Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Mixed‐method process evaluation of the Welsh National Exercise Referral Scheme

Mixed‐method process evaluation of the Welsh National Exercise Referral Scheme Purpose – Primary‐care referral to community‐based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed‐method process evaluation exploring how outcomes were achieved. Design/methodology/approach – Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi‐structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme. Findings – NERS offered patients a programme of supervised, group‐based discounted exercise. However, motivational interviewing, goal‐setting and patient follow‐up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient‐only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non‐car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS. Originality/value – In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed‐method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Health Education Emerald Publishing

Mixed‐method process evaluation of the Welsh National Exercise Referral Scheme

Download PDF
26 pages

Loading next page...
 
/lp/emerald-publishing/mixed-method-process-evaluation-of-the-welsh-national-exercise-rsVv9Jxz71
Publisher
Emerald Publishing
Copyright
Copyright © 2013 Emerald Group Publishing Limited. All rights reserved.
ISSN
0965-4283
DOI
10.1108/HE-08-2012-0046
Publisher site
See Article on Publisher Site

Abstract

Purpose – Primary‐care referral to community‐based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed‐method process evaluation exploring how outcomes were achieved. Design/methodology/approach – Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi‐structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme. Findings – NERS offered patients a programme of supervised, group‐based discounted exercise. However, motivational interviewing, goal‐setting and patient follow‐up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient‐only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non‐car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS. Originality/value – In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed‐method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.

Journal

Health Education – Emerald Publishing

Published: Oct 11, 2013

Keywords: Evaluation; Behaviour change; Physical activity; Exercise; Process evaluation; Exercise referral; Complex interventions

References

  • Using thematic analysis in psychology
    Braun, V.; Clarke, V.
  • Emergency department medication lists are not accurate
    Caglar, S.; Henneman, P.L.; Blank, F.S.; Smithline, H.A.; Henneman, E.A.
  • Start Active, Stay Active: A Report on Physical Activity from the Four Home Countries
    Chief Medical Officers of England, Scotland, Wales, and Northern Ireland
  • Factors associated with non‐participation in a physical activity promotion trial
    Chinn, D.J.; White, M.; Howel, D.; Harland, J.O.E.; Drinkwater, C.K.
  • Developing and Evaluating Complex Interventions: New Guidance
    Craig, P.; Dieppe, P.; Macintyre, S.; Michie, S.; Nazareth, I.; Petticrew, M.
  • ‘I feel totally at one, totally alive and totally happy’: a psycho‐social explanation of the physical activity and mental health relationship
    Crone, D.; Smith, A.; Gough, B.
  • Uptake and participation in physical activity referral schemes in the UK: an investigation of patients referred with mental health problems
    Crone, D.; Johnston, L.H.; Gidlow, C.; Henley, C.; James, D.V.B.
  • National Quality Assurance Framework for Exercise Referral Schemes
    Department of Health
  • Let's Get Moving: A New Physical Activity Care Pathway for the NHS: Commissioning Guidance
    Department of Health
  • Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation
    Dugdill, L.; Graham, R.C.; McNair, F.
  • ‘I wouldn’t have been interested in just sitting round a table talking about cancer’; exploring the experiences of women with breast cancer in a group exercise trial
    Emslie, C.; Whyte, F.; Campbell, A.; Mutrie, N.; Lee, L.; Ritchie, D.; Kearney, N.
  • State of the art reviews: methods of evaluation: issues and implications for physical activity referral schemes
    Gidlow, C.; Johnston, L.H.; Crone, D.; James, D.V.B.
  • Socio‐demographic patterning of referral, uptake and attendance in physical activity referral schemes
    Gidlow, C.; Johnston, L.H.; Crone, D.; Morris, C.; Smith, A.; Foster, C.; James, D.V.
  • An Evaluation Report of the Glasgow Exercise Referral Scheme
    Greater Glasgow Health Board
  • Looking for more than weight loss and fitness gain: psychosocial dimensions among elder women in a primary‐care exercise‐referral program
    Hardcastle, S.; Taylor, A.H.
  • Finding an exercise identity in an older body: ‘it's redefining yourself and working out who you are’
    Hardcastle, S.; Taylor, A.H.
  • The Newcastle exercise project: a randomised controlled trial of methods, to promote physical activity in primary care
    Harland, J.; White, M.; Drinkwater, C.; Chinn, D.; Farr, L.; Howel, D.
  • Applied Logistic Regression
    Hosmer, D.W.; Lemeshow, S.
  • The effectiveness of ‘exercise on prescription’ in stimulating physical activity among women in ethnic minority groups in the Netherlands: protocol for a randomized controlled trial
    Hosper, K.; Deutekom, M.; Stronks, P.
  • Exercise evaluation randomised trial (EXERT): a randomised trial comparing GP referral for leisure centre‐based exercise, community‐based walking and advice only
    Isaacs, A.J.; Critchley, J.A.; Tai, S.S.; Buckingham, K.; Westley, D.; Harridge, S.D.R.; Smith, C; Gottlieb, J.M.
  • Factors associated with physical activity referral uptake and participation
    James, D.V.B.; Johnston, L.H.; Crone, D.; Sidford, A.H.; Gidlow, C.; Morris, C.; Foster, C.
  • Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design
    Jolly, K.; Duda, J.; Daley, A.; Eves, F.; Mutrie, N.; Ntoumanis, N.; Rouse, P.; Lodhia, R.; Williams, G.C.
  • Physical activity on prescription in primary health care: a follow‐up of physical activity level and quality of life
    Kallings, L.V.; Leijon, M.; Hellenius, M.L.; Stahle, A.
  • Measuring adaptations of motivational interviewing: the development and validation of the behavior change counseling index (BECCI)
    Lane, C.; Huws‐Thomas, M.; Hood, K.; Rollnick, S.; Edwards, K.; Robling, M.
  • Exercise on prescription for women aged 40‐74 recruited through primary care: two year randomised controlled trial
    Lawton, B.A.; Rose, S.B.; Elley, C.R.; Dowell, A.C.; Fenton, A.; Moyes, S.A.
  • An evaluation of the effectiveness of ‘Active for Life’: an exercise referral scheme in West Suffolk
    Lee, A.S.W.; Griffin, S.J.; Simmons, R.K.
  • Does a physical activity referral scheme improve the physical activity among routine primary health care patients?
    Leijon, M.E.; Bendtsen, P.; Nilsen, P.; Festin, K.; Stahle, A.
  • Exercise on prescription: does it work?
    Lord, J.C.; Green, F.
  • Review of motivational interviewing in promoting health behaviors
    Martins, R.K.; McNeil, D.W.
  • Ten things that motivational interviewing is not
    Miller, W.R.; Rollnick, S.
  • Toward a theory of motivational interviewing
    Miller, W.R.; Rose, G.R.
  • Facilitating adherence to physical activity: exercise professionals’ experiences of the national exercise referral scheme in Wales. A qualitative study
    Moore, G.F.; Moore, L.; Murphy, S.
  • Integration of motivational interviewing into practice in the national exercise referral scheme in Wales: a mixed methods study
    Moore, G.F.; Moore, L.; Murphy, S.
  • Approaches to increase physical activity: reviewing the evidence for exercise‐referral schemes
    Morgan, O.
  • A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation
    Murphy, S.; Raisanen, L.; Moore, G.F.; Edwards, R.; Linck, P.; Williams, N.; Ud Din, N.; Hale, J.; Roberts, C.; McNish, E.; Moore, L.
  • An evaluation of the effectiveness and cost effectiveness of the national exercise referral scheme in Wales, UK: a randomised controlled trial of a public health policy initiative
    Murphy, S.M.; Edwards, R.T.; Williams, N.; Raisanen, L.; Moore, G.F.; Linck, P.; Hounsome, N.; Din, N.U.; Moore, L.
  • Four Commonly Used Methods to Increase Physical Activity: Brief Interventions In Primary Care, Exercise Referral Schemes, Pedometers and Community‐based Exercise Programmes for Walking and Cycling
    NICE
  • Rapid Review of the Economic Evidence of Physical Activity Interventions
    NICE
  • Levels and predictors of exercise referral scheme uptake and adherence: a systematic review
    Pavey, T.; Taylor, A.; Hillsdon, M.; Fox, K.; Campbell, J.; Foster, C.; Moxham, T.; Mutrie, N.; Searle, J.; Taylor, R.
  • Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta‐analysis
    Pavey, T.G.; Taylor, A.H.; Fox, K.R.; Hillsdon, M.; Anokye, N.; Campbell, J.L.; Foster, C.; Green, C.; Moxham, T.; Mutrie, N.; Searle, J.; Trueman, P.; Taylor, R.
  • Realistic Evaluation
    Pawson, R.; Tilley, N.
  • A theory of therapy, personality and interpersonal relationships as developed in the client‐centered framework
    Rogers, C.
  • Physical activity on prescription (PAP): costs and consequences of a randomized, controlled trial in primary healthcare
    Romé, Å.; Persson, U.; Ekdahl, C.; Gard, G.
  • Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes?
    Schmidt, M.; Absalah, S.; Nierkens, V.; Stronks, K.
  • Why are GP exercise schemes so successful (for those who attend)?
    Singh, S.
  • Exercise on prescription: a randomized study on the effect of counseling vs counseling and supervised exercise
    Sorensen, J.B.; Kragstrup, J.; Skovgaard, T.; Puggaard, L.
  • Running along parallel lines: how political reality impedes the evaluation of public health interventions. A case study of exercise referral schemes in England
    Sowden, S.L.; Raine, R.
  • Do general practices provide equitable access to physical activity interventions?
    Sowden, S.L.; Breeze, E.; Barber, J.; Raine, R.
  • The experiences of older people participating in exercise referral schemes
    Stathi, A.; McKenna, J.; Fox, K.R.
  • Process Evaluation for Public Health Interventions and Research
    Steckler, A.; Linnan, L.
  • Effectiveness of a primary care exercise referral intervention for changing physical self‐perceptions over 9 months
    Taylor, A.H.; Fox, K.R.
  • Effectiveness of exercise‐referral schemes to promote physical activity in adults: systematic review
    Williams, N.H.; Hendry, M.; France, B.; Lewis, R.; Wilkinson, C.
  • GP exercise referral schemes: improving the patient's experience
    Wormald, H.; Ingle, L.
  • Participants’ perceptions of a lifestyle approach to promoting physical activity: targeting deprived communities in Kingston‐Upon‐Hull
    Wormald, H.; Waters, H.; Sleap, M.; Ingle, L.