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Patients experiences of physical activity on prescription with access to counsellors in routine care: a qualitative study in Sweden
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Reg Kronoberg, Sweden.
Reg Kronoberg, Sweden; Linnaeus Univ, Sweden.
Reg Kronoberg, Sweden; Lund Univ, Sweden.
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
2019 (engelsk)Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, artikkel-id 210Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BackgroundPhysical activity on prescription (PAP) has been implemented in several countries, including Sweden, to support patients who might benefit from increased physical activity. This study explores the experiences of recipients of PAP in routine health care in Sweden that offers the recipients support from physical activity counsellors. The aim was to explore influences on engagement in physical activity by PAP recipients from a long-term perspective.MethodsWe conducted individual semi-structured interviews using a topic guide with a purposively selected sample of 13 adult PAP recipients 1.5 to 2.5years after PAP. Interviews were recorded, transcribed verbatim and analysed through inductive and deductive content analysis. The questions were informed by Capability-Opportunity-Motivation-Behaviour (COM-B), which was also used as a framework to analyse the data by means of categorizing the factors (influences on the behaviour).ResultsTen factors (i.e. sub-categories) that influenced the participants engagement in physical activity were identified. PAP recipients capability to engage in physical activity was associated with adapting the PAP to the individuals physical capacity and taking into account the individuals previous experiences of physical activity. PAP recipients opportunity to engage in physical activity was related to receiving a prescription, receiving professional counselling and follow-up from a physical activity counsellor, collaboration between prescriber and counsellor, having access to appropriate activities, having a balanced life situation and having support from someone who encouraged continued physical activity. PAP recipients motivation to engage in physical activity was associated with the desire to improve his or her health condition and finding activities that encouraged continuation.ConclusionsPAP recipients engagement in physical activity was influenced by their capability, opportunity and motivation to undertake this behaviour. Numerous extraneous factors influence capability and motivation. Physical activity counsellors were found to be important for sustained activity because they use an individual approach to counselling and flexible follow-up adapted to each individuals need of support.

sted, utgiver, år, opplag, sider
BMC , 2019. Vol. 19, artikkel-id 210
Emneord [en]
Qualitative research; Physical activity; Health care; Patients; Counselling
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-154997DOI: 10.1186/s12889-019-6535-5ISI: 000459398500001PubMedID: 30786907OAI: oai:DiVA.org:liu-154997DiVA, id: diva2:1297549
Merknad

Funding Agencies|Department of Research and Development, Region Kronoberg; Medical Research Council of Southeast Sweden (FORSS); Linkoping University, Department of Medical and Health Sciences

Tilgjengelig fra: 2019-03-20 Laget: 2019-03-20 Sist oppdatert: 2023-08-28
Inngår i avhandling
1. Physical activity on prescription with access to counsellor support implemented in routine care: Healthcare and patient perspectives
Åpne denne publikasjonen i ny fane eller vindu >>Physical activity on prescription with access to counsellor support implemented in routine care: Healthcare and patient perspectives
2022 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Background: The Swedish PAP (physical activity on prescription) programme FaR®, introduced in 2001, has been adopted by all Swedish regions, which are responsible for provision of healthcare in Sweden. Several studies have shown positive outcomes of the Swedish PAP on patients’ physical activity and other health-related outcomes. There are no guidelines for best practises of the Swedish PAP, which has led to the development of different organizational structures for its delivery. This thesis project was developed with the ambition of providing knowledge for further development of PAP in clinical practise.

Aim: The overall aim was to investigate and generate improved understanding of a structure for physical activity on prescription with access to physical activity counsellors, implemented in routine healthcare.

Methods: To address the overall aim, four real-world studies with different design and analysis methods were carried out. The study population consisted of patients 18 years or older prescribed PAP in primary and secondary care in Region Kronoberg’s healthcare organization. Study I investigated characteristics of healthcare delivery of PAP over a four-year period, including all patients prescribed PAP in these years. Study II explored factors that influenced patient’s long-term engagement in physical activity after prescription. Study III investigated differences in physical activity and health-related quality of life (HRQoL) at one-year follow-up between patients who used versus patients who did not use counsellor support after prescription. Study IV investigated factors associated with patients increase in physical activity at one-year follow-up. Data sources for the studies were electronic medical records (Studies I, II, III and IV), individual interviews (Study II) and a baseline and a follow-up questionnaire (Studies III and IV). Different statistical analyses were performed in Studies I, III and IV. Study II used qualitative content analysis based on an approach including both inductive and deductive analysis. The final study samples of PAP recipients were N = 4,879 (Study I), n = 13 (Study II), n = 400 (Study = III) and n = 355 (Study IV).

Results: Study I: 4,879 PAP recipients were identified, one-third had used the offer of counsellor support. PAP recipients had a high frequency of diagnosis and healthcare consumption prior to PAP. Counsellor users had higher frequency of multiple diagnoses and healthcare visits than non-counsellor users. The main prescriber of PAP was physicians and the main prescribing setting was primary care. Study II: PAP recipients’ long-term engagement with physical activity was influenced by the determinants of capability, opportunity, and motivation. Receiving a prescription of physical activity, and professional counselling and follow up from a physical activity counsellor, and adaption of PAP to the individual’s capacity were important for patients change of physical activity. Study III: Counsellor users had better outcomes in both physical activity and HRQoL than non-users of this support. Study IV: Nearly half of the PAP recipients had increased physical activity one year after prescription. Increased physical activity was positively associated with lower baseline activity, counsellor use, and positive perception of given support after PAP.

Conclusions: Patients who were prescribed PAP had a high frequency of diagnoses and high healthcare consumption in the year prior to the prescription. Due to the positive findings regarding patient outcomes on physical activity, and patient experiences of counsellor support, it could be suggested that individualized counselling and follow up by a physical activity counsellor is of importance for patients’ engagement in physical activity, especially for patients with lower baseline activity. Since increased activity was also seen among nonusers of counsellor support, a general recommendation for physical activity counsellor support for all PAP recipients could not be suggested.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2022. s. 83
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1828
Emneord
Physical activity on prescription, Counselling, Counsellor, Health care, Patients
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-189990 (URN)10.3384/9789179294663 (DOI)9789179294656 (ISBN)9789179294663 (ISBN)
Disputas
2022-12-08, Belladonna, Hus 511, Campus US, Linköping, 13:00
Opponent
Veileder
Tilgjengelig fra: 2022-11-15 Laget: 2022-11-15 Sist oppdatert: 2022-11-21bibliografisk kontrollert

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