Abstract
BackgroundThe positive impact of physical activity programmes has been recognised, but the current uptake is low. Authorities believe delivering these programmes in a shared-care model is a future perspective. The present study aimed to identify the barriers and facilitators affecting physical activity programme implementation in a shared-care model delivered with the cooperation of all the types of healthcare professionals involved.MethodsThirty-one individual interviews with primary healthcare professionals (PHPs) and four focus group interviews with 39 secondary healthcare professionals (SHPs) were undertaken. We used Grol and Flottorp’s theoretical models to identify barriers and facilitators in six domains: (1) physical activity programmes, (2) patients, (3) healthcare professionals, (4) social setting, (5) organisation and (6) law and governance.ResultsIn the domain of physical activity programmes, those physical activity programmes that were non-tailored to the patients’ needs impeded successful implementation. In the domain of healthcare professionals, the knowledge and skills pertaining to physical activity programmes and non-commitment of healthcare professionals impeded implementation. HCPs expressed their concerns about the negative influence of the patient’s social network. Most barriers occurred in the domain of organisation. The PHPs and SHPs raised concerns about ineffective collaboration and networks between hospitals. Only the PHPs raised concerns about poor communication, indeterminate roles, and lack of collaboration with SHPs. Insufficient and unclear insurance coverage of physical activity programmes was a barrier in the domain of law and governance.ConclusionsImproving the domain of organisation seems the most challenging because the collaboration, communication, networks, and interactive roles between the PHPs and SHPs are all inadequate. Survivor care plans, more use of health information technology, improved rehabilitation guidelines, and better networks might benefit implementing physical activity programmes.
Highlights
The positive impact of physical activity programmes has been recognised, but the current uptake is low
A shared-care model with care partly shifted to primary healthcare professionals (PHPs) may be a solution
Individual interviews were conducted with 31 PHPs, of whom 7 came from the region of the categorical hospital, 3 from the region of the university hospital, 8 from the region of the teaching hospital, and 8 and 5 from the region of the two non-teaching hospitals
Summary
Choice and tailoring - Choice in HCP providing programme, frequency, duration, format of programme, exclusive physical (exercise classes) or multidimensional programme, individual or as group sessions and inside or outside of cancer treatment facility - Tailored on patient characteristics: patient personality, lifestyle, cultural and economic background, age, tumour type, physical and psychosocial status Characteristics of patients Unaffordable physical activity programme - Patient cannot finance physical activity programme Too little knowledge about their own health and healthcare process No responsibility for their own health Characteristics of professionals PHPs without enough knowledge and skills about physical activity programmes PHPs expecting extra work - PHPs expecting more time pressure due to extra work Non-committed HCPs - HCPs do not expect benefit for the patient HCPs disliking new approaches (shared survivor-care system) Characteristics of the social setting and context in which the physical activity programme has to be applied Negative influence of social network on patient Characteristics of the organisation Not enough cooperation between healthcare institutes Difficulties reaching physical activity programme contact persons Insufficient quality insurance Not enough networking Not enough coordination Inadequate triage system Physical activity programme offered at wrong time in the treatment schedule Physical activity programme scheduled at the wrong place and time Not enough information about physical activity programmes available to patient Limited capacity for delivering physical activity programmes - Limited capacity of financial sources, facilities and materials - Limited capacity of HCPs Characteristics of the laws and governance Unclear insurance. It’s really a horrible job for us to get everything all done.”
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