Downey John, Shearn Katie, Brown Nicola, Wadey Ross, Breckon Jeff
School of Sport, Health, and Wellbeing, Plymouth Marjon University, Plymouth, PL6 8BH, UK.
Centre for Health and Social care Research, Sheffield Hallam University, Sheffield, S10 2BP, UK.
BMC Health Serv Res. 2021 Apr 13;21(1):335. doi: 10.1186/s12913-021-06349-9.
Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom.
An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework.
Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice.
The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.
运动转诊计划已在全球范围内的发达国家实施，以提高患有一系列健康问题的久坐不动患者的身体活动水平，尽管其效用受到质疑。了解行为改变实践的实施机制对于避免不当停用并支持未来的服务规划很重要。本研究的目的是建立初步理论，以了解英国运动转诊从业者的行为改变实践受到哪些因素的影响。
开展了为期八个月的聚焦人种志研究，以进行现实主义评价的第一阶段，包括参与观察、访谈、文件分析和反思性日志记录。采用了一个全面的实施框架（综合实施研究框架），提供了大量的决定因素清单。根据理论领域框架（在能力、机会、动机、行为模型内）对机制进行分类，提供了一个将框架层次联系起来的解释工具。
提出了三个项目理论。首先，当有以行为改变为导向的规划和培训时，动机和能力会受到影响。其次，如果领导层支持行为改变实践，动机就会受到影响。最后，卫生专业人员与从业者之间的整合将影响动机和能力。影响动机和能力的必要条件包括以人为本的氛围、有认知的从业者和已建立的实践社区。
这些发现首次阐明了运动转诊服务中实施行为改变实践的必要要素。这些结果概述了关于行为改变实施的条件、资源和解释的新兴理论，可为服务发展提供参考。
