Factors influencing patient uptake of an exercise referral scheme: a qualitative study

Abstract

Exercise referral schemes aim to increase physical activity amongst inactive individuals with or at risk of long-term health conditions. Yet many patients referred to these schemes (by health professionals) fail to take up the exercise opportunities on offer. Understanding factors influencing uptake to exercise referral schemes may help improve future attendance. Using the Socio-Ecological Model as a framework, this qualitative study aimed to explore factors influencing uptake to an exercise referral scheme based in the North West of England. Semi-structured interviews were conducted with referred patients (n=38) about their reasons for referral, interactions with referring health professionals, events following referral and ideas to improve future uptake. Data were analysed thematically and mapped onto the constructs of the Socio-Ecological Model. Factors reported to influence uptake included intrapersonal (past PA experiences, motivation, competing priorities), interpersonal (scheme explanations, support) and organisational influences (scheme promotion, communication between service, cost). Whilst several intrapersonal-level factors influenced patient decisions to uptake the exercise referral scheme, modifiable interpersonal and organisational factors were identified as potential targets for intervention. Recommendations are made for improving awareness of exercise referral schemes and for enhancing communication between referring practitioners, patients and referral scheme staff.

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

“…34 This is more likely to occur when enablers of exercise are present at multiple levels; including adequate resources and funding. 32…”

“…27 A study of 43 sports physicians similarly found that while these physicians had positive attitudes to exercise counselling, only 51% indicated they often discussed physical activity with patients. 31 Studies of exercise attitudes and adherence to exercise training have focused largely on patient perspectives 32,33 ; few have considered treating clinician or implementers' perspectives, although these may influence patient behaviour, and offer valuable insights into improving patient adherence. 34 To our knowledge, there are no published studies assessing physicians' attitudes towards exercise or rehabilitation and their perspectives on perceived barriers and enablers of exercise for patients with PH.…”

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

“…One review suggests reason for referral as a predictor of scheme uptake [23], with those referred for a specific medical condition more likely to uptake, while other reviews report less clear findings [21]. A recent qualitative study [28] offers some insight into factors which influence uptake decisions, highlighting factors across the intrapersonal (past physical activity experience, motivation, competing demands), interpersonal (support and scheme understanding) and organisational (promotion, communication and cost) levels of the socioecological model. As portrayed above, the current evidence base appears somewhat conflicting, which is a likely reflection of the adoption of different uptake definitions and, even more so, the notable divergence in ERSs both within and across countries [29].…”

Are exercise referral schemes associated with an increase in physical activity? Observational findings using individual patient data meta-analysis from The National Referral database

“…Although this study reviewed the effects of ERSs on change in physical activity, it does not consider the reasons for why participants chose to attend an ERS. Indeed, many factors influence uptake (Birtwistle et al 2018) and it seems likely would influence engagement throughout also. Some participants may have attended due to their own motivation to improve their health conditions, whereas, other participants may have only attended because their GP advised them to.…”