title: Co-production and evaluation of an evidence-based approach to promote physical activity for adults with health conditions
Creators: name: Buckley, B
Publisher: name: Liverpool John Moores University
Year: 2021

description: Physical activity (PA) as medicine is well-established, and targeting the most at-risk populations enhances the potential to impact public health (proportional universalism). Exercise Referral Schemes (ERSs) provide a promising framework to support PA behaviour change in inactive individuals with health conditions. Yet, due to a lack of scientific evidence and behaviour change theory underpinning the design of ERSs, there has been a lack of evidence of effectiveness. Translational research is required to improve the effectiveness of ERSs for promoting PA behaviour change and to ensure they reflect the needs of service users. Thus, the overarching aim of this PhD was to co-produce, pilot, and evaluate a PA referral scheme to support long-term behaviour change in individuals with health conditions. This process was underpinned by the Medical Research Council guidance for complex interventions and a pragmatic process and outcome evaluation framework. Study one involved the co-production of a PA referral scheme with a multidisciplinary stakeholder group, providing an insight into a) factors that must be considered when translating evidence to practice in a PA referral setting, and b) challenges and facilitators of conducting participatory research involving multiple stakeholders. The co-production process highlighted cultural and pragmatic issues related to PA referral provision such as an ‘exercise prescription’ focus and fear of litigation. This process resulted in an intervention framework designed to be implemented within existing infrastructures. The framework involved 1-to-1 PA behaviour change consultations underpinned by Self-Determination Theory. Study two explored the preliminary effectiveness and acceptability of the previously co-produced PA referral scheme (Co-PARS). Findings demonstrated that the Co-PARS elicited improvements in PA and cardiometabolic health at 12 weeks. Process data suggested, however, that further refinements were required to bring intervention delivery in-line with the intended PA behaviour change approach. These intervention adaptations were then implemented in preparation for study 3. Study three consisted of a pragmatic, quasi-experimental trial that investigated the effectiveness of the refined Co-PARS, compared to usual care and a no-treatment control. Results extended that of the previous pilot study, in that clinically meaningful improvements were observed in cardiovascular health markers and mental wellbeing compared to usual care and no-treatment at 12 weeks. No changes were however, noted in PA or motivational variables. Embedded process evaluation revealed that intervention fidelity and participant attendance rates were improved from that of the previous pilot study. Through this iterative process, a PA referral scheme was co-produced, piloted, and evaluated that was deemed effective at improving participant health and importantly, feasible to implement in practice. The intervention was underpinned by Self-Determination Theory, incorporating 1-to-1 behaviour change consultations, which focussed on facilitating long-term PA behaviour change. It is the iterative nature which the author wishes to emphasise as a vital process if we are to bridge the gap between scientific evidence and what works in practice. Of note, however, longer-term follow up is required to determine if such effects are sustained.