General practice referral of \u2018at risk\u2019 populations to community leisure services: applying the RE-AIM framework to evaluate the impact of a community-based physical activity programme for inactive adults with long-term conditions

E L Bird,J E Powell,M S Y Biddle

doi:10.1186/s12889-019-7701-5

Abstract

BackgroundIn the UK a high proportion of adults with long-term conditions do not engage in regular physical activity. General practice (GP) referral to community-based physical activity is one strategy that has gained traction in recent years. However, evidence for the real-world effectiveness and translation of such programmes is limited. This study aimed to evaluate the individual and organisational impacts of the ‘CLICK into Activity’ programme - GP referral of inactive adults living with (or at risk of) long-term conditions to community-based physical activity.MethodsA mixed methods evaluation using the RE-AIM framework was conducted with data obtained from a range of sources: follow-up questionnaires, qualitative interviews, and programme-related documentation, including programme cost data. Triangulation methods were used to analyse data, with findings synthesised across each dimension of the RE-AIM framework.ResultsA total of 602 individuals were referred to CLICK into Activity physical activity sessions. Of those referred, 326 individuals participated in at least one session; the programme therefore reached 30.2% of the 1080 recruitment target. A range of individual-, social-, and environmental-level factors contributed to initial physical activity participation. Positive changes over time in physical activity and other outcomes assessed were observed among participants. Programme adoption at GP surgeries was successful, but the GP referral process was not consistently implemented across sites. Physical activity sessions were successfully implemented, with programme deliverers and group-based delivery identified as having an influential effect on programme outcomes. Changes to physical activity session content were made in response to participant feedback. CLICK into Activity cost £175,000 over 3 years, with an average cost per person attending at least one programme session of £535.ConclusionsDespite not reaching its recruitment target, CLICK into Activity was successfully adopted. Positive outcomes were associated with participation, although low 6- and 12-month follow-up response rates limit understanding of longer-term programme effects. Contextual and individual factors, which may facilitate successful implementation with the target population, were identified. Findings highlight strategies to be explored in future development and implementation of GP referral to community-based physical activity programmes targeting inactive adults living with (or at risk of) long-term conditions.

Highlights

In the UK a high proportion of adults with long-term conditions do not engage in regular physical activity
Despite clear evidence demonstrating the benefits associated with regular physical activity, self-report data from England suggest that approximately one fifth of men and one quarter of women are inactive, [3] costing an estimated £7.4 billion each year [4]
Gatekeepers from nine General practice (GP) surgeries agreed to participate in GP referral to community-based physical activity, and three trained exercise specialists experienced in working with inactive adults were recruited to deliver the physical activity sessions

Summary

Introduction

In the UK a high proportion of adults with long-term conditions do not engage in regular physical activity. General practice (GP) referral to community-based physical activity is one strategy that has gained traction in recent years. This study aimed to evaluate the individual and organisational impacts of the ‘CLICK into Activity’ programme - GP referral of inactive adults living with (or at risk of) long-term conditions to community-based physical activity. An increase in long-term conditions, alongside an ageing population, has created pressure on the delivery of services in General Practice (GP). This has led to General Practitioners and commissioners in the UK advocating and developing collaborative working practices with social prescribing services in the community [8]. Social prescribing schemes allow primary health care professionals to refer patients to a non-medical service, such as community-based physical activities, art classes, and nature-based activities, with the aim of improving patients’ health and wellbeing [8, 9]

Objectives

Methods

Results

Discussion

Conclusion