Abstract:Recently, social workers have been identified as a key messenger group for promoting physical activity (PA) to disabled people. Also identified is the need to train social workers in PA promotion. In response, the purpose of this article is to inform the design of a training programme prototype aiming to support social workers to become active PA messengers. We conducted a three-round Delphi study to identify the essential contents and teaching methods for the programme, as well as the challenges that may jeop… Show more
“…Doing so would encompass a much broader workforce, including local authorities and third sector organisations, alongside the National Health Service (NHS), and the involvement of service users [37]. Indeed, there is a growing acknowledgment that allied health professionals and social workers have a key role to play in tackling physical inactivity and addressing health inequalities, as part of a workforce that spans the health and social care sectors [38][39][40][41]. Furthermore, designing WSAs that bring together and support such a workforce in tackling issues such as physical inactivity aligns with agendas to develop more integrated and preventative practices across health and social care [37,[42][43][44].…”
Section: Whole System Approaches To Physical Inactivitymentioning
Background
Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently.
Methods
The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM’s design, implementation and/or delivery. Data was analysed using Braun and Clarke’s reflexive thematic analysis.
Results
Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change.
Conclusions
These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.
“…Doing so would encompass a much broader workforce, including local authorities and third sector organisations, alongside the National Health Service (NHS), and the involvement of service users [37]. Indeed, there is a growing acknowledgment that allied health professionals and social workers have a key role to play in tackling physical inactivity and addressing health inequalities, as part of a workforce that spans the health and social care sectors [38][39][40][41]. Furthermore, designing WSAs that bring together and support such a workforce in tackling issues such as physical inactivity aligns with agendas to develop more integrated and preventative practices across health and social care [37,[42][43][44].…”
Section: Whole System Approaches To Physical Inactivitymentioning
Background
Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently.
Methods
The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM’s design, implementation and/or delivery. Data was analysed using Braun and Clarke’s reflexive thematic analysis.
Results
Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change.
Conclusions
These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.
“…Previous research which have aimed to develop PA promotion training for health and social care professionals have used a Delphi design to inform the training program design and components [ 13 , 14 , 15 ]. The Delphi technique was originally developed with the aim of reaching consensus among a group of experts through the use of multiple questionnaires interspersed with feedback [ 16 ].…”
Research suggests adults with visual impairment would increase their physical activity (PA) if they were advised to by a professional working in visual impairment services. However, there are no training programs which are targeted at enabling these professionals to promote PA. Therefore, this study aims to inform a UK-based training program which facilitates PA promotion within visual impairment services. A modified Delphi technique was used, consisting of a focus group and two rounds of surveys. The panel included 17 experts in round one, and 12 experts in round two. Consensus was defined as equal to or greater than 70% agreement. The panel agreed training should: educate professionals on PA benefits, injury prevention, and wellbeing, address myths associated with PA, address health and safety concerns, help professionals to find local PA opportunities, and include a networking session for professionals in visual impairment services and local PA providers. The panel agreed training should also target PA providers and volunteers for visual impairment services, and that training should be delivered online and in-person. In conclusion, training should provide professionals with the capability to promote PA and to establish stakeholder partnerships. The present findings can inform future research which tests the panel’s recommendations.
“…Figure 1.The Delphi study results. Modified from Monforte et al (2022). To interpret the figure, please consider the following.…”
Section: Introductionmentioning
confidence: 99%
“…I'm much happier talking about the issues… I can see why you would do it because presumably that [i.e. the Delphi Method] does fit some Monforte et al (2022). To interpret the figure, please consider the following.…”
Section: Introductionmentioning
confidence: 99%
“…Sixty experts were initially recruited, and twenty filled in the third and last questionnaire round. The results of the Delphi study are published in Monforte et al (2022 ) and summarised in the Figure 1 . This figure will have an important role in this article for reasons revealed later.…”
This research developed from a co-produced project called Moving Social Work. The purpose of this ongoing project is to train social workers in how to promote physical activity for and to disabled people. The first stage of the project consisted of building evidence to design a training programme prototype. As part of this stage, a Delphi study was conducted to ask leading experts about what should be included in the prototype. Questionnaires were sent to participants until consensus was reached. In reflecting on the results, people involved in the study commented that there was more about the experts’ opinions than percentages of agreement. Our co-production partners resolved that the Delphi was insufficient and called for detailed conversations with the experts. In response to this call, follow-up interviews with 10 experts who participated in the final questionnaire round of the Delphi were carried out. The interviews were co-produced, dyadic and data prompted. Dialogical inquiry was used to frame and co-analyse data. The results illuminate the capacity of qualitative research to justify, rectify, complicate, clarify, concretize, expand and question consensus-based evidence. The implications of the results for Moving Social Work are discussed. Beyond the empirical border of the project, wider contributions to literature are presented. As part of these, two key statements are highlighted and warranted: dialogical inquiry supports the practice of co-produced research, and Delphi studies should be followed by a Big Q qualitative study.
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