Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention

BMC Public Health

Tess Harris¹  Peter Whincup¹  Julia Fox-Rushby²  Michael Ussher¹  Steve Iliffe⁴  Sally Kerry³  Derek G Cook¹  Christina Victor⁵  Jaime Smith¹  Rebecca Normansell¹ 

[1] Population Health Research Institute, St George’s University of London, London SW17 ORE, UK;Health Economics Research Group, Brunel University, London UB83PH, UK;Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London E12AT, UK;Research Department of Primary Care & Population Health, University College, London NW3 2PF, UK;Gerontology and Health Services Research Unit, College of Health and Life Sciences, Brunel University, London UB8 3PH, UK

关键词: Older adults;    Primary care;    Walking;    Pedometer intervention;    Physical activity;    Qualitative research;   

Others  :  1092352
DOI  :  10.1186/1471-2458-14-1272

 received in 2014-10-13, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

The majority of mid-life and older adults in the UK are not achieving recommended physical activity levels and inactivity is associated with many health problems. Walking is a safe, appropriate exercise. The PACE-UP trial sought to increase walking through the structured use of a pedometer and handbook, with and without support from a practice nurse trained in behaviour change techniques (BCTs). Understanding barriers and facilitators to engagement with a primary care based physical activity intervention is essential for future trials and programmes.

Methods

We conducted semi-structured telephone interviews using a topic guide with purposive samples of participants who did and did not increase their walking from both intervention groups. Interviews were audio-recorded, transcribed and coded independently by researchers prior to performing a thematic analysis. Responsiveness to the specific BCTs used was also analysed.

Results

Forty-three trial participants were interviewed in early 2014. Almost all felt they had benefitted, irrespective of their change in step-count, and that primary care was an appropriate setting.

Important facilitators included a desire for a healthy lifestyle, improved physical health, enjoyment of walking in the local environment, having a flexible routine allowing for an increase in walking, appropriate self and external monitoring and support from others.

Important barriers included physical health problems, an inflexible routine, work and other commitments, the weather and a mistrust of the monitoring equipment.

BCTs that were reported to have the most impact included: providing information about behaviour-health link; prompting self-monitoring and review of goals and outcomes; providing feedback; providing specific information about how to increase walking; planning social support/change; and relapse prevention. Rewards were unhelpful.

Conclusions

Despite our expectation that there would be a difference between the experiences of those who did and did not objectively increase their walking, we found that most participants considered themselves to have succeeded in the trial and benefitted from taking part. Barriers and facilitators were similar across demographic groups and trial outcomes. Findings indicated several BCTs on which PA trial and programme planners could focus efforts with the expectation of greatest impact as well as strong support for primary care as an appropriate venue.

Trial registration

ISRCTN98538934.

【 授权许可】

   
2014 Normansell et al.; licensee BioMed Central.

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