Abstract
BackgroundExercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom.MethodsAn eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework.ResultsThree programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice.ConclusionsThe findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.
Highlights
Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned
If Exercise referral scheme (ERS) can be appraised in a valid manner research is needed to understand how context impacts evidence implementation and the processes that influence practitioner behaviour [13], the aim of this research was to build initial ideas about how behaviour change practices are implemented in ERSs in real time naturalistic settings
The mechanisms are represented using motivation and capability labels to enhance the transferability of the findings to other implementation scenarios and encompass multiple interpretations from practitioners (Fig. 1)
Summary
Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Exercise Referral Schemes (ERSs) are a primary care service used extensively in the USA, Canada, across Europe, New Zealand, and Australia [2]. Schemes typically involve inactive patients, who present with an array of chronic diseases, who are referred by a health professional to an exercise specialist for a time limited PA programme [3]. It is noted that evidence is constrained by the heterogeneity of programme provisions and poor evaluative practices [5, 6]
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