A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS)

Abstract

Background Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes. Methods We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy. Results Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change). Conclusion Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice.

Current Practice of Physical Activity Counselling within Physiotherapy Usual Care and Influences on Its Use: A Cross-Sectional Survey

“…One possible explanation is that physiotherapists may be uncertain about community services and whether exercise leaders have the knowledge, skills, and facilities to cater and potentially tailor physical activity for people who have a physical disability. The newly developed UK Physical Activity Referral Scheme (PARS) Taxonomy [ 38 ] provides a structure to detail physical activity service characteristics and referral processes. This structure may be worth testing as a tool for physiotherapists to gather information about local services to enable selection of services that cater for their patients and thus facilitate referrals.…”

Gender Differences in Uptake, Adherence and Experiences: A Longitudinal, Mixed-Methods Study of a Physical Activity Referral Scheme in Scotland, UK

“…Effectiveness appears to be influenced by who is referred (referral), how many of those referred initially participate (uptake) and, of those who start, how many continue to participate (adherence) [ 13 ]. There is a lack of understanding about whom PARS successfully engage with, and analyses are limited by a lack of standardised definitions for uptake and adherence [ 14 ]. These issues limit the ability of schemes to either inform HCPs about which of their patients are more likely to engage, or to develop and test new ways to engage with those that PARS do not currently reach successfully [ 15 ].…”

The National ReferAll Database: An Open Dataset of Exercise Referral Schemes Across the UK

“…However, understanding this requires greater homogeneity in reporting to support evaluation. Hanson et al [ 31 ] have recently developed, through a Delphi process, a taxonomy for reporting and classifying physical activity referral schemes including ERS. Through following such an approach, the implementation of standardisation then, at least, has a starting point, and indeed many, though not all, aspects of this are captured in The National Referral Database at present.…”

“…Details of the schemes, classifications and characteristics included in the database are incomplete, something which our phase 1 analyses were unable to consider. Though many elements of the newly developed taxonomy from Hanson et al [ 31 ] are captured in the database, and in this phase 2 data cut, we were able to include the type of scheme, many other key characteristics are not captured. For example, the database currently lacks information regarding the prescription of exercise provided in each scheme using consistent criteria (e.g., FITT) This is a major limitation in drawing conclusions regarding what might work in terms of specific ERS.…”