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Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation
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Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation.

John Downey1, Katie Shearn2, Nicola Brown3

  • 1School of Sport, Health, and Wellbeing, Plymouth Marjon University, Plymouth, PL6 8BH, UK. Jdowney@marjon.ac.uk.

BMC Health Services Research
|April 14, 2021
PubMed
Summary

Implementing behaviour change practices in Exercise Referral Schemes requires supportive leadership and integrated healthcare teams. Enhanced practitioner motivation and capability are key for successful physical activity interventions in sedentary patients.

Keywords:
Behaviour changeImplementationKnowledge translationMechanisms of actionPhysical activityPrimary care

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Area of Science:

  • Public Health
  • Behavioural Science
  • Health Services Research

Background:

  • Exercise Referral Schemes (ERS) aim to increase physical activity in sedentary individuals but face scrutiny regarding effectiveness.
  • Understanding the implementation of behaviour change practices within ERS is crucial for service sustainability and planning.
  • This study addresses the need for theoretical insights into practitioner behaviour change practices in UK-based ERS.

Purpose of the Study:

  • To develop initial programme theories explaining influences on behaviour change practices among Exercise Referral practitioners.
  • To identify key determinants and mechanisms affecting practitioner behaviour change implementation within ERS.

Main Methods:

  • An eight-month focused ethnography, the initial phase of a realist evaluation, was employed.
  • Data collection included participant observation, interviews, document analysis, and reflexive journaling.
  • The Consolidated Framework for Implementation Research and the Theoretical Domains Framework (Capability, Opportunity, Motivation, Behaviour model) guided the analysis.

Main Results:

  • Three programme theories emerged regarding factors influencing practitioner motivation and capability.
  • Behaviour change-oriented planning, training, supportive leadership, and integration with health professionals positively influence motivation and capability.
  • A person-centred climate, knowledgeable practitioners, and established communities of practice are essential conditions.

Conclusions:

  • This study provides the first articulation of necessary elements for implementing behaviour change practices in ERS.
  • Findings offer emerging theories on conditions, resources, and explanations for behaviour change implementation.
  • The results can inform the development and improvement of Exercise Referral services.