How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK

Hanson, Coral, Oliver, Emily, Dodd-Reynolds, Caroline and Allin, Linda (2019) How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK. BMJ Open, 9 (2). e024370. ISSN 2044-6055

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Abstract

Objectives: Exercise referral schemes are internationally widespread. This study aimed to give an in-depth understanding of experiences of patients referred by healthcare professionals to one such scheme in the United Kingdom.

Design: The study employed a qualitative longitudinal approach using semi-structured interviews, with results reported using COREQ guidelines.

Setting: Two leisure centres providing an ‘emerging best-practice’ exercise referral scheme in northeast England.

Participants: Referred patients (n = 11) who had not yet commenced the scheme, were recruited on a voluntary basis. Seven females and four males, with a range of non-communicable diseases: cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems participated.

Intervention: 24-week, twice weekly supervised exercise sessions and three one-to-one assessments (pre-scheme, 12-weeks and 24-weeks) for patients referred from primary and secondary care.

Primary outcome measures: Two longitudinal semi-structured interviews, prior to commencement and 12-20 weeks later, were thematically analysed using the framework approach. Analysis comprised seven stages: transcription, familiarisation, coding, development and application of an analytical framework, charting data using a matrix, and interpretation of data. Interpretation went beyond descriptions of individual cases to develop themes, which identified and offered possible explanations for differing participant experiences.

Results: Three overarching themes emerged. First, ‘success’, with engaged participants focused on health outcomes and reported increases in physical activity. Second, ‘struggle’, with short-term success but concerns regarding continued engagement. Participants reported scheme dependency and cyclical needs. Finally, ‘defeat’, where ill health, social anxiety, and/or poor participation experience made engagement difficult.

Conclusion: Some success in engaging those with non-communicable diseases was reported, resulting in positive effects on health and wellbeing. The study highlights complexity within exercise referral schemes, and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for referrals finding engagement difficult.

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