“It’s not just about walking.....it’s the practice nurse that makes it work”: a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care

Abstract

BackgroundPhysical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations.MethodsSemi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFive key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of ‘pre-trial’ and ‘delivery of the intervention’. Two additional ‘post-trial’ themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging.ConclusionDelivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting.Trial registrationPACE-Lift ISRCTN 42122561, PACE-UP ISRCTN 98538934.

The feasibility and acceptability of nurse‐led chronic disease management interventions in primary care: An integrative review

“…Commonly cited barriers to the intervention were associated with inadequate preparation of primary care nurses, lack of support, workload and funding (Beighton et al., ; Halcomb, Furler, et al., ; Hanley et al., ; Hegney et al., ; Verwey et al., ; Zwar et al., ). Variability was seen in the amount of preparatory education and ongoing support provided to nurses.…”

“…The challenge of integrating interventions into existing nursing practice in primary care was another key barrier identified across included studies (Beighton et al., ; Halcomb, Furler, et al., ; Hegney et al., ; Verwey et al., ; Zwar et al., ). For some primary care nurses, there was a struggle to find time to deliver the interventions in an already busy workload.…”

“…For some primary care nurses, there was a struggle to find time to deliver the interventions in an already busy workload. Additionally, time constraints were directly associated with funding in several studies, where the sustainability of interventions was questioned due to the lack of funding to remunerate primary care nurse activity (Beighton et al., ; Halcomb, Furler, et al., ; Hanley et al., ; Lock et al., ; Verwey et al., ).…”

“…() and Beighton et al. () highlighted how primary care nurses tailored interventions to the specific needs of the individual. Several studies also identified the important role played by the primary care nurse in supporting and monitoring consumer progress toward health goals (Beighton et al., ; Hanley et al., ; Verwey et al., ).…”

Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial

“…Qualitative evaluations from nonparticipants [25], participants [26], and practice nurses [27] are already published. An additional paper comparing trial participants and nonparticipants is also in progress.…”