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Facilitating adherence to physical activity exercise professionals experiences of the National Exercise Referral Scheme in Wales. a qualitative study.doc

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Facilitating adherence to physical activity exercise professionals experiences of the National Exercise Referral Scheme in Wales. a qualitative study

Mooreetal.BMCPublicHealth2011,11:935 /1471-2458/11/935 RESEARCH ARTICLE OpenAccess Facilitatingadherencetophysicalactivity: exerciseprofessionals’experiencesofthe NationalExerciseReferralSchemeinWales.a qualitativestudy GrahamFMoore*,LaurenceMooreandSimonMurphy Abstract Background:Althoughimplementers’experiencesofexercisereferralschemes(ERS)mayprovidevaluableinsights intohowtheirreachandeffectivenessmightbeimproved,mostqualitativeresearchhasincludedonlyviewsof patients.Thispaperexploresexerciseprofessionals’experiencesofengagingdiverseclinicalpopulationsinanERS, andemergenceoflocalpracticestosupportuptakeandadherenceintheNationalExerciseReferralScheme(NERS) inWales. Methods:Thirty-eightexerciseprofessionalsinvolvedinthedeliveryofNERSin12localhealthboard(LHB)areas inWalestookpartinasemi-structuredtelephoneinterview.Thematicanalysiswasconducted. Results:Professionals’accountsofferedinsightsintohowperceivedneedsandresponsestoNERSvariedby patientcharacteristics.Adherencewasdescribedasmorelikelywherethepatientsoughtreferralfromahealth professionalratherthanbeingadvisedtoattend.Hence,professionalssometimesdescribedaneedforthereferral processtoidentifypatientsforwhomchangewasalreadyinternallymotivated.Inaddition,mentalhealthpatients wereseenasfacingadditionalbarriers,suchasincreasedanxietiesabouttheexerciseenvironment.Professionals describedtheirroleasinvolvinghelpingpatientstoovercomeanxietiesabouttheexerciseenvironment,whilst providingeducationandinterpersonalsupporttoassistpatients’confidenceandmotivation.However,some concernswereraisedregardingthelevelsofsupportthattheprofessionalshouldofferwhilstavoiding dependence.Patient-onlygroupactivitiesweredescribedassupportingadherencebycreatinganempathic environment,socialsupportandmodelling.Furthermore,effectivelyfosteringsocialsupportnetworkswas identifiedasakeymechanismforreducingdependenceandmaintainingchangesinthelongerterm. Conclusions:WhetherERSshouldidentifymotivatedpatients,orincorporateactivitiestosupportinternal