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Inequalities and Inclusion in Exercise Referral Schemes: A Mixed-Method Multi-Scheme Analysis
Emily J Oliver1, Caroline Dodd-Reynolds2, Adetayo Kasim3
1Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK.
Summary
Exercise referral schemes show promise for engaging at-risk populations but face challenges with adherence for individuals with complex needs. Identifying inclusive practices is key to improving outcomes and reducing health inequalities.
Area of Science:
- Public Health
- Health Services Research
- Exercise Science
Background:
- Physical activity prescription via exercise referral schemes is a recognized strategy for disease prevention and management.
- Existing research primarily focuses on within-scheme analyses, limiting understanding of outcome variations and health equity impacts.
- The influence of these schemes on health inequalities and optimal strategies for including vulnerable populations remain unclear.
Purpose of the Study:
- To investigate the factors influencing uptake, adherence, and outcomes within exercise referral schemes.
- To identify best practices for enhancing scheme inclusivity and addressing health inequalities.
- To analyze the impact of scheme-level demographics and individual complex circumstances on participation and completion.
Main Methods:
- Utilized multilevel Bayesian inference on secondary data from the National Referral Database (23,782 individuals, 14 schemes).
- Employed grounded theory analysis of interviews with scheme coordinators from identified inclusive schemes (n=4).
- Examined scheme-level demographics and individual-level data on uptake, adherence, and completion.
Main Results:
- Scheme uptake was influenced by local demographic factors, with some schemes demonstrating greater inclusivity.
- Schemes successfully engaged populations at higher risk of poor health, including those from deprived areas and ethnic minority backgrounds.
- Lower completion rates were observed for individuals with complex circumstances, such as mental health-related referrals, highlighting nuanced health inequalities.
Conclusions:
- Exercise referral schemes can engage diverse and at-risk populations, offering a valuable public health tool.
- Creative strategies like partnership building and workforce diversity can improve access and engagement.
- Recommendations include operational adjustments to support tailored interventions and ensure the viability of inclusive practices for diverse populations.
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