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Silva CS, Godinho C, Encantado J, Rodrigues B, Carraça EV, Teixeira PJ, Silva MN. Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review. BMC Health Serv Res 2023; 23:1082. [PMID: 37821932 PMCID: PMC10568782 DOI: 10.1186/s12913-023-09881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral. METHODS A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The "Tailored Implementation for Chronic Diseases" (TICD) framework was adapted to extract and synthesize barriers and facilitators. RESULTS Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals' knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions' cost and financial incentives; tools and materials; and professionals' cognitions and attitudes. "Social, political and legal factors" domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains. CONCLUSION The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions' effectiveness.
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Affiliation(s)
- Catarina Santos Silva
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal.
| | - Cristina Godinho
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Jorge Encantado
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Bruno Rodrigues
- CIAFEL, Faculdade de Desporto da Universidade Do Porto, Porto, Portugal
| | - Eliana V Carraça
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
| | - Pedro J Teixeira
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Marlene Nunes Silva
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
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Benn NL, Jervis-Rademeyer H, Benson K, Chan K, Lee JW, Inness EL, Wolfe DL, Alizadeh-Meghrazi M, Masani K, Musselman KE. Identifying priorities for balance interventions through a participatory co-design approach with end-users. BMC Neurol 2023; 23:266. [PMID: 37442947 DOI: 10.1186/s12883-023-03312-5] [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: 01/11/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance. METHODS Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants' experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers. RESULTS Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one's balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual's unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously. CONCLUSIONS End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.
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Affiliation(s)
- Natasha L Benn
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Hope Jervis-Rademeyer
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Kayla Benson
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Katherine Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jae W Lee
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Elizabeth L Inness
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, Canada
| | | | - Kei Masani
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- Department of Physical Therapy, University of Toronto, Toronto, Canada.
- SCI Mobility Lab, KITE-Toronto Rehabilitation Institute, UHN, 520 Sutherland Drive, Toronto, M4G 3V9, Canada.
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McKeon G, Mastrogiovanni C, Teychenne M, Rosenbaum S. Barriers and Facilitators to Participating in an Exercise Referral Scheme among Women Living in a Low Socioeconomic Area in Australia: A Qualitative Investigation Using the COM-B and Theoretical Domains Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12312. [PMID: 36231623 PMCID: PMC9565931 DOI: 10.3390/ijerph191912312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Despite the health benefits of regular physical activity, women experiencing socioeconomic disadvantage are at high risk of inactivity. Reasons are multifactorial but likely include broad structural and contextual factors, e.g., lack of access to physical activity programs, as well as individual and interpersonal factors, e.g., lack of motivation and childcaring responsibilities. Few studies among women of low socioeconomic position (SEP) have explored these factors in-depth, yet an understanding of these factors can help inform the development and improve the uptake of exercise referral schemes. The Theoretical Domains Framework (TDF) and COM-B model (capability, opportunity, motivation and behaviour) were employed to understand behaviours for intervention development. Therefore, using these behaviour change models, this study aimed to explore the barriers and facilitators influencing the use of an exercise referral scheme among women living in a socioeconomically disadvantaged area. METHODS Semi-structured interviews were conducted with women who had registered with a free exercise referral scheme (Live Life Get Active) and living in a low socioeconomic neighbourhood in Sydney, Australia. Reflexive thematic analysis and framework analysis were used to allow naturally identified themes to be determined and then allocated to theoretically driven domains. RESULTS Nine women were interviewed (aged 30-69 years). Eighteen themes were identified and mapped directly on to the six COM-B constructs. The most reported barriers to using the physical activity referral scheme related to the opportunity construct of the COM-B model, specifically childcare responsibilities, work commitments and environmental barriers. Key facilitators were enjoyment (motivation), no cost (opportunity), instructor led (opportunity) and social support (opportunity). CONCLUSION Future exercise referral schemes targeting women living in low-SEP neighbourhoods should ensure programs are designed and delivered to overcome barriers aligned with the constructs of the COM-B model, particularly opportunity-related constructors.
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Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052, Australia
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Chiara Mastrogiovanni
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3217, Australia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052, Australia
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Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168726. [PMID: 34444473 PMCID: PMC8394072 DOI: 10.3390/ijerph18168726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women's only wellness center that exchanged ExRx for free access (1-3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21-78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were "readiness" and "right timing" for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were "mismatched expectations" and "competing priorities". Common themes among all women were "sense of community" and "ease of location". ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.
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Oliver EJ, Buckley BJ, Dodd-Reynolds C, Downey J, Hanson CL, Henderson H, Hawkins J, Steele J, Wade M, Watson PM. Where next for the design, delivery and evaluation of community-based physical activity prescription? Emerging lessons from the United Kingdom. Appl Physiol Nutr Metab 2021; 46:1430-1434. [PMID: 34324824 DOI: 10.1139/apnm-2021-0101] [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]
Abstract
Despite widespread use, community-based physical activity prescription is controversial. Data limitations have resulted in a lack of clarity about what works, under what circumstances, and for whom, reflected in conservative policy recommendations. In this commentary we challenge a predominantly negative discourse, using contemporary research to highlight promising findings and 'lessons learnt' for design, delivery, and evaluation. In doing so, we argue for the importance of a more nuanced approach to future commissioning and evaluation. Contribution: • Amalgamating learning from multiple research teams to create recommendations for advancing physical activity prescription.
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Affiliation(s)
- Emily J Oliver
- Durham University, 3057, Sport and Exercise Sciences, 42 Old Elvet, Durham, Durham, United Kingdom of Great Britain and Northern Ireland, DH1 3LE;
| | - Benjamin Jr Buckley
- University of Liverpool, 4591, Liverpool Centre for Cardiovascular Science, Liverpool, Merseyside, United Kingdom of Great Britain and Northern Ireland;
| | - Caroline Dodd-Reynolds
- Durham University, 3057, Sport and Exercise Sciences, Durham, United Kingdom of Great Britain and Northern Ireland;
| | - John Downey
- Plymouth Marjon University, 6629, Plymouth, Devon, United Kingdom of Great Britain and Northern Ireland;
| | - Coral L Hanson
- Edinburgh Napier University, 3121, Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland;
| | - Hannah Henderson
- University of Lincoln, 4547, Lincoln, Lincolnshire, United Kingdom of Great Britain and Northern Ireland;
| | - Jemma Hawkins
- Cardiff University, 2112, Cardiff, South Glamorgan, United Kingdom of Great Britain and Northern Ireland;
| | - James Steele
- Solent University, 7422, Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Matthew Wade
- ukactive Research Institute, 569080, London, United Kingdom of Great Britain and Northern Ireland;
| | - Paula M Watson
- Liverpool John Moores University, 4589, Liverpool, Merseyside, United Kingdom of Great Britain and Northern Ireland;
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Homayouni TS, Ruth A, Abbott-Tate Z, Burger H, Rahim S, Murray C, Wannamaker R, Chan Carusone S, O'Brien KK. Experiences engaging in a group-based physiotherapist-led exercise programme for adults living with HIV and complex multimorbidity: a qualitative study. BMJ Open 2021; 11:e045158. [PMID: 34315789 PMCID: PMC8317082 DOI: 10.1136/bmjopen-2020-045158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore experiences participating in a group-based physiotherapist (PT)-led exercise programme among people living with HIV and complex multimorbidity. DESIGN We conducted a qualitative descriptive study using semistructured interviews. RECRUITMENT AND SETTING We recruited community-dwelling adults living with HIV who engaged in a group-based PT-led exercise programme within an HIV-specialty hospital in Toronto, Canada. Interviews were conducted in-person or by telephone. PARTICIPANTS Eight men and two women with a median age of 58 years and median of six concurrent conditions in addition to HIV, who had attended ≥2 classes of the exercise programme. DATA COLLECTION Interviews explored (1) reasons for engaging in the programme, (2) experiences with exercise prior to and after joining the programme, (3) facilitators and barriers to engagement and (4) perceived impacts of participation on health and disability. We administered the HIV Disability Questionnaire and a demographic questionnaire. RESULTS Experiences spanned perspectives prior to, during and after the PT-led exercise programme. Reasons for engaging in the programme included addressing health-related goals. Participants identified accessibility, the flexible schedule, interprofessional staff and the HIV-specific, group-based environment as facilitators to engagement. Participants reported high attendance rates, but identified episodic health challenges and overcrowded space as potential barriers to attending exercise classes. Perceived impacts on health and disability outcomes included improved physical, mental, social and cognitive health, and activities of daily living. Anticipated or actual experiences transitioning to independent exercise included facilitators (supportive programme leaders) and barriers (challenges motivatiing self to exercise alone). CONCLUSIONS Features of the programme that facilitated engagement included the interprofessional, group-based environment that offered tailored exercise in an HIV-specific facility, whereby participants perceived benefits in domains of health and disability. However, challenges transitioning to independent exercise remain. Group-based PT-led exercise programmes may facilitate engagement in exercise among adults living with HIV and complex multimorbidity.
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Affiliation(s)
- Tina S Homayouni
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alex Ruth
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Abbott-Tate
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Burger
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaera Rahim
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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Mino E, Geidl W, Naber I, Weissenfels A, Klamroth S, Gelius P, Abu-Omar K, Pfeifer K. Physical activity referral scheme components: a study protocol for systematic review and meta-regression. BMJ Open 2021; 11:e049549. [PMID: 34145021 PMCID: PMC8215250 DOI: 10.1136/bmjopen-2021-049549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
INTRODUCTION In its attempt to establish effective physical activity promotion methods, research on physical activity referral schemes (PARS) is attracting significant attention. Sometimes known as physical activity on prescription schemes, PARS involve a well-defined procedure whereby a primary healthcare professional introduces a participant to the topic of physical activity and employs prescription or referral forms to connect the participant to physical activity opportunities, such as local fitness offers. The planned systematic review will focus on these referral routes and scheme components and how they are integrated into various PARS models worldwide. We seek to identify the evidence-based core components that play the most important roles in the effectiveness of PARS. METHODS AND ANALYSIS The development and reporting of the protocol follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We plan to conduct a systematic main literature search on PubMed, Scopus, Web of Science, CINAHL, HTA, SpringerLink and other databases. We will include studies that report outcomes on physical activity, PARS uptake and adherence rates or descriptive information about PARS models. We intend for all review stages, citation screening, data extraction and risk of bias assessment to be conducted by at least two independent reviewers. As a broad spectrum of study designs, including randomised and non-randomised studies of interventions and mixed methods, will be eligible, we will use three separate tools to assess the risk of bias in individual studies. The data will be primarily synthesised narratively, following Intervention Component Analysis. If the data allow, we will perform a random-effects meta-analysis and meta-regression to investigate the impact of specific PARS components on effect sizes. ETHICS AND DISSEMINATION This systematic review does not require formal ethics approval. The results will be submitted to a peer-reviewed journal and international conferences to reach the scientific community. PROSPERO REGISTRATION NUMBER CRD42021233229.
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Affiliation(s)
- Eriselda Mino
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Wolfgang Geidl
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Inga Naber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Anja Weissenfels
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Sarah Klamroth
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
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Delivery Approaches Within Exercise Referral Schemes: A Survey of Current Practice in England. J Phys Act Health 2021; 18:357-373. [PMID: 33730692 DOI: 10.1123/jpah.2020-0388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise referral schemes in England offer referred participants an opportunity to take part in an exercise prescription in a nonclinical environment. The aim of these schemes is to effect clinical health benefits, yet there is limited evidence of schemes' effectiveness, which could be due to the heterogeneity in design, implementation, and evaluation. Additionally, there has been no concerted effort to map program characteristics. OBJECTIVE To understand what key delivery approaches are currently used within exercise referral schemes in England. METHODS Across England, a total of 30 schemes with a combined total of 85,259 exercise referral scheme participants completed a Consensus on Exercise Reporting Template-guided questionnaire. The questionnaire explored program delivery, nonexercise components, and program management. RESULTS Results found that program delivery varied, though many schemes were typically 12 weeks in length, offering participants 2 exercise sessions in a fitness gym or studio per week, using a combination of exercises. Adherence was typically measured through attendance, with nonexercise components and program management varying by scheme. CONCLUSION This research provides a snapshot of current delivery approaches and supports the development of a large-scale mapping exercise to review further schemes across the whole of the United Kingdom in order to provide evidence of best practice and delivery approaches nationwide.
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Inequalities and Inclusion in Exercise Referral Schemes: A Mixed-Method Multi-Scheme Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063033. [PMID: 33809451 PMCID: PMC7999569 DOI: 10.3390/ijerph18063033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/28/2022]
Abstract
Physical activity prescription, commonly through exercise referral schemes, is an established disease prevention and management pathway. There is considerable heterogeneity in terms of uptake, adherence, and outcomes, but because within-scheme analyses dominate previous research, there is limited contextual understanding of this variance. Both the impact of schemes on health inequalities and best practices for inclusion of at-risk groups are unclear. To address this, we modelled secondary data from the multi-scheme National Referral Database, comprising 23,782 individuals across 14 referral schemes, using a multilevel Bayesian inference approach. Scheme-level local demographics identified over-sampling in uptake; on the basis of uptake and completion data, more inclusive schemes (n = 4) were identified. Scheme coordinators were interviewed, and data were analyzed using a grounded theory approach. Inequalities presented in a nuanced way. Schemes showed promise for engaging populations at greater risk of poor health (e.g., those from more deprived areas or of an ethnic minority background). However, the completion odds were lower for those with a range of complex circumstances (e.g., a mental health-related referral). We identified creative best practices for widening access (e.g., partnership building), maintaining engagement (e.g., workforce diversity), and tailoring support, but recommend changes to wider operational contexts to ensure such approaches are viable.
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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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12
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Buckley BJ, Thijssen DH, Murphy RC, Graves LE, Cochrane M, Gillison F, Crone D, Wilson PM, Whyte G, Watson PM. Pragmatic evaluation of a coproduced physical activity referral scheme: a UK quasi-experimental study. BMJ Open 2020; 10:e034580. [PMID: 33004383 PMCID: PMC7534707 DOI: 10.1136/bmjopen-2019-034580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES UK exercise referral schemes (ERSs) have been criticised for focusing too much on exercise prescription and not enough on sustainable physical activity (PA) behaviour change. Previously, a theoretically grounded intervention (coproduced PA referral scheme, Co-PARS) was coproduced to support long-term PA behaviour change in individuals with health conditions. The purpose of this study was to investigate the effectiveness of Co-PARS compared with a usual care ERS and no treatment for increasing cardiorespiratory fitness. DESIGN A three-arm quasi-experimental trial. SETTING Two leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control. PARTICIPANTS 68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment. INTERVENTION 16-weeks of PA behaviour change support delivered at 4, 8, 12 and 18 weeks, in addition to the usual care 12-week leisure centre access. OUTCOME MEASURES Cardiorespiratory fitness, vascular health, PA and mental well-being were measured at baseline, 12 weeks and 6 months (PA and mental well-being only). Fitness centre engagement (co-PARS and usual care) and behaviour change consultation attendance (co-PARS) were assessed. Following an intention-to-treat approach, repeated-measures linear mixed models were used to explore intervention effects. RESULTS Significant improvements in cardiorespiratory fitness (p=0.002) and vascular health (p=0.002) were found in co-PARS compared with usual care and no-treatment at 12 weeks. No significant changes in PA or well-being at 12 weeks or 6 months were noted. Intervention engagement was higher in co-PARS than usual care, though this was not statistically significant. CONCLUSION A coproduced PA behaviour change intervention led to promising improvements in cardiorespiratory and vascular health at 12 weeks, despite no effect for PA levels at 12 weeks or 6 months. TRIAL REGISTRATION NUMBER NCT03490747.
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Affiliation(s)
- Benjamin Jr Buckley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Dick Hj Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rebecca C Murphy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lee Ef Graves
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Madeleine Cochrane
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Philip M Wilson
- Department of Kinesiology, Brock University, Saint Catharines, Ontario, Canada
| | - Greg Whyte
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Paula M Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Green Health Partnerships in Scotland; Pathways for Social Prescribing and Physical Activity Referral. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186832. [PMID: 32962081 PMCID: PMC7560024 DOI: 10.3390/ijerph17186832] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022]
Abstract
Increased exposure to green space has many health benefits. Scottish Green Health Partnerships (GHPs) have established green health referral pathways to enable community-based interventions to contribute to primary prevention and the maintenance of health for those with established disease. This qualitative study included focus groups and semi-structured telephone interviews with a range of professionals involved in strategic planning for and the development and provision of green health interventions (n = 55). We explored views about establishing GHPs. GHPs worked well, and green health was a good strategic fit with public health priorities. Interventions required embedding into core planning for health, local authority, social care and the third sector to ensure integration into non-medical prescribing models. There were concerns about sustainability and speed of change required for integration due to limited funding. Referral pathways were in the early development stages and intervention provision varied. Participants recognised challenges in addressing equity, developing green health messaging, volunteering capacity and providing evidence of success. Green health interventions have potential to integrate successfully with social prescribing and physical activity referral. Participants recommended GHPs engage political and health champions, embed green health in strategic planning, target mental health, develop simple, positively framed messaging, provide volunteer support and implement robust routine data collection to allow future examination of success.
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Dodd-Reynolds CJ, Vallis D, Kasim A, Akhter N, Hanson CL. The Northumberland Exercise Referral Scheme as a Universal Community Weight Management Programme: A Mixed Methods Exploration of Outcomes, Expectations and Experiences across a Social Gradient. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155297. [PMID: 32717836 PMCID: PMC7432420 DOI: 10.3390/ijerph17155297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/20/2023]
Abstract
Exercise referral schemes (ERS) are internationally recognised, yet little attention has been paid to discrete referral groups or the influence of wider social determinants of health. The primary quantitative element of this mixed methods study used a mixed effects linear model to examine associations of sociodemographic predictors, obesity class and profession of referrer on weight and physical activity (PA) variables for weight-related referrals (n = 3624) to an established 24-week ERS. Chained equations modelling imputed missing data. The embedded qualitative element (n = 7) used individual semi-structured interviews to explore participant weight-related expectations and experiences. Age, gender and profession of referrer influenced weight loss. PA increased and was influenced by age and gender. The weight gap between the most and least obese narrowed over time but the PA gap between most and least widened. Age, employment and obesity class were most predictive of missing data but would unlikely alter overall conclusions. Qualitative themes were weight-loss support, personal circumstances and strategies, and weight expectations versus wellbeing rewards. This ERS worked, did not widen existing obesity inequalities, but demonstrated evidence of PA inequalities for those living with deprivation. To improve equity of experience, we recommend further stakeholder dialogue around referral experience and ongoing support needs.
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Affiliation(s)
- Caroline J. Dodd-Reynolds
- Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
- Correspondence:
| | - Dimitris Vallis
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Durham Research Methods Centre, Durham University, Durham DH1 3HN, UK;
- Department of Anthropology, Durham University, Durham DH1 3HN, UK
| | - Nasima Akhter
- Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham DH1 3HN, UK; (A.K.); (N.A.)
- Department of Anthropology, Durham University, Durham DH1 3HN, UK
| | - Coral L. Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
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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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