Determinants of attendance in a countrywide physical activity referral scheme.

The evidence of the benefits of physical activity for health is unequivocal. Physical activity referral schemes (PARSs) have grown exponentially in the last decade, and are a popular way for primary care trusts (PCTs) and local councils to meet the growing targets set by the Government to promote physical activity to the increasingly sedentary population. However, the efficacy of PARS to increase physical activity and in turn health has yet to be proven. Little is known about the determinants associated with uptake of referral and progress through schemes, as there is little published data following patients from point of referral. This prospective cohort study aimed to explore the influence of referral scheme processes and participant characteristics upon their access to, and exit from, the scheme. The dataset is unique as it contains a large cohort of participants (n=2958), and follows them from initial point of referral by their health professional until their discharge from the scheme. Scheme process variables were arranged into categories that represented the public health policy and physical activity context of the current study. Logistic regression was used to analyse the data, as it allows the prediction of a discrete outcome, such as scheme attendance level, from a set of variables of mixed data types, such as age and referring health professional. Findings predicted the scheme processes and participant characteristics that were associated with the four stages that marked participants' journeys through the scheme. More women (62.3%, N=1842) accessed the scheme via their health professional than men, while those with mental health and overweight/obesity referral reasons were consistently less likely to progress through contact (mental health OR 0.353 CI 0.188-0.663 P= 0.001, overweight OR 0.586 CI 0.362-0.951 P=0.03), allocation to leisure provider (mental health OR 0.550 CI 0.338-0.896 P=0.016, overweight OR 0.695 CI 0.495-0.975 P=0.035) and attendance of one or more sessions with a leisure provider (mental health OR 0.399 CI 0.275-0.579 P=0.001, overweight 0.639 CI 0.501-0.814 P=0.001). Older participants (OR 1.016 CI 1.010-1.023 P=0.001) and men (OR 1.00 - Reference value) were more likely to complete their planned physical activity sessions than younger or female (OR 0.823 CI 0.681-0.994 P=0.043) participants. Highlighting that PARSs do have a place within public health, but that those with obesity/overweight and mental health referral reasons need greater support to progress through the scheme and access physical activity. This study is the first to explore the impact of scheme processes upon participants journey through PARS, and the contribution of scheme processes upon participants' use (attendance) of PARS. This prospective cohort study marks a move away from previous research designs used to evaluate PARS. Although PARS are not the answer for public health, and the population level behaviour change needed, they should be acknowledged for providing a supported introduction to physical activity for specialist populations and as this study found, can be successful mediums for targeted groups of individuals to accomplish regular attendance to a physical activity programme over a period of time

Factors associated with physical activity referral uptake and participation

The aim of this study was to examine participant and scheme characteristics in relation to access, uptake, and participation in a physical activity referral scheme (PARS) using a prospective population-based longitudinal design. Participants (n = 3762) were recruited over a 3-year period. Logistic regression analyses identified the factors associated with the outcomes of referral uptake, participation, and completion (>= 80% attendance). Participant's age, sex, referral reason, referring health professional, and type of leisure provider were the independent variables. Based on binary logistic regression analysis (n=2631), only primary referral reason was associated with the PARS coordinator making contact with the participants. In addition to the influence of referral reason, females were also more likely (odds ratio 1.250, 95% confidence interval 1.003-1.559, P = 0.047) to agree to be assigned to a leisure provider. Referral reason and referring health professional were associated with taking up a referral opportunity. Older participants (1.016, 1.010-1.023, P = 0.001) and males were more likely to complete the referral. In conclusion, the PARS format may be less appropriate for those more constrained by time (women, young adults) and those with certain referral reasons (overweight/obesity, mental health conditions). More appropriate targeting at the point of referral could improve participation rates by revealing or addressing barriers that might later result in dropout

Methods of connecting primary care patients with community-based physical activity opportunities:A realist scoping review

Funding: NHS Fife Endowment Fund (Grant Number(s): FIF142).Deemed a global public health problem by the World Health Organization, physical inactivity is estimated to be responsible for one in six deaths in the United Kingdom (UK) and to cost the nation's economy £7.4 billion per year. A response to the problem receiving increasing attention is connecting primary care patients with community-based physical activity opportunities. We aimed to explore what is known about the effectiveness of different methods of connecting primary care patients with community-based physical activity opportunities in the United Kingdom by answering three research questions: 1) What methods of connection from primary care to community-based physical activity opportunities have been evaluated?; 2) What processes of physical activity promotion incorporating such methods of connection are (or are not) effective or acceptable, for whom, to what extent and under what circumstances; 3) How and why are (or are not) those processes effective or acceptable? We conducted a realist scoping review in which we searched Cochrane, Medline, PsycNET, Google Advanced Search, National Health Service (NHS) Evidence and NHS Health Scotland from inception until August 2020. We identified that five methods of connection from primary care to community-based physical activity opportunities had been evaluated. These were embedded in 15 processes of physical activity promotion, involving patient identification and behaviour change strategy delivery, as well as connection. In the contexts in which they were implemented, four of those processes had strong positive findings, three had moderately positive findings and eight had negative findings. The underlying theories of change were highly supported for three processes, supported to an extent for four and refuted for eight processes. Comparisons of the processes and their theories of change revealed several indications helpful for future development of effective processes. Our review also highlighted the limited evidence base in the area and the resulting need for well-designed theory-based evaluations.Publisher PDFPeer reviewe

Determinants of attendance in a countrywide physical activity referral scheme

The evidence of the benefits of physical activity for health is unequivocal. Physical activity referral schemes (PARSs) have grown exponentially in the last decade, and are a popular way for primary care trusts (PCTs) and local councils to meet the growing targets set by the Government to promote physical activity to the increasingly sedentary population. However, the efficacy of PARS to increase physical activity and in turn health has yet to be proven. Little is known about the determinants associated with uptake of referral and progress through schemes, as there is little published data following patients from point of referral. This prospective cohort study aimed to explore the influence of referral scheme processes and participant characteristics upon their access to, and exit from, the scheme. The dataset is unique as it contains a large cohort of participants (n=2958), and follows them from initial point of referral by their health professional until their discharge from the scheme. Scheme process variables were arranged into categories that represented the public health policy and physical activity context of the current study. Logistic regression was used to analyse the data, as it allows the prediction of a discrete outcome, such as scheme attendance level, from a set of variables of mixed data types, such as age and referring health professional. Findings predicted the scheme processes and participant characteristics that were associated with the four stages that marked participants' journeys through the scheme. More women (62.3%, N=1842) accessed the scheme via their health professional than men, while those with mental health and overweight/obesity referral reasons were consistently less likely to progress through contact (mental health OR 0.353 CI 0.188-0.663 P= 0.001, overweight OR 0.586 CI 0.362-0.951 P=0.03), allocation to leisure provider (mental health OR 0.550 CI 0.338-0.896 P=0.016, overweight OR 0.695 CI 0.495-0.975 P=0.035) and attendance of one or more sessions with a leisure provider (mental health OR 0.399 CI 0.275-0.579 P=0.001, overweight 0.639 CI 0.501-0.814 P=0.001). Older participants (OR 1.016 CI 1.010-1.023 P=0.001) and men (OR 1.00 - Reference value) were more likely to complete their planned physical activity sessions than younger or female (OR 0.823 CI 0.681-0.994 P=0.043) participants. Highlighting that PARSs do have a place within public health, but that those with obesity/overweight and mental health referral reasons need greater support to progress through the scheme and access physical activity. This study is the first to explore the impact of scheme processes upon participants journey through PARS, and the contribution of scheme processes upon participants' use (attendance) of PARS. This prospective cohort study marks a move away from previous research designs used to evaluate PARS. Although PARS are not the answer for public health, and the population level behaviour change needed, they should be acknowledged for providing a supported introduction to physical activity for specialist populations and as this study found, can be successful mediums for targeted groups of individuals to accomplish regular attendance to a physical activity programme over a period of time