Dataset Information

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK.

ABSTRACT:

Objectives

Exercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such scheme in the UK.

Design

The study employed a qualitative longitudinal approach using semistructured interviews, with results reported using Consolidated criteria for Reporting Qualitative research guidelines.

Setting

Two leisure centres providing an 'emerging best-practice' ERS in northeast England.

Participants

Referred patients (n=11), who had not yet commenced the scheme, were recruited on a voluntary basis. Seven females and four males, with a range of non-communicable diseases, such as cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems, participated.

Intervention

24-weeks, two times per week, of supervised exercise sessions and three one-to-one assessments (prescheme, 12?weeks and 24?weeks) for patients referred from primary and secondary care.

Primary outcome measures

Two longitudinal semistructured interviews, prior to commencement and 12-20 weeks later, were thematically analysed using the framework approach. Analysis comprised seven stages: transcription, familiarisation, coding, development and application of an analytical framework, charting data using a matrix and interpretation of data. Interpretation went beyond descriptions of individual cases to develop themes, which identified and offered possible explanations for differing participant experiences.

Results

Three overarching themes emerged. First, 'success', with engaged participants focused on health outcomes and reported increases in physical activity. Second, 'struggle', with short-term success but concerns regarding continued engagement. Participants reported scheme dependency and cyclical needs. Finally, 'defeat', where ill health, social anxiety and/or poor participation experience made engagement difficult.

Conclusion

Some success in engaging those with non-communicable diseases was reported, resulting in positive effects on health and well-being. The study highlights complexity within ERSs and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for referrals finding engagement difficult.

SUBMITTER: Hanson CL

PROVIDER: S-EPMC6398729 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK.

Hanson Coral L CL Oliver Emily J EJ Dodd-Reynolds Caroline J CJ Allin Linda J LJ

BMJ open 20190220 2

<h4>Objectives</h4>Exercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such scheme in the UK.<h4>Design</h4>The study employed a qualitative longitudinal approach using semistructured interviews, with results reported using Consolidated criteria for Reporting Qualitative research guidelines.<h4>Setting</h4>Two leisure ...[more]

PMID: 30787087

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Project description:Exercise on referral schemes (ERS) are widely commissioned in the UK but there is little evidence of their association with physical activity levels. We sought to assess the Northumberland exercise on referral scheme in terms of increased levels of physical activity and identify predictors of engagement.A naturalistic observational study.9 local authority leisure sites in Northumberland.2233 patients referred from primary and secondary care between July 2009 and September 2010.A 24-week programme including motivational consultations and supervised exercise sessions for participants.Uptake, 12-week adherence, 24-week completion, changes in Godin Leisure-Time Exercise Questionnaire scores after 24-weeks and attendance levels at supervised exercise sessions during the scheme. Three binary logistic regressions were used to examine demographic and referral factors associated with initial uptake, 12-week adherence and 24-week completion.Uptake was 81% (n=1811), 12-week adherence was 53.5% (n=968) and 24-week completion was 42.9% (n=777). Participants who completed significantly increased their self-reported physical activity levels at 24-weeks t (638)=-11.55, p<0.001. Completers attended a mean of 22.87 (12.47 SD) of a target 48 supervised sessions. Increasing age, being female and leisure site were associated with uptake, increasing age, Index of Multiple Deprivation and leisure site were associated with 12-week adherence and Body Mass Index and leisure site were associated with 24-week completion. Each regression significantly increased the prediction accuracy of stage of exit (non-starters vs starters 81.5%, dropouts before 12 weeks vs 12-week adherers 66.9%, and dropouts between 13 and 24 weeks 82.2%).Completers of the Northumberland ERS increased physical activity at 24 weeks, although the levels achieved were below the current UK guidelines of 150 min of moderate exercise per week. Leisure site was associated with uptake, adherence and completion.

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Project description:ObjectivesUK 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.DesignA three-arm quasi-experimental trial.SettingTwo leisure centres providing (1) Co-PARS, (2) usual exercise referral care and one no-treatment control.Participants68 adults with lifestyle-related health conditions (eg, cardiovascular, diabetes, depression) were recruited to co-PARS, usual care or no treatment.Intervention16-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 measuresCardiorespiratory 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.ResultsSignificant 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.ConclusionA 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 numberNCT03490747.

Project description:Affective interethnic ties are highly effective for improving out-group attitudes, especially during adolescence. Yet, young people face several obstacles to developing such ties in society. One potential means of fostering greater interethnic connectivity is through youth engagement: that is, formal, organized social participation in groups, clubs, or activities. However, little is still known about its effectiveness; especially for overcoming structural obstacles to contact in society, such as residential segregation. This study has two aims: to robustly examine whether youth engagement can build positive interethnic contact among young people; and, to perform the first systematic test of whether sites of engagement can act as "Associational Bridges", providing greater opportunities for contact among youth from more segregated environments. To pursue these aims, the study exploited a unique data opportunity to perform a quasi-experimental analysis of a large-scale, nationally-implemented youth engagement scheme in the United Kingdom. The study uses pre-test/post-test data on N = 1371 participants (Mage = 16.7; 63% Female; 36% non-White) and N = 1946 propensity-score matched controls (Mage = 16.7; 62% Female; 36% non-White). Applying a (matched) difference-in-difference approach, the findings demonstrate that participation led to an increase in affective interethnic ties, which were evident at least 4-6 months after involvement had ended. Participation also had a stronger positive impact on youth from more residentially segregated areas: although joining the scheme with fewer interethnic ties, post-participation they reported just as many ties as their peers from less segregated areas. However, participation had no difference in effects for youth from more or less ethnically diverse areas. Youth engagement may thus be an effective tool for fostering positive contact; particularly among those from more segregated environments. However, attention should be paid to the design and recruitment practices of engagement programs to understand which structural barriers to contact in society they can overcome.

Project description:IntroductionAs the world continues to grapple with the COVID-19 pandemic, emerging evidence suggests that individuals from ethnic minority backgrounds may be disproportionately affected. The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) project has been initiated to generate rapid evidence on whether and why ethnicity affects COVID-19 diagnosis and clinical outcomes in healthcare workers (HCWs) in the UK, through five interlinked work packages/work streams, three of which form the basis of this protocol. The ethico-legal work (Work Package 3) aims to understand and address legal, ethical and acceptability issues around big data research; the HCWs' experiences study (Work Package 4) explores their work and personal experiences, perceptions of risk, support and coping mechanisms; the stakeholder engagement work (Work Package 5) aims to provide feedback and support with the formulation and dissemination of the project recommendations.Methods and analysisWork Package 3 has two different research strands: (A) desk-based doctrinal research; and (B) empirical qualitative research with key opinion leaders. For the empirical research, in-depth interviews will be conducted digitally and recorded with participants' permission. Recordings will be transcribed, coded and analysed using thematic analysis. In Work Package 4, online in-depth interviews and focus groups will be conducted with approximately 150 HCWs, from across the UK, and these will be recorded with participants' consent. The recordings will be transcribed and coded and data will be analysed using thematic analysis. Work Package 5 will achieve its objectives through regular group meetings and in-group discussions.Ethics and disseminationEthical approval has been received from the London-Brighton & Sussex Research Ethics Committee of the Health Research Authority (Ref No 20/HRA/4718). Results of the study will be published in open-access journals, and disseminated through conference presentations, project website, stakeholder organisations, media and scientific advisory groups.Trial registration numberISRCTN11811602.

Dataset Information

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK.

Objectives

Design

Setting

Participants

Intervention

Primary outcome measures

Results

Conclusion

Publications

How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK.

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