescribing approaches internationally. Social prescribing programs can be summarised as including six planning stages and six program processes. We provide guidance for decision-makers regarding what to consider when designing social prescribing programs.
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Affiliation(s)
- Candice Oster
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Skelton
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard Leibbrandt
- College of Science & Engineering, Flinders University, Adelaide, SA, Australia
| | - Sonia Hines
- College of Medicine & Public Health, Flinders Rural and Remote Health, Flinders University, Alice Springs, Northern Territory, Australia
| | - Billie Bonevski
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
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Jackman PC, Lane A, Allen-Collinson J, Henderson H. Older adults' and service providers' experiences of a settings-based health promotion initiative in English football. Health Promot Int 2023; 38:daad027. [PMID: 37339012 PMCID: PMC10797665 DOI: 10.1093/heapro/daad027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
The study was undertaken to explore the experiences of older adults and service providers in a settings-based health promotion initiative in a football club. We conducted semi-structured interviews with 10 older adults attending an 'Extra Time Hub' (ETH) and two staff delivering the initiative. Our reflexive thematic analysis generated six themes. Findings revealed the brand of the sports club attracted some to join the ETH, but through partnerships with local agencies, the initiative was also successful in widening participation beyond older adults with an interest in football. Participants perceived that the ETH was beneficial for their mental health, helped them develop social connections, and promoted positive physical activity experiences. Moreover, the variety of pleasures derived from participation were also discussed. Our findings also illustrate the central role of staff in older adults' experiences of this form of health promotion. Overall, this study contributes to understandings of settings-based health promotion activities in sports clubs, and also demonstrates the potential for sports clubs to widen engagement with the local community through health promotion for older adults.
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Affiliation(s)
- Patricia C Jackman
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Aoife Lane
- Department of Sport and Health Sciences, Technological University of the Shannon, Athlone, Ireland
| | | | - Hannah Henderson
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
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Desjardins É, Sultan-Taïeb H, St-Hilaire F, Vézina N, Ledoux É, Naji R, Bélanger P. Implementation process evaluation of an ergonomic train the trainer program: How to learn from mechanisms and the temporal structure of processes? EVALUATION AND PROGRAM PLANNING 2023; 97:102233. [PMID: 36682138 DOI: 10.1016/j.evalprogplan.2023.102233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
In implementation process evaluation, the analysis of the temporal structure of processes is key for understanding the successive interactions between the flow of practitioners' actions and evolving workplace reactions and context. However, capturing the temporal structure of processes in data analysis is a methodological challenge, and available literature to overcome this challenge is scarce, especially for workplace ergonomic interventions. The aim of this paper was to perform an implementation process evaluation of an ergonomic train the trainer program taking into account the temporal structure of processes. We provided a method for qualitative data analysis based on a three-stage strategy: 1) producing the timeline of the implemented intervention, 2) identifying influential factors, 3) identifying determinant mechanisms (sequence of influential factors that intervened in the implementation process). This method allowed us to identify six determinant mechanisms positioned on the timeline of the intervention. Obstacles and levers were identified as a sequence of interrelated causes and consequences rather than isolated factors. We recommended success strategies for practitioners, while also shedding light on how organizations can better be prepared to undertake the intervention and their required actions to attain targeted intervention objectives.
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Affiliation(s)
- Émilie Desjardins
- Université du Québec à Montréal - Department of Organization and Human Resources, School of Management, 320, rue Sainte-Catherine Est, Montréal, Québec H2X 1L7, Canada.
| | - Hélène Sultan-Taïeb
- Université du Québec à Montréal - Department of Organization and Human Resources, School of Management, 320, rue Sainte-Catherine Est, Montréal, Québec H2X 1L7, Canada.
| | - France St-Hilaire
- Université de Sherbrooke - Department of Management and Human Resources, Business School, 2500, boulevard de l'Université, Sherbrooke, Québec J1K 2R1, Canada.
| | - Nicole Vézina
- Université du Québec à Montréal - Department of Physical Activity, 141, avenue du Président-Kennedy, Montréal, Québec H2X 1Y4, Canada.
| | - Élise Ledoux
- Université du Québec à Montréal - Department of Physical Activity, 141, avenue du Président-Kennedy, Montréal, Québec H2X 1Y4, Canada.
| | - Rita Naji
- Université du Québec à Montréal - Department of Organization and Human Resources, School of Management, 320, rue Sainte-Catherine Est, Montréal, Québec H2X 1L7, Canada.
| | - Patricia Bélanger
- Université du Québec à Montréal - Department of Physical Activity, 141, avenue du Président-Kennedy, Montréal, Québec H2X 1Y4, Canada.
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Shore CB, Galloway SDR, Gorely T, Hunter AM, Hubbard G. Exercise Referral Instructors' Perspectives on Supporting and Motivating Participants to Uptake, Attend and Adhere to Exercise Prescription: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:203. [PMID: 35010462 PMCID: PMC8750611 DOI: 10.3390/ijerph19010203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Exercise referral schemes are designed to support people with non-communicable diseases to increase their levels of exercise to improve health. However, uptake and attendance are low. This exploratory qualitative study aims to understand uptake and attendance from the perspectives of exercise referral instructors using semi-structured interviews. Six exercise referral instructors from one exercise referral scheme across four exercise referral sites were interviewed. Four themes emerged: (i) the role that instructors perceive they have and approaches instructors take to motivate participants to take-up, attend exercise referral and adhere to their exercise prescription; (ii) instructors' use of different techniques, which could help elicit behaviour change; (iii) instructors' perceptions of participants' views of exercise referral schemes; and (iv) barriers towards providing an exercise referral scheme. Exercise referral instructors play an important, multifaceted role in the uptake, attendance and adherence to exercise referral. On-going education and peer support for instructors may be useful. Instructors' perspectives help us to further understand how health and leisure services can design successful exercise referral schemes.
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Affiliation(s)
- Colin B. Shore
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford GU2 7YH, UK
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK; (S.D.R.G.); (A.M.H.)
| | - Stuart D. R. Galloway
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK; (S.D.R.G.); (A.M.H.)
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands (UHI), Inverness IV2 3JH, UK; (T.G.); (G.H.)
| | - Angus M. Hunter
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK; (S.D.R.G.); (A.M.H.)
- Department of Sports Science, Nottingham Trent University, Nottingham NG11 8NS, UK
| | - Gill Hubbard
- Department of Nursing and Midwifery, University of the Highlands and Islands (UHI), Inverness IV2 3JH, UK; (T.G.); (G.H.)
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Hagelskjær V, Nielsen KT, von Bulow C, Oestergaard LG, Graff M, Wæhrens EE. Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE). BMJ Open 2021; 11:e051722. [PMID: 34836902 PMCID: PMC8628341 DOI: 10.1136/bmjopen-2021-051722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council's guidance on how to develop and evaluate complex interventions, the occupational therapy programme (A Better everyday LifE (ABLE)) was developed and feasibility tested. The aim of this protocol is to report the planned design and methods for evaluating effectiveness, process and cost-effectiveness of the programme. METHODS AND ANALYSIS The evaluation is designed as a randomised controlled trial with blinded assessors and investigators. Eighty participants with chronic conditions and ADL problems are randomly allocated to ABLE or usual occupational therapy. Data for effectiveness and cost-effectiveness evaluations are collected at baseline (week 0), post intervention (week 10) and follow-up (week 26). Coprimary outcomes are self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)). Secondary outcomes are perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS). Explorative outcomes are occupational balance (Occupational Balance Questionnaire); perceived change (Client-Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument). The process evaluation is based on quantitative data from registration forms and qualitative interview data, collected during and after the intervention period. A realist evaluation approach is applied. A programme theory expresses how context (C) and mechanisms (M) in the programme may lead to certain outcomes (O), in so-called CMO configurations. Outcomes in the cost-effectiveness evaluation are quality-adjusted life years (EuroQool 5-dimension) and changes in ADL ability (AMPS, ADL-I). Costs are estimated from microcosting and national registers. ETHICS AND DISSEMINATION Danish Data Protection Service Agency approval: Journal-nr.: P-2020-203. The Ethical Committee confirmed no approval needed: Journal-nr.: 19 045 758. Dissemination for study participants, in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER NCT04295837.
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Affiliation(s)
- Vita Hagelskjær
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Occupational Therapy, VIA University College, Holstebro, Denmark
| | - Kristina Tomra Nielsen
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Cecilie von Bulow
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
- DEFACTUM, Department of Public Health and Rehabilitation, Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Maud Graff
- Department of Rehabilitation & Scientific Institute for Quality of Care Research, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eva Ejlersen Wæhrens
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
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Morgan K, Lewis J, Hawkins J, Moore G. From a research trial to routine practice: stakeholders' perceptions and experiences of referrals to the National Exercise Referral Scheme (NERS) in Wales. BMC Health Serv Res 2021; 21:1232. [PMID: 34774040 PMCID: PMC8590360 DOI: 10.1186/s12913-021-07266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Over ten years on from a randomised controlled trial and subsequent national roll-out, the National Exercise Referral Scheme (NERS) continues to be routinely delivered in primary care across Wales, UK. Few studies have revisited effective interventions years into their delivery in routine practice to understand how implementation, and perceived effects, have been maintained over time. This study explores perceptions and experiences of referral to NERS among referrers, scheme deliverers and patients. Methods Individual, semi-structured interviews were conducted with 50 stakeholders: scheme referrers (n = 9); scheme deliverers (n = 22); and referred patients (n = 19). Convenience sampling techniques were used to recruit scheme referrers and purposive sampling to recruit scheme deliverers and patients. Thematic analysis was employed. Results Analyses resulted in five key themes; referrer characteristics, geographical disparities in referral and scheme access, reinforcements for awareness of the scheme, patient characteristics and processes and context underpinning a referral. Overall there was a high concordance of views between all three stakeholder groups and barriers and facilitators were found to be entwined within and across themes. Referral barriers persisting since the earlier trial included a lack of consultation time and a lack of referral feedback. Newly identified barriers included a lack of scheme awareness and a referral system perceived to be time intensive and disjointed. Key referral facilitators included patient self-referrals, a growing scheme reputation and promotional activities of scheme deliverers. Conclusions Findings provide evidence that could inform the further development of NERS and wider exercise referral schemes to ensure the referral process is timely, efficient and equitable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07266-7.
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Affiliation(s)
- Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK.
| | - Jennifer Lewis
- School of Medicine, Cardiff University, Neuadd Meirionnydd, CF14 4YS, Cardiff, UK
| | - Jemma Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK
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Albert FA, Malau-Aduli AEO, Crowe MJ, Malau-Aduli BS. Australian patients' perception of the efficacy of the physical activity referral scheme (PARS). PATIENT EDUCATION AND COUNSELING 2021; 104:2803-2813. [PMID: 33941421 DOI: 10.1016/j.pec.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2021] [Accepted: 04/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Optimum physical activity (PA) interventions could be delivered via physical activity referral schemes (PARS) if utilised adequately. However, the evidence supporting PARS effectiveness is weak due to low uptake and non-adherence to interventions. OBJECTIVE Patients' experiences of PARS were explored to obtain in-depth insight into their perceived quality of care and practical ways to optimise the programme's effectiveness. METHODS A sequential explanatory mixed methods design was employed to probe cross-sectional quantitative survey data (n = 111) on patients' knowledge and beliefs about PA and PARS and qualitative interview data (n = 15) on their experiences of PARS. Informed by Donabedian framework of healthcare quality assessment, quantitative and qualitative findings were integrated to identify practical ways to enhance PARS effectiveness. RESULTS Participants displayed good PA knowledge, had positive beliefs and perceived PARS to be useful. Nonetheless, bottlenecks in the structure and process of PARS impact on patient health outcomes and hinder the programme's uptake. CONCLUSION Exploring other referral mechanisms into PARS such as self or nurse-initiated referrals could improve the programme's visibility and effectiveness. PRACTICE IMPLICATIONS Improved support, enhanced visibility of EPs, ongoing interactions between GPs and EPs and education about referral pathways would foster improved uptake, adherence and health outcomes for patients.
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Affiliation(s)
- Francis A Albert
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
| | - Aduli E O Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Melissa J Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey A, Lovell-Smith C, Gallanders J, Cooney JK, Williams N. 'Function First': how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods. BMJ Open 2021; 11:e046751. [PMID: 34315792 PMCID: PMC8317101 DOI: 10.1136/bmjopen-2020-046751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory. DESIGN Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation. RESULTS A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions. ABRIDGED REALIST PROGRAMME THEORY Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy. CO-DESIGN The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change. CONCLUSIONS Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | | | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Tensions and opportunities in social prescribing. Developing a framework to facilitate its implementation and evaluation in primary care: a realist review. BJGP Open 2021; 5:BJGPO.2021.0017. [PMID: 33849895 PMCID: PMC8278514 DOI: 10.3399/bjgpo.2021.0017] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS). Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice. Aim To define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorising and evaluating SP within primary care. Design & setting Realist review of secondary data from primary care-based SP schemes. Method Academic articles and grey literature were searched for qualitative and quantitative evidence following the Realist And Meta-narrative Evidence Syntheses — Evolving Standards (RAMESES). Common SP practices were characterised in three settings (general practice, link workers, and community sector) using archetypes that ranged from best to worst practice. Results A total of 140 studies were included for analysis. Resources were identified influencing the type and potential impact of SP practices and four dimensions were outlined in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, and knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, and transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy, accessibility, and continuity of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding, and suitable monitoring strategies). Findings were synthesised in a multilevel, dynamic, and usable SP framework. Conclusion The realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational, and policy resources are needed to ensure SP best practice in primary care.
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Roland CB, Knudsen SDP, Alomairah SA, Andersen AD, Bendix J, Clausen TD, Molsted S, Jensen AK, Teilmann G, Jespersen AP, Larsen JE, Hall GV, Andersen E, Barrès R, Mortensen OH, Maindal HT, Tarnow L, Løkkegaard ECL, Stallknecht B. Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol. BMJ Open 2021; 11:e043671. [PMID: 33741668 PMCID: PMC7986889 DOI: 10.1136/bmjopen-2020-043671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring. METHODS AND ANALYSIS A single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA. ETHICS AND DISSEMINATION The study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances. TRIAL REGISTRATION NUMBER NCT03679130. PROTOCOL VERSION This paper was written per the study protocol version 8 dated 28 August 2019.
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Affiliation(s)
- Caroline Borup Roland
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Signe de Place Knudsen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Andersen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jane Bendix
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Department of Paediatrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Astrid Pernille Jespersen
- The Saxo Institute, University of Copenhagen, Centre for Health Research in the Humanities, Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Emil Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Romain Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hartvig Mortensen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus Universitet, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lise Tarnow
- Steno Diabetes Center Copenhagen, Holbaek, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Bell J, Neubeck L, Jin K, Kelly P, Hanson CL. Understanding Leisure Centre-Based Physical Activity after Physical Activity Referral: Evidence from Scheme Participants and Completers in Northumberland UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062957. [PMID: 33805813 PMCID: PMC7998171 DOI: 10.3390/ijerph18062957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
Physical activity referral schemes (PARS) are a popular physical activity (PA) intervention in the UK. Little is known about the type, intensity and duration of PA undertaken during and post PARS. We calculated weekly leisure centre-based moderate/vigorous PA for PARS participants (n = 448) and PARS completers (n = 746) in Northumberland, UK, between March 2019–February 2020 using administrative data. We categorised activity levels (<30 min/week, 30–149 min/week and ≥150 min/week) and used ordinal regression to examine predictors for activity category achieved. PARS participants took part in a median of 57.0 min (IQR 26.0–90.0) and PARS completers a median of 68.0 min (IQR 42.0–100.0) moderate/vigorous leisure centre-based PA per week. Being a PARS completer (OR: 2.14, 95% CI: 1.61–2.82) was a positive predictor of achieving a higher level of physical activity category compared to PARS participants. Female PARS participants were less likely (OR: 0.65, 95% CI: 0.43–0.97) to achieve ≥30 min of moderate/vigorous LCPA per week compared to male PARS participants. PARS participants achieved 38.0% and PARS completers 45.3% of the World Health Organisation recommended ≥150 min of moderate/vigorous weekly PA through leisure centre use. Strategies integrated within PARS to promote PA outside of leisure centre-based activity may help participants achieve PA guidelines.
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Affiliation(s)
- Jordan Bell
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4DN, UK; (L.N.); (C.L.H.)
- Correspondence:
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4DN, UK; (L.N.); (C.L.H.)
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia
| | - Kai Jin
- Centre for Medical Informatics, University of Edinburgh, Edinburgh EH16 4UX, UK;
| | - Paul Kelly
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK;
| | - Coral L. Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4DN, UK; (L.N.); (C.L.H.)
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Multi-Stakeholder Retrospective Acceptability of a Peer Support Intervention for Exercise Referral. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041720. [PMID: 33578966 PMCID: PMC7916654 DOI: 10.3390/ijerph18041720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
Perceived social support opportunities are central to successful exercise referral scheme (ERS) client experiences. However, there remains a lack of guidance on how ERSs can embed social support opportunities within their provision. This study presents retrospective acceptability findings from a 12-week social-identity-informed peer support intervention to enhance perceived social support among clients of an English ERS. Five peer volunteers were recruited, trained, and deployed in supervised ERS sessions across two sites. Peers assisted exercise referral officers (EROs) by providing supplementary practical, informational, motivational, and emotional support to ERS clients. Individual semi-structured interviews were conducted with peers (n = 4), EROs (n = 2), and clients (n = 5) and analysed thematically. The analysis identified three primary themes. The first theme detailed how EROs utilised peer volunteers to supplement the ERS client experience. This theme delineated peer roles within the ERS context and identified salient individual peer characteristics that contributed to their success. The second theme described peer acceptability among the various stakeholders. Peers were valued for their ability to reduce burden on EROs and to enhance perceptions of comfort among ERS clients. The final theme presented participant feedback regarding how the intervention may be further refined and enhanced. Peers represented a cost-effective and acceptable means of providing auxiliary social support to ERS clients. Moving forward, the structured integration of peers can improve the accessibility of social support among ERS participants, thus facilitating better rates of ERS completion.
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Hanson CL, Neubeck L, Kyle RG, Brown N, Gallagher R, Clark RA, McHale S, Dawkes S. Gender Differences in Uptake, Adherence and Experiences: A Longitudinal, Mixed-Methods Study of a Physical Activity Referral Scheme in Scotland, UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041700. [PMID: 33578836 PMCID: PMC7916623 DOI: 10.3390/ijerph18041700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/20/2022]
Abstract
Physical activity referral schemes (PARS) are implemented internationally to increase physical activity (PA), but evidence of effectiveness for population subgroups is equivocal. We examined gender differences for a Scottish PARS. This mixed-methods, concurrent longitudinal study had equal status quantitative and qualitative components. We conducted 348 telephone interviews across three time points (pre-scheme, 12 and 52 weeks). These included validated self-reported PA and exercise self-efficacy measures and open-ended questions about experiences. We recruited 136 participants, of whom 120 completed 12-week and 92 completed 52-week interviews. PARS uptake was 83.8% (114/136), and 12-week adherence for those who started was 43.0% (49/114). Living in less deprived areas was associated with better uptake (p = 0.021) and 12-week adherence (p = 0.020), and with male uptake (p = 0.024) in gender-stratified analysis. Female adherers significantly increased self-reported PA at 12 weeks (p = 0.005) but not 52 weeks. Males significantly increased exercise self-efficacy between baseline and 52 weeks (p = 0.009). Three qualitative themes and eight subthemes developed; gender perspectives, personal factors (health, social circumstances, transport and attendance benefits) and scheme factors (communication, social/staff support, individualisation and age appropriateness). Both genders valued the PARS. To increase uptake, adherence and PA, PARS should ensure timely, personalised communication, individualised, affordable PA and include mechanisms to re-engage those who disengage temporarily.
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Affiliation(s)
- Coral L. Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
- Correspondence: ; Tel.: +44-131-455-3457
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
- Sydney Nursing School, Charles Perkins Centre, Johns Hopkins Road, University of Sydney, Sydney, NSW 2006, Australia;
| | - Richard G. Kyle
- Research & Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff CF10 4BZ, UK;
| | - Norrie Brown
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
| | - Robyn Gallagher
- Sydney Nursing School, Charles Perkins Centre, Johns Hopkins Road, University of Sydney, Sydney, NSW 2006, Australia;
| | - Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5001, Australia;
| | - Sheona McHale
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
- School of Nursing, Midwifery and Paramedic Practice, Garthdee Campus, Robert Gordon University, Aberdeen AB10 7QE, UK
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17
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Hanson CL, Oliver EJ, Dodd-Reynolds CJ, Pearsons A, Kelly P. A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS). Int J Behav Nutr Phys Act 2020; 17:158. [PMID: 33267840 PMCID: PMC7709269 DOI: 10.1186/s12966-020-01050-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes. Methods We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy. Results Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change). Conclusion Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-020-01050-2.
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Affiliation(s)
- Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK.
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, DH1 3HN, UK
| | | | - Alice Pearsons
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, EH8 8AQ, UK
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18
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Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Functionality of Physical Activity Referral Schemes (PARS): A Systematic Review. Front Public Health 2020; 8:257. [PMID: 32671011 PMCID: PMC7329989 DOI: 10.3389/fpubh.2020.00257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Physical activity (PA) is vital to maintaining good health. However, WHO estimates that 60% of the world's population are inadequately active. To enhance PA, Physical Activity Referral Schemes (PARS) have been established by some countries. Objective: This study examined the functionality of the PARS process across different countries. Methods: This systematic review was performed and reported in accordance with the PRISMA guidelines. Sixteen electronic databases were searched from January 1990 to May 2020. PARS studies, published in English language and in peer-reviewed journals, that reported adherence, outcomes, disease conditions, interventions, facilitators and barriers, were included in this review. Results: Twenty-seven studies conducted across eight countries met the inclusion criteria. Most patients were referred for sedentary/inactivity reasons and supervised group-based activities was the most used intervention. Participants' average adherence rate was 77.5%. Adherence was either facilitated or hindered by type of support provided during and after intervention period. Inclusion of PA allied health specialist in the intervention enhanced positive health outcomes. Conclusion: PARS is a key driver and motivator for individuals to undertake and adhere to PA interventions. Utilization of guidelines on evidence-based interventional PA for different types of diseases, effective use of common group supervised activities and the involvement of PA specialists may aid PA adherence and foster positive health outcomes.
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Affiliation(s)
- Francis Ali Albert
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Melissa J Crowe
- Division of Tropical Health and Medicine, James Cook University, Douglas, QLD, Australia
| | - Aduli E O Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, QLD, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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Husk K, Blockley K, Lovell R, Bethel A, Lang I, Byng R, Garside R. What approaches to social prescribing work, for whom, and in what circumstances? A realist review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:309-324. [PMID: 31502314 PMCID: PMC7027770 DOI: 10.1111/hsc.12839] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 05/06/2023]
Abstract
The use of non-medical referral, community referral or social prescribing interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of 'if-then' statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web-based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.
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Affiliation(s)
- Kerryn Husk
- NIHR CLAHRC South West Peninsula (PenCLAHRC)Faculty of Medicine and DentistryUniversity of PlymouthPlymouthUK
| | - Kelly Blockley
- NIHR CLAHRC South West Peninsula (PenCLAHRC)College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rebecca Lovell
- European Centre for Environment and Human HealthCollege of Medicine and HealthUniversity of ExeterExeterUK
| | - Alison Bethel
- NIHR CLAHRC South West Peninsula (PenCLAHRC)College of Medicine and HealthUniversity of ExeterExeterUK
| | - Iain Lang
- NIHR CLAHRC South West Peninsula (PenCLAHRC)College of Medicine and HealthUniversity of ExeterExeterUK
| | - Richard Byng
- NIHR CLAHRC South West Peninsula (PenCLAHRC)Faculty of Medicine and DentistryUniversity of PlymouthPlymouthUK
| | - Ruth Garside
- European Centre for Environment and Human HealthCollege of Medicine and HealthUniversity of ExeterExeterUK
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20
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Scott SD, Rotter T, Flynn R, Brooks HM, Plesuk T, Bannar-Martin KH, Chambers T, Hartling L. Systematic review of the use of process evaluations in knowledge translation research. Syst Rev 2019; 8:266. [PMID: 31699136 PMCID: PMC6836407 DOI: 10.1186/s13643-019-1161-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/13/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Experimental designs for evaluating knowledge translation (KT) interventions can provide strong estimates of effectiveness but offer limited insight into how the intervention worked. Consequently, process evaluations have been used to explore the causal mechanisms at work; however, there are limited standards to guide this work. This study synthesizes current evidence of KT process evaluations to provide future methodological recommendations. METHODS Peer-reviewed search strategies were developed by a health research librarian. Studies had to be in English, published since 1996, and were not excluded based on design. Studies had to (1) be a process evaluation of a KT intervention study in primary health, (2) be a primary research study, and (3) include a licensed healthcare professional delivering or receiving the intervention. A two-step, two-person hybrid screening approach was used for study inclusion with inter-rater reliability ranging from 94 to 95%. Data on study design, data collection, theoretical influences, and approaches used to evaluate the KT intervention, analysis, and outcomes were extracted by two reviewers. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). RESULTS Of the 20,968 articles screened, 226 studies fit our inclusion criteria. The majority of process evaluations used qualitative forms of data collection (43.4%) and individual interviews as the predominant data collection method. 72.1% of studies evaluated barriers and/or facilitators to implementation. 59.7% of process evaluations were stand-alone evaluations. The timing of data collection varied widely with post-intervention data collection being the most frequent (46.0%). Only 38.1% of the studies were informed by theory. Furthermore, 38.9% of studies had MMAT scores of 50 or less indicating poor methodological quality. CONCLUSIONS There is widespread acceptance that the generalizability of quantitative trials of KT interventions would be significantly enhanced through complementary process evaluations. However, this systematic review found that process evaluations are of mixed quality and lack theoretical guidance. Most process evaluation data collection occurred post-intervention undermining the ability to evaluate the process of implementation. Strong science and methodological guidance is needed to underpin and guide the design and execution of process evaluations in KT science. REGISTRATION This study is not registered with PROSPERO.
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Affiliation(s)
- Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Thomas Rotter
- School of Nursing, Queen’s University, Kingston, Ontario Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Hannah M. Brooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Tabatha Plesuk
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | | | - Thane Chambers
- University of Alberta Libraries, Edmonton, Alberta Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
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21
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Hawkins J, Charles JM, Edwards M, Hallingberg B, McConnon L, Edwards RT, Jago R, Kelson M, Morgan K, Murphy S, Oliver EJ, Simpson SA, Moore G. Acceptability and Feasibility of Implementing Accelorometry-Based Activity Monitors and a Linked Web Portal in an Exercise Referral Scheme: Feasibility Randomized Controlled Trial. J Med Internet Res 2019; 21:e12374. [PMID: 30924791 PMCID: PMC6460312 DOI: 10.2196/12374] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 01/22/2023] Open
Abstract
Background Exercise referral schemes (ERSs) are recommended for patients with health conditions or risk factors. Evidence points to the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, but effects often diminish over time. Techniques such as goal setting, self-monitoring, and personalized feedback may support motivation for physical activity and maintenance of effects. Wearable technologies could provide an opportunity to integrate motivational techniques into exercise schemes. However, little is known about acceptability to exercise referral populations or implementation feasibility within exercise referral services. Objective To determine the feasibility and acceptability of implementing an activity-monitoring device within the Welsh National ERS to inform a decision on whether and how to proceed to an effectiveness trial. Methods We conducted a feasability randomized controlled trial with embedded mixed-methods process evaluation and an exploratory economic analysis. Adults (N=156) were randomized to intervention (plus usual practice; n=88) or usual practice only (n=68). Usual practice was a 16-week structured exercise program. The intervention group additionally received an accelerometry-based activity monitor (MyWellnessKey) and associated Web platform (MyWellnessCloud). The primary outcomes were predefined progression criteria assessing acceptability and feasibility of the intervention and proposed evaluation. Postal questionnaires were completed at baseline (time 0:T0), 16 weeks (T1), and 12 months after T0 (T2). Routine data were accessed at the same time-points. A subsample of intervention participants and scheme staff were interviewed following the initiation of intervention delivery and at T2. Results Participants were on average aged 56.6 (SD 16.3) years and mostly female (101/156, 64.7%) and white (150/156, 96.2%). Only 2 of 5 progression criteria were met; recruitment and randomization methods were acceptable to participants, and contamination was low. However, recruitment and retention rates (11.3% and 67.3%, respectively) fell substantially short of target criteria (20% and 80%, respectively), and disproportionally recruited from the least deprived quintile. Only 57.4% of intervention participants reported receipt of the intervention (below the 80% progression threshold). Less than half reported the intervention to be acceptable at T2. Participant and staff interviews revealed barriers to intervention delivery and engagement related to the device design as well as context-specific technological challenges, all of which made it difficult to integrate the technology into the service. Routinely collected health economic measures had substantial missing data, suggesting that other methods for collecting these should be used in future. Conclusions To our knowledge, this is the first study to evaluate short- and long-term feasibility and acceptability of integrating wearable technologies into community-based ERSs. The findings highlight device- and context-specific barriers to doing this in routine practice, with typical exercise referral populations. Key criteria for progression to a full-scale evaluation were not met. Trial Registration ISRCTN Registry ISRCTN85785652; http://www.isrctn.com/ISRCTN85785652
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Affiliation(s)
- Jemma Hawkins
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Michelle Edwards
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Britt Hallingberg
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Linda McConnon
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Mark Kelson
- Institute for Data Science and Artificial Intelligence, School of Mathematics, University of Exeter, Exeter, United Kingdom
| | - Kelly Morgan
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, United Kingdom
| | - Sharon A Simpson
- Medical Research Council and Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Graham Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Eynon M, Foad J, Downey J, Bowmer Y, Mills H. Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review. Scand J Med Sci Sports 2019; 29:638-650. [PMID: 30742334 DOI: 10.1111/sms.13403] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/04/2018] [Accepted: 02/05/2019] [Indexed: 12/30/2022]
Abstract
This paper aimed to systematically review the evidence base to uncover the key psychosocial factors that underpin adherence to an exercise referral scheme (ERS). Databases PsycINFO, MEDLINE, SPORTDiscus, Web of Science, PubMed, PsycARTICLES, Open Grey, and PsycEXTRA were systematically searched. A parallel results-based convergent synthesis was performed by identifying key themes from quantitative and qualitative studies separately. After applying inclusion and exclusion criteria, the review included 24 eligible studies. Key findings showed intrinsic motivation, psychological need satisfaction, social support, and self-efficacy to be the prominent psychosocial factors associated with ERS adherence. In addition, lower expectations for change when entering the scheme was associated with ERS adherence. This review should serve as a catalyst to provide evidence-based ERS and as such ERS providers should seek to place an emphasis on participants' expectations and beliefs when entering the scheme. Moreover, targeting the key factors of intrinsic motivation, psychological need satisfaction, social support, and self-efficacy throughout the duration of an ERS should serve to facilitate adherence.
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Affiliation(s)
- Michael Eynon
- Faculty of Sport, Health & Applied Science, St Mary's University, Twickenham, London, UK
| | - Jessica Foad
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - John Downey
- Faculty of Sport, Health & Applied Science, St Mary's University, Twickenham, London, UK
| | - Yasmin Bowmer
- Faculty of Sport, Health & Applied Science, St Mary's University, Twickenham, London, UK
| | - Hayley Mills
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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23
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Birtwistle SB, Ashcroft G, Murphy R, Gee I, Poole H, Watson PM. Factors influencing patient uptake of an exercise referral scheme: a qualitative study. HEALTH EDUCATION RESEARCH 2019; 34:113-127. [PMID: 30307496 DOI: 10.1093/her/cyy038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/21/2018] [Indexed: 06/08/2023]
Abstract
Exercise referral schemes aim to increase physical activity amongst inactive individuals with or at risk of long-term health conditions. Yet many patients referred to these schemes (by health professionals) fail to take up the exercise opportunities on offer. Understanding factors influencing uptake to exercise referral schemes may help improve future attendance. Using the Socio-Ecological Model as a framework, this qualitative study aimed to explore factors influencing uptake to an exercise referral scheme based in the North West of England. Semi-structured interviews were conducted with referred patients (n = 38) about their reasons for referral, interactions with referring health professionals, events following referral and ideas to improve future uptake. Data were analysed thematically and mapped onto the constructs of the Socio-Ecological Model. Factors reported to influence uptake included intrapersonal (past PA experiences, motivation, competing priorities), interpersonal (scheme explanations, support) and organizational influences (scheme promotion, communication between service, cost). Whilst several intrapersonal-level factors influenced patient decisions to uptake the exercise referral scheme, modifiable interpersonal and organizational factors were identified as potential targets for intervention. Recommendations are made for improving awareness of exercise referral schemes and for enhancing communication between referring practitioners, patients and referral scheme staff.
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Affiliation(s)
- S B Birtwistle
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - G Ashcroft
- School of Natural Sciences and Psychology, Liverpool John Moores University, UK
| | - R Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - I Gee
- Public Health Institute, Liverpool John Moores University, UK
| | - H Poole
- School of Natural Sciences and Psychology, Liverpool John Moores University, UK
| | - P M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
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24
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Roberts JL, Pritchard AW, Williams M, Totton N, Morrison V, Din NU, Williams NH. Mixed methods process evaluation of an enhanced community-based rehabilitation intervention for elderly patients with hip fracture. BMJ Open 2018; 8:e021486. [PMID: 30093516 PMCID: PMC6089270 DOI: 10.1136/bmjopen-2018-021486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe the implementation of an enhanced rehabilitation programme for elderly hip fracture patients with mental capacity, in a randomised feasibility study compared with usual rehabilitation. To compare processes between the two and to collect the views of patients, carers and therapy staff about trial participation. DESIGN Mixed methods process evaluation in a randomised feasibility study. SETTING Patient participants were recruited on orthopaedic and rehabilitation wards; the intervention was delivered in the community following hospital discharge. PARTICIPANTS Sixty-one older adults (aged ≥65 years) recovering from surgical treatment (replacement arthroplasty or internal fixation) following hip fracture, who were living independently prior to fracture and had mental capacity and 31 of their carers. INTERVENTIONS Usual care (control) or usual care plus an enhanced rehabilitation package (intervention). The enhanced rehabilitation consisted of a patient-held information workbook, goal-setting diary and up to six additional therapy sessions. PROCESS EVALUATION COMPONENTS Recruitment of sites and rehabilitation teams, response of rehabilitation teams, recruitment and reach in patient and carer participants, intervention delivery, delivery to individuals, response of individual patients to the enhanced intervention or usual rehabilitation, response of carer participants, unintended consequences and testing intervention theory and context. RESULTS Usual rehabilitation care was very variable. The enhanced rehabilitation group received a mean of five additional therapy sessions. All of the returned goal-setting diaries had inputs from the therapy team, and half had written comments by the patients and carers. Focus group themes: variation of usual care and its impact on delivering the intervention; the importance of goal setting; the role of the therapist in providing reassurance about safe physical activities; and acceptability of the extra therapy sessions. CONCLUSIONS Lessons learnt for a future definitive RCT include how to enhance recruitment and improve training materials, the workbook, delivery of the extra therapy sessions and recording of usual rehabilitation care. TRIAL REGISTRATION NUMBER ISRCTN22464643; Post- results.
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Affiliation(s)
| | - Aaron W Pritchard
- Research and Development Department, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | | | - Nikki Totton
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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25
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Hubbard G, Campbell A, Fisher A, Harvie M, Maltinsky W, Mullen R, Banks E, Gracey J, Gorely T, Munro J, Ozakinci G. Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation. Pilot Feasibility Stud 2018; 4:108. [PMID: 29881639 PMCID: PMC5984397 DOI: 10.1186/s40814-018-0297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/15/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physical activity (PA) programmes effective under 'research' conditions may not be effective under 'real-world' conditions. A potential solution is to refer patients to existing PA community-based PA services. METHODS A process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-delivered PA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD. RESULTS In Phase I, 30% (n = 20) of eligible patients (n = 20) consented, 85% (n = 17) chose referral to leisure centre, and 15% (n = 3) chose cardiac rehabilitation. In Phase II, 32% (n = 12) consented, 25% (n = 3) chose leisure centre and 75% (n = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends. CONCLUSIONS The current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity. TRIAL REGISTRATION ISRCTN11183372.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK
| | - Anna Campbell
- School of Life Science, Sport and Social Science, Edinburgh Napier University, Edinburgh, EH11 4B Scotland UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT England UK
| | - Michelle Harvie
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital, Manchester, England UK
| | - Wendy Maltinsky
- Division of Health Research, Rural Health & Wellbeing, University of the Highlands and Islands, An Lòchran, Inverness Campus, Inverness, IV2 5NA Scotland UK
| | - Russell Mullen
- Highland Breast Centre, NHS Highland, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ Scotland UK
| | - Elspeth Banks
- National Cancer Research Institute, Clinical Studies Group, Angel Building, 407 St John Street, London, EC1V 4AD England UK
| | - Jackie Gracey
- School of Health Sciences, Ulster University, Jordanstown campus, Shore Road, 7, Newtown Abbey, County Antrim, BT37 OQB Northern Ireland UK
| | - Trish Gorely
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK
| | - Julie Munro
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK
| | - Gozde Ozakinci
- School of Medicine, Medical & Biological Sciences, University of St Andrews, North Haugh, St Andrews, KY16 9TF Scotland UK
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26
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Hawkins J, Edwards M, Charles J, Jago R, Kelson M, Morgan K, Murphy S, Oliver E, Simpson S, Edwards RT, Moore G. Protocol for a feasibility randomised controlled trial of the use of Physical ACtivity monitors in an Exercise Referral Setting: the PACERS study. Pilot Feasibility Stud 2017; 3:51. [PMID: 29238607 PMCID: PMC5725949 DOI: 10.1186/s40814-017-0194-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/24/2017] [Indexed: 12/04/2022] Open
Abstract
Background Exercise referral schemes are recommended by the National Institute for Clinical Excellence (NICE) for physical activity promotion among inactive patients with health conditions or risk factors. Whilst there is evidence for the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, evidence of long-term effects is limited. Techniques such as goal setting, self-monitoring and personalised feedback may support motivation for physical activity. Technologies such as activity monitoring devices provide an opportunity to enhance delivery of motivational techniques. This paper describes the PACERS study protocol, which aims to assess the feasibility and acceptability of implementing an activity monitor within the existing Welsh National Exercise Referral Scheme (NERS) and proposed evaluation methodology for a full-scale randomised controlled trial. Methods/design The PACERS study consists of a pilot randomised controlled trial, process evaluation and exploratory economic analyses. Participants will be recruited from the generic pathway of the Welsh NERS and will be randomly assigned to receive the intervention or usual practice. Usual practice is a 16-week structured exercise programme; the intervention consists of an accelerometry-based activity monitor (MyWellnessKey) and an associated web platform (MyWellnessCloud). The primary outcomes are predefined progression criteria assessing the acceptability and feasibility of the intervention and feasibility of the proposed evaluation methodology. Postal questionnaires will be completed at baseline (time 0: T0), 16 weeks after T0 (T1) and 12 months after T0 (T2). Routinely collected data will also be accessed at the same time points. A sub-sample of intervention participants and exercise referral staff will be interviewed following initiation of intervention delivery and at the end of the study. Discussion The PACERS study seeks to assess the feasibility of adding a novel motivational component to an existing effective intervention in order to enhance effects on physical activity and support longer-term maintenance. The study will provide insight into the acceptability of activity-monitoring technologies to an exercise referral population and delivery staff. Data from this study will be used to determine whether and how to proceed to a full-scale trial of effectiveness of the intervention, including any necessary refinements to intervention implementation or the proposed evaluation methodology. Trial registration ISRCTN85785652
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Affiliation(s)
- Jemma Hawkins
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD UK
| | - Michelle Edwards
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD UK
| | - Joanna Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ UK
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, BS8 1TZ UK
| | - Mark Kelson
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS UK
| | - Kelly Morgan
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD UK
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD UK
| | - Emily Oliver
- School of Applied Social Sciences, Durham University, Durham, DH1 3HN UK
| | - Sharon Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G2 3QB UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ UK
| | - Graham Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD UK
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Lambert JD, Greaves CJ, Farrand P, Cross R, Haase AM, Taylor AH. Assessment of fidelity in individual level behaviour change interventions promoting physical activity among adults: a systematic review. BMC Public Health 2017; 17:765. [PMID: 28969669 PMCID: PMC5625828 DOI: 10.1186/s12889-017-4778-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behaviour change interventions that promote physical activity have major implications for health and well-being. Measuring intervention fidelity is crucial in determining the extent to which an intervention is delivered as intended, therefore increasing scientific confidence about effectiveness. However, we lack a clear overview of how well intervention fidelity is typically assessed in physical activity trials. METHODS A systematic literature search was conducted to identify peer - reviewed physical activity promotion trials that explicitly measured intervention fidelity. Methods used to assess intervention fidelity were categorised, narratively synthesised and critiqued using assessment criteria from NIH Behaviour Change Consortium (BCC) Treatment Fidelity Framework (design, training, delivery, receipt and enactment). RESULTS Twenty eight articles reporting of twenty one studies used a wide variety of approaches to measure intervention fidelity. Delivery was the most common domain of intervention fidelity measured. Approaches used to measure fidelity across all domains varied from researcher coding of observational data (using checklists or scales) to participant self-report measures. There was considerable heterogeneity of methodological approaches to data collection with respect to instruments used, attention to psychometric properties, rater-selection, observational method and sampling strategies. CONCLUSIONS In the field of physical activity interventions, fidelity measurement is highly heterogeneous both conceptually and methodologically. Clearer articulation of the core domains of intervention fidelity, along with appropriate measurement approaches for each domain are needed to improve the methodological quality of fidelity assessment in physical activity interventions. Recommendations are provided on how this situation can be improved.
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Affiliation(s)
- Jeffrey D. Lambert
- University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Colin J. Greaves
- University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, EX4 4QG UK
| | - Rosina Cross
- Department for Health, University of Bath, Wessex House 6.9, Claverton, Bath, BA2 7AY UK
| | - Anne M. Haase
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Adrian H. Taylor
- Plymouth University, N6, ITTC, Tamar Science Park, Plymouth, Devon PL6 8BX UK
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Webb R, Hughes MG, Thomas AW, Morris K. The Ability of Exercise-Associated Oxidative Stress to Trigger Redox-Sensitive Signalling Responses. Antioxidants (Basel) 2017; 6:antiox6030063. [PMID: 28796154 PMCID: PMC5618091 DOI: 10.3390/antiox6030063] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/17/2022] Open
Abstract
In this review, we discuss exercise as an oxidative stressor, and elucidate the mechanisms and downstream consequences of exercise-induced oxidative stress. Reactive oxygen species (ROS) are generated in the mitochondria of contracting skeletal myocytes; also, their diffusion across the myocyte membrane allows their transport to neighbouring muscle tissue and to other regions of the body. Although very intense exercise can induce oxidative damage within myocytes, the magnitudes of moderate-intensity exercise-associated increases in ROS are quite modest (~two-fold increases in intracellular and extracellular ROS concentrations during exercise), and so the effects of such increases are likely to involve redox-sensitive signalling effects rather than oxidative damage. Therefore, the responses of muscle and non-muscle cells to exercise-associated redox-sensitive signalling effects will be reviewed; for example, transcription factors such as Peroxisome Proliferator Activated Receptor-gamma (PPARγ) and Liver X-Receptor-alpha (LXRα) comprise redox-activable signalling systems, and we and others have reported exercise-associated modulation of PPARγ and/or LXRα-regulated genes in skeletal myocyte and in non-muscle cell-types such as monocyte-macrophages. Finally, the consequences of such responses in the context of management of chronic inflammatory conditions, and also their implications for the design of exercise training programmes (particularly the use of dietary antioxidants alongside exercise), will be discussed.
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Affiliation(s)
- Richard Webb
- Department of Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
| | - Michael G Hughes
- Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff CF23 6XD, UK.
| | - Andrew W Thomas
- Department of Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
| | - Keith Morris
- Department of Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
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29
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Fletcher A, Jamal F, Moore G, Evans RE, Murphy S, Bonell C. Realist complex intervention science: Applying realist principles across all phases of the Medical Research Council framework for developing and evaluating complex interventions. EVALUATION (LONDON, ENGLAND : 1995) 2016; 22:286-303. [PMID: 27478401 PMCID: PMC4946011 DOI: 10.1177/1356389016652743] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The integration of realist evaluation principles within randomised controlled trials ('realist RCTs') enables evaluations of complex interventions to answer questions about what works, for whom and under what circumstances. This allows evaluators to better develop and refine mid-level programme theories. However, this is only one phase in the process of developing and evaluating complex interventions. We describe and exemplify how social scientists can integrate realist principles across all phases of the Medical Research Council framework. Intervention development, modelling, and feasibility and pilot studies need to theorise the contextual conditions necessary for intervention mechanisms to be activated. Where interventions are scaled up and translated into routine practice, realist principles also have much to offer in facilitating knowledge about longer-term sustainability, benefits and harms. Integrating a realist approach across all phases of complex intervention science is vital for considering the feasibility and likely effects of interventions for different localities and population subgroups.
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Affiliation(s)
| | | | | | | | | | - Chris Bonell
- London School of Hygiene & Tropical Medicine, UK
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Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Woods H, Anokye N, Tappenden P, Kaltenthaler E. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. Health Technol Assess 2016. [PMID: 26222987 DOI: 10.3310/hta19600] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs), in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and, therefore, may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care. DESIGN Exhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled, meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD), stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon, and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits. RESULTS The search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Pavey et al. [Pavey TG, Anokye N, Taylor AH, Trueman P, Moxham T, Fox KR, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess 2011;15(44)] to give a total of eight studies with 5190 participants. The proportion of individuals achieving 90-150 minutes of at least moderate-intensity activity per week at 6-12 months' follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). Older patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. Exercise referral gained 0.003 quality-adjusted life-years (QALYs) at an additional cost of £225 per person. The estimated mean incremental cost-effectiveness ratio (ICER) in the probabilistic sensitivity analysis was £76,276. In the univariate sensitivity analysis the results were very sensitive (ICERs ranged from < £30,000 to > £100,000) to changes in the effect of ERSs on physical activity uptake and the duration of the protective effects and the direct health-related quality-of-life gains attributable to physical activity. CONCLUSIONS Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. The cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005200. FUNDING National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Fiona Campbell
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike Holmes
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Everson-Hock
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nana Anokye
- Health Economics Research Group (HERG), Brunel University, Uxbridge, UK
| | - Paul Tappenden
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Morgan F, Battersby A, Weightman AL, Searchfield L, Turley R, Morgan H, Jagroo J, Ellis S. Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators. BMC Public Health 2016; 16:227. [PMID: 26944952 PMCID: PMC4779205 DOI: 10.1186/s12889-016-2882-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS) continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE) on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Methods Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were ‘inactive’ (i.e. they are not currently meeting UK physical activity guidelines). Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). Results Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and ‘making exercise a habit’ post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a dislike of the music and TV and a lack of confidence in operating gym equipment were frequently reported. Conclusions These findings provide valuable insights that commissioners and providers should consider. The main themes were consistent across a large number of studies and further research should concentrate on programmes that reflect these findings.
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Affiliation(s)
- Fiona Morgan
- Specialist Unit for Review Evidence (SURE), Cardiff University,1st Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK.
| | - Alysia Battersby
- Specialist Unit for Review Evidence (SURE), Cardiff University,1st Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK.
| | - Alison L Weightman
- Specialist Unit for Review Evidence (SURE), Cardiff University,1st Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK.
| | - Lydia Searchfield
- Specialist Unit for Review Evidence (SURE), Cardiff University,1st Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK.
| | - Ruth Turley
- Specialist Unit for Review Evidence (SURE), Cardiff University,1st Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK.
| | - Helen Morgan
- Specialist Unit for Review Evidence (SURE), Cardiff University,1st Floor, Neuadd Meirionnydd, Heath Park Campus, Cardiff, CF14 4YS, UK.
| | - James Jagroo
- National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BD, UK.
| | - Simon Ellis
- National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BD, UK.
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Webb R, Thompson JES, Ruffino JS, Davies NA, Watkeys L, Hooper S, Jones PM, Walters G, Clayton D, Thomas AW, Morris K, Llewellyn DH, Ward M, Wyatt-Williams J, McDonnell BJ. Evaluation of cardiovascular risk-lowering health benefits accruing from laboratory-based, community-based and exercise-referral exercise programmes. BMJ Open Sport Exerc Med 2016; 2:e000089. [PMID: 27900165 PMCID: PMC5117059 DOI: 10.1136/bmjsem-2015-000089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/22/2015] [Accepted: 01/01/2016] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate the ability of community-based exercise programmes to facilitate public participation in exercise and hence improved cardiovascular health, we assessed the respective impacts of: a continuously monitored exercise programme based within our university (study 1); a Valleys Regional Park-facilitated community-based outdoor exercise programme (study 2); a Wales National Exercise Referral Scheme-delivered exercise-referral programme (study 3). Methods Biomolecular (monocytic PPARγ target gene expression), vascular haemodynamic (central/peripheral blood pressure, arterial stiffness), clinical (insulin sensitivity, blood lipids) and anthropometric (body mass index, waist circumference, heart rate) parameters were investigated using RT-PCR, applanation tonometry, chemical analysis and standard anthropometric techniques. Results In studies 1–3, 22/28, 32/65 and 11/14 participants adhered to their respective exercise programmes, and underwent significant increases in physical activity levels. Importantly, beneficial effects similar to those seen in our previous studies (eg, modulations in expression of monocytic PPARγ target genes, decreases in blood pressure/arterial stiffness, improvements in blood lipids/insulin sensitivity) were observed (albeit to slightly differing extents) only in participants who adhered to their respective exercise programmes. While study 1 achieved more intense exercise and more pronounced beneficial effects, significant cardiovascular risk-lowering health benefits related to biomolecular markers, blood pressure, arterial stiffness and blood lipids were achieved via community/referral-based delivery modes in studies 2 and 3. Conclusions Because cardiovascular health benefits were observed in all 3 studies, we conclude that the majority of benefits previously reported in laboratory-based studies can also be achieved in community-based/exercise-referral settings. These findings may be of use in guiding policymakers with regard to introduction and/or continued implementation of community/referral-based exercise programmes.
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Affiliation(s)
- R Webb
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - J E S Thompson
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - J-S Ruffino
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - N A Davies
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - L Watkeys
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - S Hooper
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - P M Jones
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - G Walters
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - D Clayton
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - A W Thomas
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - K Morris
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - D H Llewellyn
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
| | - M Ward
- Blaengad Ltd , Wales , UK
| | - J Wyatt-Williams
- Department of Public Health Wales , Hayden Ellis Building , Cardiff , UK
| | - B J McDonnell
- Department of Biomedical Sciences , Cardiff Metropolitan University , Cardiff , UK
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Din NU, Moore GF, Murphy S, Wilkinson C, Williams NH. Health professionals' perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales. HEALTH EDUCATION JOURNAL 2015; 74:743-757. [PMID: 26527835 PMCID: PMC4604423 DOI: 10.1177/0017896914559785] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. DESIGN Qualitative semi-structured group interviews. SETTING General practice premises. METHODS Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. RESULTS Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smoking cessation. Professionals linked decisions on whether to advise physical activity to patients to their own physical activity levels and to subjective judgements of patient motivation. While some described ERS as a holistic alternative to medication, with potential social benefits, others expressed concerns regarding their limited reach and potential to exacerbate inequalities. Barriers to referral included geographic isolation and uncertainties about patient selection criteria, medico-legal responsibilities and a lack of feedback about patient progress. CONCLUSION Clinicians' concerns about expertise, priority setting and time constraints should be addressed to enhance physical activity promotion in primary care. Further research is needed to fully understand decision making relating to provision of physical activity advice and use of ERS.
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Affiliation(s)
- Nafees U Din
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, Wales, UK
| | - Graham F Moore
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Wales, UK
| | - Simon Murphy
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Wales, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, Wales, UK
| | - Nefyn H Williams
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, Wales, UK
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Littlecott HJ, Moore GF, Moore L, Murphy S. Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11:109. [PMID: 25209188 PMCID: PMC4173052 DOI: 10.1186/s12966-014-0109-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 08/18/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes. METHODS A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning. RESULTS Significant intervention effects were found for autonomous motivation and social support for exercise at 6 months. No intervention effect was observed for self-efficacy. The data are consistent with a hypothesis of partial mediation of the intervention effect by autonomous motivation. Analysis of moderators showed significant improvements in relative autonomy in all subgroups. The greatest improvements in autonomous motivation were observed among patients who were least active at baseline. DISCUSSION The present study offered key insights into psychosocial processes of change in an exercise referral scheme, with effects on physical activity mediated by autonomous motivation. Findings support the use of self-determination theory as a framework for ERS. Further research is required to explain socio-demographic patterning in responses to ERS, with changes in motivation occurring among all sub-groups of participants, though not always leading to higher adherence or behavioural change. This highlights the importance of socio-ecological approaches to developing and evaluating behaviour change interventions, which consider factors beyond the individual, including conditions in which improved motivation does or does not produce behavioural change. TRIAL REGISTER NUMBER ISRCTN47680448.
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Affiliation(s)
- Hannah J Littlecott
- />DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales UK
| | - Graham F Moore
- />DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales UK
| | - Laurence Moore
- />MRC/CSO Social & Public Health Sciences Unit (SPHSU), University of Glasgow, Glasgow, Scotland UK
| | - Simon Murphy
- />DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, Wales UK
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Hawkins JL, Oliver EJ, Wyatt-Williams J, Scale E, van Woerden HC. Assessing the feasibility of using uniaxial accelerometers with an online support platform in the delivery of a community-based exercise referral scheme. J Prim Care Community Health 2014; 5:288-90. [PMID: 24861974 DOI: 10.1177/2150131914536053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Exercise referral schemes are established within community-based health care; however, they have been criticized for failing to evidence long-term behavior change relative to usual care. As such, recent reviews have called for refinement of their delivery with a focus on embedded strategies targeting client motivation. This research letter presents findings from an initial pilot trial conducted within Wales' National Exercise Referral Scheme (NERS), examining the feasibility of using validated physical activity monitoring devices and an accompanying online platform within standard scheme delivery. 30 individuals referred to generic or cardiovascular pathways were offered the system; of these 17 agreed to participate. Common reasons for declining were clustered into lack of technology literacy or access, condition severity, or fear of costs associated with losing the device. Analysis of follow-up interviews after 4 weeks of use indicated that while participants found the monitoring devices practical and informative, only a minority (n = 4) were using the system in full. Crucially, the system element most aligned with contemporary theories of motivation (the online portal) was not used as expected. In addition, feedback from exercise referral professionals indicated that there were demands for support from clients, which might be mitigated by more effective independent system use. Recommendations for larger scale trials using similar systems include consideration of targeted patient groups, equity of access, and providing adequate technological support that is currently beyond the capacity of the NERS system.
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Affiliation(s)
| | | | - Jeannie Wyatt-Williams
- National Exercise Referral Scheme Coordinator for Wales, Welsh Local Government Association, Cardiff, UK
| | - Elaine Scale
- National Exercise Referral Scheme, Coordinator for Pembrokeshire, Milford Haven Leisure Centre, Milford Haven, UK
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