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How do participant experiences and characteristics influence engagement in exercise referral? A qualitative longitudinal study of a scheme in Northumberland, UK

Hanson, Coral L; Oliver, Emily J; Dodd-Reynolds, Caroline J; Allin, Linda J


Emily J Oliver

Caroline J Dodd-Reynolds

Linda J Allin


Exercise referral schemes (ERSs) are internationally widespread. This study aimed to gain an insight into differential engagement through understanding participant experiences of patients referred by healthcare professionals to one such scheme in the UK.
The study employed a qualitative longitudinal approach using semistructured interviews, with results reported using Consolidated criteria for Reporting Qualitative research guidelines.
Two leisure centres providing an ‘emerging best-practice’ ERS in northeast England.
Referred patients (n=11), who had not yet commenced the scheme, were recruited on a voluntary basis. Seven females and four males, with a range of noncommunicable diseases, such as cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems, participated.
24-weeks, two times per week, of supervised exercise sessions and three one-to-one assessments (prescheme, 12 weeks and 24 weeks) for patients referred from primary and secondary care.
Primary outcome measures
Two longitudinal semistructured interviews, prior to commencement and 12–20 weeks later, were thematically analysed using the framework approach. Analysis comprised seven stages: transcription, familiarisation, coding, development and application of an analytical framework, charting data using a matrix and interpretation of data. Interpretation went beyond descriptions of individual cases to develop themes, which identified and offered possible explanations for differing participant experiences.
Three overarching themes emerged. First, ‘success’, with engaged participants focused on health outcomes and reported increases in physical activity. Second, ‘struggle’, with short-term success but concerns regarding continued engagement. Participants reported scheme dependency and cyclical needs. Finally, ‘defeat’, where ill health, social anxiety and/or poor participation experience made engagement difficult.
Some success in engaging those with noncommunicable diseases was reported, resulting in positive effects on health and well-being. The study highlights complexity within ERSs and inequality of access for
those with challenging health and social circumstances. Improved, or different, behaviour change support is required for referrals finding engagement difficult.

Journal Article Type Article
Acceptance Date Dec 17, 2018
Online Publication Date Feb 20, 2019
Publication Date 2019-02
Deposit Date Feb 11, 2019
Publicly Available Date Mar 5, 2019
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 9
Issue 2
Article Number e024370
Public URL
Contract Date Mar 5, 2019


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Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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