The impact of an exercise referral scheme on patients and health professionals: a longitudinal qualitative study.

Queen, Martyn (2013) The impact of an exercise referral scheme on patients and health professionals: a longitudinal qualitative study. PhD thesis, University of Gloucestershire.

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Abstract

Understanding the complexities associated with physical activity behaviour is problematic as it is a complex phenomenon that the majority of the population do not engage with. Sedentary lifestyles have been associated with a range of diseases, more prevalent in areas of social deprivation than in affluent areas. The objective of this research was to gain a comprehensive understanding of the experiences of a group of patients and their referring health professionals, in respect to what the experience meant to them and its impact on their lives. A qualitative longitudinal approach was used to maximise the ecological validity of the study. The practice based exercise referral scheme took place in a South West Devon city. The data collection phase comprised of two parts. Twelve interviews were carried out with referred patients on three occasions (0, 8 and 12 months). The second phase consisted of six interviews with the referring health professionals on two separate occasions (0 and 8 months). Grounded theory methodology guided the analysis resulting in two conceptual models. The first model emerged from the health professional’s data. It depicted the context in which the patients were referred into the scheme and represented the phenomena ‘patient take-up of a practice based exercise referral scheme’. The second model emerged from the patient’s data, depicted the context in which the patients experienced the scheme and represented the phenomena ‘the impact of long term involvement with an exercise referral scheme on patient’s perceived health status. These findings were interpreted further to gain insights into the core categories of ‘easier referral’ and ‘feeling better’, which emerged from the first and second models respectively. The analysis highlighted the multidimensional nature of these two categories. ‘Easier referral’ embraced a wide range of notions. For example, structural systems, interactional tactics and training needs. Barriers to referral included not prioritising referrals and gender stereotypes. Enablers included tactics to engage the patient with the scheme. ‘Feeling better’ embraced a wide range of beliefs held by the patients. For example, the impact of the scheme on perceived health status, the impact of sedentary behaviour on disease aetiology and the support systems necessary for adherence. Key motivators for adherence were, feeling good, health status and medical implications. Through unpacking the two concepts of ‘feeling better’ and ‘easier referral’ the findings provide new knowledge on the potential that exercise referral schemes have to improve long term quality of life for patients. The findings also suggest methods that health professionals can improve patient take-up of schemes. This insight can inform researchers and future evaluation design of exercise referral schemes to be more representative of the genuine long term impact on the health of patients. Future schemes would benefit by developing: engagement tactics; training to reduce risk to health professionals; fostering gender neutral patient perceptions; and identification and use of support systems by exercise professionals. This context specific evidence adds to the current research and as such can inform future practice and research. This study has shown that a practice based exercise referral scheme can enable patients to develop long term physical activity behaviour, apply learnt behaviour to their lifestyles, help to manage medical conditions and improve perceptions of health status.

Item Type: Thesis (PhD)
Uncontrolled Keywords: Exercise referral scheme, physical activity behaviour, health status, sedentary lifstyle, grounded theory methodology, England
Subjects: Q Science > QP Physiology
R Medicine > RA Public aspects of medicine
Divisions: Schools and Research Institutes > School of Sport & Exercise
Depositing User: Susan Turner
Date Deposited: 17 Feb 2015 15:03
Last Modified: 17 Feb 2015 15:03
URI: http://eprints.glos.ac.uk/id/eprint/1380

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