Oliver Emily J, Dodd-Reynolds Caroline, Kasim Adetayo, Vallis Dimitrios
Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK.
Durham Research Methods Centre, Department of Sport and Exercise Sciences, Durham University, Durham DH1 3LE, UK.
Int J Environ Res Public Health. 2021 Mar 16;18(6):3033. doi: 10.3390/ijerph18063033.
Physical activity prescription, commonly through exercise referral schemes, is an established disease prevention and management pathway. There is considerable heterogeneity in terms of uptake, adherence, and outcomes, but because within-scheme analyses dominate previous research, there is limited contextual understanding of this variance. Both the impact of schemes on health inequalities and best practices for inclusion of at-risk groups are unclear. To address this, we modelled secondary data from the multi-scheme National Referral Database, comprising 23,782 individuals across 14 referral schemes, using a multilevel Bayesian inference approach. Scheme-level local demographics identified over-sampling in uptake; on the basis of uptake and completion data, more inclusive schemes ( = 4) were identified. Scheme coordinators were interviewed, and data were analyzed using a grounded theory approach. Inequalities presented in a nuanced way. Schemes showed promise for engaging populations at greater risk of poor health (e.g., those from more deprived areas or of an ethnic minority background). However, the completion odds were lower for those with a range of complex circumstances (e.g., a mental health-related referral). We identified creative best practices for widening access (e.g., partnership building), maintaining engagement (e.g., workforce diversity), and tailoring support, but recommend changes to wider operational contexts to ensure such approaches are viable.
体育活动处方通常通过运动转诊计划来实施，是一种既定的疾病预防和管理途径。在参与率、依从性和结果方面存在相当大的异质性，但由于以往研究主要是方案内部分析，因此对这种差异的背景了解有限。方案对健康不平等的影响以及纳入高危群体的最佳做法都不明确。为了解决这个问题，我们使用多级贝叶斯推理方法，对来自多方案国家转诊数据库的二次数据进行了建模，该数据库包含来自14个转诊计划的23782个人。方案层面的当地人口统计数据显示在参与率方面存在过度抽样；根据参与率和完成数据，确定了更具包容性的方案（=4）。对方案协调员进行了访谈，并使用扎根理论方法对数据进行了分析。不平等现象呈现出细微差别。这些方案有望让健康状况较差风险更高的人群参与进来（例如，来自更贫困地区或少数民族背景的人群）。然而，对于有一系列复杂情况的人（例如，与心理健康相关的转诊），完成几率较低。我们确定了扩大参与机会（例如，建立伙伴关系）、维持参与度（例如，员工队伍多元化）和量身定制支持的创新最佳做法，但建议改变更广泛的运营环境，以确保这些方法可行。
