Community-based exercise referral pathway and primary care

• Research type

  Research Study

• Full title

  Increasing physical activity levels: Designing a referral pathway to a community- and volunteer-based physical activity programme

• IRAS ID

  248451

• Contact name

  Frank Sullivan

• Contact email

  fms20@st-andrews.ac.uk

• Sponsor organisation

  University of St Andrews

• Duration of Study in the UK

  0 years, 11 months, 30 days

• Research summary

  Research Summary
  Community referral schemes enable primary care providers to refer people to a range of local, non-medical, community- and volunteer-based services. Also known as ‘social prescribing’, this relatively new approach to health care covers a broad range of activities led by community volunteers, such as educational sessions, dietary advice, stress management and exercise. The National Institute for Health and Care Excellence (NICE) guideline on exercise referral schemes to promote physical activity also notes that ‘those offering alternatives to gym-based activities, that are less expensive and give a degree of personal choice, seem to improve adherence’ (National Institute for Health and Care Excellence, 2014). To accommodate these factors, the proposed project aims to improve adherence to physical activity through a community-based programme.

  The main research aims are (1) to design processes for referring patients from primary care to jogscotland, and (2) to perform a small pilot study on our new referral processes to assess uptake by health care providers and patients. To achieve these aims, we will review the literature and our own existing data on the effectiveness of community-based efforts to promote physical activity, and perform interviews with patients and GPs to understand their views about barriers and facilitators, their thoughts on being offered a referral to a community-based exercise scheme, and their views on what would be the most effective and acceptable way of referral. This phase of the project will then be followed by a small feasibility study to test several different referral methods and use the results to inform the design of a full trial on referral pathways to a community-based exercise scheme.

  Summary of Results
  PA promotion using connection to community-based opportunities was seen by both primary care HPs and patients to be of value. Our qualitative interviews with HPs and patients found many positives were seen to be had from connecting and promoting PA to patients from their HP at their GP practice; - 1) the link to health and/or specific health conditions and improving health through PA, 2) the motivational role of the HP and how promotion and connection to a PA group is seen to ‘legitimatise’ the patient going and following up on taking action, 3) knowledge of tangible local options for patients, a solution of which includes the opportunity for both patients and HPs to ‘Meet and Greet’ with members/leaders of local PA groups at GP practice.
  The identified methods of connection from our study involves varied associated workload levels for the HP, from passive involvement (advertisement in practice waiting areas such as video clip), to a light touch informal active signposting (brief conversation and handout during consultation), to formal referral or prescribing (health record issued letter). Across and within these methods there was some variability in the patient’s level of action (i.e. from low level where connections are made for them to a higher level, where they self-refer to seek further information). These varying connection methods highlight the diverse and individualist needs and wants of HPs and patients for PA promotion opportunities. Importantly, implementation of connecting patients to community-based PA opportunities was often restricted by barriers for the HPs in terms of lack of knowledge, time and resources of suitable, varied and locally available opportunities.
  Our findings suggest that supporting HPs to deliver PA promotion must focus on:
  • resource solutions, examples such as access to an intermediary person or community information hub,
  • practice-linked social support for patients through ’Meet and Greet’, or ‘Buddy’ systems for connecting with PA opportunities

  These aspects were seen to be central in giving patients greater variety of PA options and the vital information and support to connect with these local community-based opportunities.

  Understanding gained from this project can thus be utilised to enable primary care patients to be linked to a structured and volunteer-led physical activity programme in their communities in Fife.

• REC name

  London - Stanmore Research Ethics Committee

• REC reference

  18/LO/1588

• Date of REC Opinion

  17 Sep 2018

• REC opinion

  Further Information Favourable Opinion