A mixed-methods process evaluation of a combined physical activity and psychological therapy intervention for socially disadvantaged young people.

Abstract

Background: There is a growing body of evidence to suggest that interventions combining physical activity with psychological therapy can improve engagement, retention, and psychological outcomes of young people experiencing homelessness (YPEH). However, the challenges associated with implementing such interventions remain poorly understood. To address this lack of understanding, the aim of this study was to evaluate the barriers and facilitators to implementation of a community-based intervention comprising physical activity and psychotherapy for YPEH. Methods: A retrospective mixed-methods process evaluation was undertaken to explore recruitment and retention, fidelity, dose delivered, and dose received, of the intervention. Quantitative data sources included attendance registers, which were analysed using descriptive statistics, with qualitative data obtained from interviews with implementers, and focus groups with participants, which were analysed using a predominantly deductive thematic approach. This data was subsequently triangulated with intervention-fidelity monitoring forms, and non-participant observations to support interpretation of the findings. Results: Six participants initially enrolled into the study, with three achieving >75% attendance. Challenges to recruitment and retention were multi-factorial, however, a lack of organisational resources (staff support and transportation) appeared to have the greatest influence. Implementer interviews and monitoring forms evidenced that fidelity and dose delivered of both intervention components (physical activity and psychotherapy) were good. Moreover, triangulated data suggested that adaptations did not adversely impact on effectiveness. Dose received by participants was indicative of their engagement with sessions rather than attendance, including perceived quality of the intervention received. Contextual barriers and facilitators to implementation outcomes were identified across individual, organisational, and intervention-level domains. Conclusions: Implementation-related factors across multiple levels contributed to challenges encountered, rather than a lack of feasibility or acceptability of a combined physical activity and psychotherapy intervention. Allowing flexibility for necessary adaptations was identified as a key facilitator to intervention delivery and contributed to positive experiences reported by participants. Working with stakeholders from project inception may be necessary for overcoming identified barriers, could help facilitate scale-up of the intervention, and facilitate the translation from research into routine practice.