Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention.
Study Goal
The researchers aimed to understand barriers and facilitators to engagement with a primary care-based walking intervention using pedometers and behavior change techniques.
Results Summary
Most participants felt they benefited from the intervention, regardless of step-count changes, with key facilitators including health motivation and support, while barriers included physical health problems and time constraints. Behavior change techniques like self-monitoring and goal-setting were impactful, whereas rewards were not helpful.
Population
Mid-life and older adults in the UK not meeting recommended physical activity levels.
Effective Dosage
Not specified (pedometer and handbook with/without nurse support).
Duration
Not specified.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
structured use of a pedometer and handbook | increase | walking | mid-life and older adults in the UK | - | sought to increase | #1 |
structured use of a pedometer and handbook with support from a practice nurse trained in behaviour change techniques | increase | walking | mid-life and older adults in the UK | - | sought to increase | #2 |
providing information about behaviour-health link | increase | walking | trial participants | - | reported to have the most impact | #3 |
prompting self-monitoring and review of goals and outcomes | increase | walking | trial participants | - | reported to have the most impact | #4 |
providing feedback | increase | walking | trial participants | - | reported to have the most impact | #5 |
providing specific information about how to increase walking | increase | walking | trial participants | - | reported to have the most impact | #6 |
planning social support/change | increase | walking | trial participants | - | reported to have the most impact | #7 |
relapse prevention | increase | walking | trial participants | - | reported to have the most impact | #8 |
rewards | no change | walking | trial participants | - | were unhelpful | #9 |
BACKGROUND: The majority of mid-life and older adults in the UK are not achieving recommended physical activity levels and inactivity is associated with many health problems. Walking is a safe, appropriate exercise. The PACE-UP trial sought to increase walking through the structured use of a pedometer and handbook, with and without support from a practice nurse trained in behaviour change techniques (BCTs). Understanding barriers and facilitators to engagement with a primary care based physical activity intervention is essential for future trials and programmes. METHODS: We conducted semi-structured telephone interviews using a topic guide with purposive samples of participants who did and did not increase their walking from both intervention groups. Interviews were audio-recorded, transcribed and coded independently by researchers prior to performing a thematic analysis. Responsiveness to the specific BCTs used was also analysed. RESULTS: Forty-three trial participants were interviewed in early 2014. Almost all felt they had benefitted, irrespective of their change in step-count, and that primary care was an appropriate setting.Important facilitators included a desire for a healthy lifestyle, improved physical health, enjoyment of walking in the local environment, having a flexible routine allowing for an increase in walking, appropriate self and external monitoring and support from others.Important barriers included physical health problems, an inflexible routine, work and other commitments, the weather and a mistrust of the monitoring equipment.BCTs that were reported to have the most impact included: providing information about behaviour-health link; prompting self-monitoring and review of goals and outcomes; providing feedback; providing specific information about how to increase walking; planning social support/change; and relapse prevention. Rewards were unhelpful. CONCLUSIONS: Despite our expectation that there would be a difference between the experiences of those who did and did not objectively increase their walking, we found that most participants considered themselves to have succeeded in the trial and benefitted from taking part. Barriers and facilitators were similar across demographic groups and trial outcomes. Findings indicated several BCTs on which PA trial and programme planners could focus efforts with the expectation of greatest impact as well as strong support for primary care as an appropriate venue. TRIAL REGISTRATION: ISRCTN98538934.