Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK.
School of Medicine, Cardiff University, Neuadd Meirionnydd, CF14 4YS, Cardiff, UK.
BMC Health Serv Res. 2021 Nov 13;21(1):1232. doi: 10.1186/s12913-021-07266-7.
Over ten years on from a randomised controlled trial and subsequent national roll-out, the National Exercise Referral Scheme (NERS) continues to be routinely delivered in primary care across Wales, UK. Few studies have revisited effective interventions years into their delivery in routine practice to understand how implementation, and perceived effects, have been maintained over time. This study explores perceptions and experiences of referral to NERS among referrers, scheme deliverers and patients.
Individual, semi-structured interviews were conducted with 50 stakeholders: scheme referrers (n = 9); scheme deliverers (n = 22); and referred patients (n = 19). Convenience sampling techniques were used to recruit scheme referrers and purposive sampling to recruit scheme deliverers and patients. Thematic analysis was employed.
Analyses resulted in five key themes; referrer characteristics, geographical disparities in referral and scheme access, reinforcements for awareness of the scheme, patient characteristics and processes and context underpinning a referral. Overall there was a high concordance of views between all three stakeholder groups and barriers and facilitators were found to be entwined within and across themes. Referral barriers persisting since the earlier trial included a lack of consultation time and a lack of referral feedback. Newly identified barriers included a lack of scheme awareness and a referral system perceived to be time intensive and disjointed. Key referral facilitators included patient self-referrals, a growing scheme reputation and promotional activities of scheme deliverers.
Findings provide evidence that could inform the further development of NERS and wider exercise referral schemes to ensure the referral process is timely, efficient and equitable.
自一项随机对照试验和随后的全国推广以来，已经过去了十多年，英国威尔士的基层医疗服务仍在常规开展国家运动推荐计划（NERS）。很少有研究在常规实践中对有效干预措施进行多年回顾，以了解实施情况和长期以来的感知效果。本研究探讨了推荐者、计划执行者和患者对 NERS 推荐的看法和经验。
对 50 名利益相关者进行了个体半结构化访谈：计划推荐者（n=9）；计划执行者（n=22）；和被推荐的患者（n=19）。采用便利抽样技术招募计划推荐者，采用目的抽样招募计划执行者和患者。采用主题分析。
分析结果产生了五个关键主题；推荐者特征、推荐和计划获得的地域差异、提高对计划的认识的强化因素、患者特征以及支持推荐的流程和背景。总体而言，所有三个利益相关者群体之间的观点高度一致，障碍和促进因素在各个主题内和主题之间相互交织。自早期试验以来一直存在的推荐障碍包括缺乏咨询时间和缺乏推荐反馈。新发现的障碍包括对计划缺乏认识，以及被认为耗时且不连贯的推荐系统。关键的推荐促进因素包括患者的自我推荐、计划声誉的提高以及计划执行者的推广活动。
研究结果提供了证据，可以为 NERS 和更广泛的运动推荐计划的进一步发展提供信息，以确保推荐过程及时、高效和公平。
