Physical activity referral schemes: adherence and physical activity behaviour change

It is well known that engaging in physical activity (PA) reduces the risk of developing non-communicable diseases and improves general health. However, at the time of this research, less than half of the UK population met the recommended levels of PA (DH, 2010). Physical activity referral schemes (PARS) are one of the interventions available in primary care (NICE, 2006a) for disease prevention and health improvement, despite a high dropout rate (Gidlow, 2005) and unknown long-term effectiveness (Pavey et al., 2011). The main aim of the four studies presented in this thesis was to explore the adherence and behaviour change towards PARS in Northamptonshire. The first study measured the long-term change in PA levels after participation in Activity on Referral (AOR). The key outcome was a significant increase in self-reported long-term PA levels (mean difference 1000 MET minutes/week) for 105 adhering participants from a total of 2228 participants. One in every 21 referred individuals self-reported an increase in PA at 12 months. To explore the high levels of non-adherence, an interpretative phenomenological analysis (IPA; Smith, 1996) was conducted with seven non-adhering AOR participants. The findings showed that being listened to at the point of referral, a range of positive experiences during the induction, alternative opportunities to increase activity, and potential to re-engage in PARS were some of the factors that enhanced adherence. Even though currently the key behaviour change measure for a PA intervention is an increase in PA, there is no gold standard self-reporting PA measure. Therefore, the third study was a comparison that tested the applicability of the new General Practice Physical Activity Questionnaire (GPPAQ) and the internationally validated International Physical Activity Questionnaire (IPAQ). The GPPAQ is recommended to be used as a screening tool by health professionals for the latest PARS called Let‟s Get Moving (LGM). There was a significantly weak association between IPAQ and GPPAQ. Hence, the GPPAQ is only recommended to be used as a PA screening tool and not for evaluating PA levels for PARS research studies. The final study was based on the new LGM physical activity care pathway which included a brief intervention using Motivational Interviewing (MI), a communication style that elicits the individuals‟ ambivalence regarding PA. Eight out of 21 participants self-reported a PA increase at 6 months and the MI used during the PARS was coded at beginner level. The two PARS included in this thesis were compared for adherence; LGM adherence was 65% compared to 23% AOR adherence at 3 months. In conclusion, this research has demonstrated that PA levels do increase for PARS participants in the long term, but the dropout rate can be concerning. By using a mixed-methods approach, the lived experience of participants enhances the understanding of reasons behind non-adherence. The comparative study involving LGM and AOR samples showed that interventions with elements of MI might be a better investment of commissioned resources.