‘Function First’: how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods

Abstract

ObjectivesTo develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.DesignRealist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.ResultsA taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions.Abridged realist programme theoryRoutinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.Co-designThe programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change.ConclusionsPrevious physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.

Barriers and facilitators to the use of digital systems in primary care to deliver physical activity advice using COM-B and theoretical domains framework

“…This qualitative study expands upon previous findings on the barriers and facilitators to delivering PA advice in primary care (Albert et al, 2020;Hall et al, 2021), by using a behavioural framework to systematically identify the barriers and facilitators to using digital systems to deliver PA advice in primary care. The findings from this study indicate that important influences relating to knowledge, time and confidence for delivering PA advice are also important for using digital systems.…”

“…The mixed views regarding the usability and utility of digital systems emerging from this study builds upon previous findings for eHealth interventions to deliver PA advice. Similarly, some HCPs find eHealth interventions useful and easy to use, but others perceive eHealth interventions to be time consuming or ineffective, with technical issues, inexperienced staff and the complexity of programmes being barriers to their use (Neudorf et al, 2020;Wattanapisit et al, 2020a;Wattanapisit et al, 2020b;Hall et al, 2021).…”

“…As with delivering PA advice (Lamming et al, 2017;Hall et al, 2021), time was a barrier to using digital systems, which is closely related to its efficiency and ease of use. Cumbersome digital tools that are poorly integrated slow down work and disrupt workflow, creating a barrier to their use to support delivering PA advice (Granja et al, 2018;Poppe et al, 2018;Wattanapisit et al, 2021a).…”

“…One approach is to deliver PA advice to patients within primary care. As a trusted source of health-related information that frequently interacts with large proportions of the population, healthcare professionals (HCP) within primary care have pivotal roles in encouraging greater PA (Jones et al, 2019, Hall et al, 2021. As many as one in four people say they would be more active if they were advised by a GP or a nurse (Orrow et al, 2012).…”

“…Despite knowledge amongst HCPs that increasing PA is beneficial for their patients (Wattanapisit et al, 2019), a number of reviews and studies have identified key obstacles that limit the delivery of PA advice in primary care. Important obstacles include a lack of knowledge (of national PA guidelines, of how to deliver advice, of what advice to give, of how to communicate effectively) (Chatterjee et al, 2017;Goryakin et al, 2018;Wattanapisit et al, 2019;Huntington et al, 2020, Hall et al, 2021, a lack of tools or resources (Hall et al, 2021), an inability to follow up on patients (Wattanapisit et al, 2019;Hall et al, 2021), the perceived readiness and motivation of the patient to change (Albert et al, 2020;Hall et al, 2021), a lack of confidence (Belanger et al, 2017) and time constraints (Gustavsson et al, 2018;Wattanapisit et al, 2019;Hall et al, 2021).…”