"It's not just about walking.....it's the practice nurse that makes it work": a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care.

Carole Beighton,Derek Cook,Julia Fox-Rushby,Tess Harris,Christina Victor,Alison Woodcock,Sally Kerry,Rebecca Normansell,Peter Whincup,Steve Iliffe,Michael Ussher

doi:10.1186/s12889-015-2568-6

Abstract

BackgroundPhysical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations.MethodsSemi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFive key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of ‘pre-trial’ and ‘delivery of the intervention’. Two additional ‘post-trial’ themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging.ConclusionDelivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting.Trial registrationPACE-Lift ISRCTN 42122561, PACE-UP ISRCTN 98538934.

Highlights

Physical activity (PA) is important for physical and mental health in adults and older adults
The aim of this paper is to provide an additional layer of evaluation by exploring the views of the practice nurses, focusing upon the perceived enablers and barriers to delivering the complex PA interventions, identifying the benefits they gained as practitioners from participating in the trial and their evaluation of the acceptability of the intervention for use within routine PA consultations in a general practice (GP) setting
Complex PA interventions have multiple elements which can present as both enablers and barriers and we need to ascertain which elements within the complex intervention might be adapted for successful use within routine consultations

Summary

Introduction

Physical activity (PA) is important for physical and mental health in adults and older adults. 2011 and 2014, ten general practices and 12 practice nurses from within Oxfordshire and Berkshire West Primary Care Trusts and across South West London participated in two large randomised controlled trials of pedometer-based walking interventions, the PACE-Lift and PACE-UP trials Both trials investigated whether adults could increase their PA levels using complex interventions to increase walking, provided on an individual basis within practice nurse physical activity consultations and practice nurses, with their experience and expertise in supporting behaviour change, were identified as the most appropriate health care professionals to deliver the interventions. The interventions in both trials were based on pedometer step-count feedback (and accelerometer feedback in the PACE-Lift trial) combined with practice nurse PA consultations.

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