Physical activity promotion in primary care: Health professional and patient views on connecting primary care patients with community-based physical activity opportunities

Abstract Background Inconclusive evidence in support of referrals from health professionals to gym-based exercise programmes has raised a concern for the roll-out of such schemes and highlights the importance of developing and maintaining links between primary care settings and community-based opportunities to improve physical activity levels. This study aimed to identify methods of connecting primary care patients to community-based physical activity opportunities, using the example of jog scotland , and to explore what factors can facilitate this connection. Methods We conducted a qualitative exploratory study utilising semi-structured interviews with primary care patients (n=14) and health professionals (HP) (n=14) from one UK National Health Service (NHS) board. We analysed the transcripts separately for patients and HPs using thematic analysis and synthesised them for potential methods of connection. Sub-themes for patients and HPs were mapped onto relevant components of the capability, opportunity, motivation behavioural (COM-B) model and theoretical domains framework (TDF) to identify barriers and facilitators for connecting primary care to community jog scotland groups. Results Three potential methods of connecting patients to community-based jog scotland groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators to connecting patients to jog scotland groups fell into five TDF domains for HPs and two COM-B model components for patients. Conclusions Our findings suggest that for patients, the acknowledgement and raising of the topic of physical activity improvement by their HP can help to justify as well as facilitate and motivate action to change. The workload associated with connecting patients to community-based opportunities is central to the implementation by HPs. Resource solutions (e.g. intermediary person or community information hub) and social support opportunities for patients (e.g. meet and greet) can provide patients with a greater variety of physical activity options and the vital information and support for connecting with local community-based opportunities, such as jog scotland .

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Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

BJGP Open ◽

10.3399/bjgpopen20x101100 ◽

2020 ◽

Vol 4 (3) ◽

pp. bjgpopen20X101100

Author(s):

Sharon Ann Carstairs ◽

Rayna H Rogowsky ◽

Kathryn B Cunningham ◽

Frank Sullivan ◽

Gozde Ozakinci

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Professionals ◽

Theoretical Domains Framework ◽

Barriers And Facilitators ◽

Structured Interviews ◽

Community Based ◽

Healthcare Settings ◽

Primary Care Patients ◽

Exercise Programmes

BackgroundInconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels.AimThis study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogscotland.Design & settingAn exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted.MethodPatient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups.ResultsThree methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients.ConclusionFor patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.

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Experiences in physical activity promotion in health care settings for primary prevention in the UK

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/11 ◽

2014 ◽

Vol 62 (2) ◽

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Professionals ◽

Controlled Trial ◽

Full Range ◽

Tertiary Care ◽

Physical Activity Promotion ◽

Community Based ◽

Activity Promotion ◽

Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

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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 ◽

10.1177/0017896914559785 ◽

2014 ◽

Vol 74 (6) ◽

pp. 743-757 ◽

Cited By ~ 29

Author(s):

Nafees U Din ◽

Graham F Moore ◽

Simon Murphy ◽

Clare Wilkinson ◽

Nefyn H Williams

Keyword(s):

Physical Activity ◽

Primary Care ◽

Process Evaluation ◽

Health Professionals ◽

Physical Activity Promotion ◽

Activity Promotion ◽

Exercise Referral ◽

Exercise Referral Scheme

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Physical activity promotion in the health care setting in Switzerland

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/9 ◽

2014 ◽

Vol 62 (2) ◽

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Health Professionals ◽

Care Setting ◽

Physical Activity Promotion ◽

Health Care Setting ◽

Primary Health ◽

Activity Promotion

The role of regular physical activity for population health has been clearly documented. Improvements in population levels of physical activity require long-term implementation of a combination of measures, including the evidence based approaches described in the “seven best investments for physical activity” (www.globalpa.org.uk): whole-of-school programmes, transport, urban planning, integration of physical activity promotion into primary health care systems, public education, community-wide programmes, sport for all. The health care setting has a particular role in this context, particularly in its access to physically inactive individuals. Switzerland has seen a number of successful research projects in this field, but there has been no wide adaptation of these approaches in the medical community. In recent years, a group of institutions including the Swiss College of Primary Care Medicine, the Policlinique Médicale Universitaire in Lausanne, the Ligue Vaudoise contre les Maladies Cardiovasculaires and the Institute of Social and Preventive Medicine of the University of Zurich have therefore focussed on the development of a physical activity counselling approach based on international evidence as well as on established tools, but streamlined to the specific demands of primary health care providers in Switzerland. PAPRICA (Physical Activity Promotion in Primary Care, www.paprica.ch) has been the result of these developments, and nearly 300 health professionals, most of them primary care physicians, have been successfully trained so far. PAPRICA is implemented together with the Swiss Society for Sports Medicine and a number of regional partners. The development of a national programme structure is currently under preparation. This will allow Switzerland to explore and better use the potential of physicians and other health professionals in the promotion of physical activity and in the fight against non-communicable diseases.

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Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16020213 ◽

2019 ◽

Vol 16 (2) ◽

pp. 213 ◽

Cited By ~ 1

Author(s):

Maria Belizan ◽

R. Chaparro ◽

Marilina Santero ◽

Natalia Elorriaga ◽

Nadja Kartschmit ◽

...

Keyword(s):

Physical Activity ◽

Mixed Methods ◽

Local Community ◽

Project Evaluation ◽

Political Support ◽

Healthy Diet ◽

Barriers And Facilitators ◽

Structured Interviews ◽

Community Based Interventions ◽

Community Based

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

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Methods of connecting primary care patients with community‐based physical activity opportunities: A realist scoping review

Health & Social Care in the Community ◽

10.1111/hsc.13186 ◽

2020 ◽

Author(s):

Kathryn B. Cunningham ◽

Rayna H. Rogowsky ◽

Sharon A. Carstairs ◽

Frank Sullivan ◽

Gozde Ozakinci

Keyword(s):

Physical Activity ◽

Primary Care ◽

Scoping Review ◽

Community Based ◽

Primary Care Patients

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Barriers and facilitators to the use of digital systems in primary care to deliver physical activity advice using COM-B and theoretical domains framework

10.31234/osf.io/7rqvn ◽

2021 ◽

Author(s):

Paulina Bondaronek ◽

Samuel James Dicken ◽

Seth Jennings ◽

Verity Mallion ◽

Chryssa Stefanidou

Keyword(s):

Physical Activity ◽

Primary Care ◽

Physical Inactivity ◽

Data Privacy ◽

Theoretical Domains Framework ◽

Ease Of Use ◽

Digital Systems ◽

Barriers And Facilitators ◽

Long Term Conditions ◽

Physical Activity Advice

Background: Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes and cancer; increasing physical activity (PA) is therefore a public health priority. Healthcare professionals (HCPs) in primary care have been identified as being pivotal in addressing physical inactivity, yet few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including a lack of time, confidence or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital systems are used to deliver physical activity advice in primary care consultations, and what factors influence their use.The aim of this study was to understand the use of digital systems to support primary care consultations and to identify the barriers and facilitators to using these systems.Methods: 25 semi-structured interviews were conducted with HCPs in primary care. Professionals were sampled purposively based on profession (general practitioners, practice nurses and healthcare assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. Data were analysed using thematic analysis to identify influences on the use of digital systems. Themes were categorised using COM-B and the theoretical domains framework (TDF) to identify the barriers and facilitators to using digital systems to support the delivery of PA advice in primary care consultations.Results: Identified themes fell within eight TDF domains (linked COM-B component follows in parentheses): Knowledge (Psychological Capability), Skills (Psychological Capability), Environmental Context and Resources (Physical Opportunity), Social Influence (Social Opportunity), Beliefs about Capabilities (Reflective Motivation), Beliefs about Consequences (Reflective Motivation), Reinforcement (Automatic Motivation), and Emotions (Automatic Motivation). The most prominent barrier/facilitator within psychological capability was ‘having the skills to use digital systems’. ‘Training in the use of digital systems’ was also mentioned several times. The most notable barriers/facilitators within physical opportunity were ‘time constraints’, the ‘efficiency of digital systems’, the ‘simplicity and ease of use’ of digital systems, and ‘integration with existing systems’. Other physical opportunity barriers were ‘lack of access to digital systems’ and ‘technical support in the use of digital systems’. With respect to social opportunity, a notable barrier was the sense that ‘digital systems reduce interpersonal communications’ with patients. ‘Patient preference’ was also mentioned as a barrier/facilitator. Several important barriers and/or facilitators were within reflective motivation, including ‘confidence to use digital systems’, ‘beliefs about the usefulness of digital systems’, the ‘belief that digital systems ‘are the way forward’’, ‘beliefs related to data privacy and security concerns’, and ‘perceptions about patient capabilities’. With respect to automatic motivation, barriers/facilitators included ‘familiarity and availability’ regarding digital systems, and the fact that digital systems ‘prompt behaviour’. Conclusions: A variety of influences were identified on the use of digital systems to support primary care consultations. These findings provide a foundation to design a digital system that addresses the barriers and leverages the facilitators to support PA advice provision within primary care, to elicit patient behaviour change and increase PA.

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Symposium 17: Physical activity interventions using the transtheoretical model: A Transtheoretical Model-based Physical Activity Intervention Targeting Overweight/Obese Primary Care Patients: PACE Results from Italy

PsycEXTRA Dataset ◽

10.1037/e547922012-265 ◽

2003 ◽

Author(s):

Claudio R. Nigg ◽

Massimo Bolognesi ◽

Massimo Massarini

Keyword(s):

Physical Activity ◽

Primary Care ◽

Transtheoretical Model ◽

Physical Activity Intervention ◽

Model Based ◽

Physical Activity Interventions ◽

Primary Care Patients

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The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing

10.31219/osf.io/2sxc3 ◽

2020 ◽

Author(s):

Matthew Wade ◽

Nicola Brown ◽

James Steele ◽

Steven Mann ◽

Bernadette Dancy ◽

...

Keyword(s):

Physical Activity ◽

Primary Care ◽

Motivational Interviewing ◽

Social Action ◽

Multilevel Models ◽

Physical Activity Intervention ◽

Mental Wellbeing ◽

Community Based ◽

The Impact ◽

Time Point

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

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