‘Function First—Be Active, Stay Independent’—promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design

Abstract

IntroductionPeople with long-term conditions typically have reduced physical functioning, are less physically active and therefore become less able to live independently and do the things they enjoy. However, assessment and promotion of physical function and physical activity is not part of routine management in primary care. This project aims to develop evidence-based recommendations about how primary care can best help people to become more physically active in order to maintain and improve their physical function, thus promoting independence.Methods and analysisThis study takes a realist synthesis approach, following RAMESES guidance, with embedded co-production and co-design. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. Stage 2 will involve focused literature searching, data extraction and synthesis to provide evidence to support or refute the initial programme theories. Searches for evidence will focus on physical activity interventions involving the assessment of physical function which are relevant to primary care. We will describe ‘what works’, ‘for whom’ and ‘in what circumstances’ and develop conjectured programme theories using context, mechanism and outcome configurations. Stage 3 will test and refine these theories through individual stakeholder interviews. The resulting theory-driven recommendations will feed into Stage 4 which will involve three sequential co-design stakeholder workshops in which practical ideas for service innovation in primary care will be developed.Ethics and disseminationHealthcare and Medical Sciences Academic Ethics Committee (Reference 2018-16308) and NHS Wales Research Ethics Committee 5 approval (References 256 729 and 262726) have been obtained. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports.PROSPERO registration numberCRD42018103027.

‘Function First’: how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods

“…In this study, 'co-production' refers to the co-production of the whole research project with stakeholders, and 'co-design' refers to the specific activities, within the co-produced research project, which focused on designing a set of resources. The overall methods are detailed elsewhere 24 25 and a visual summary is provided in online supplemental figure 1.…”

“…We developed and amended an iterative systematic search strategy including search terms such as 'physical activity', 'physical function' and 'primary care'. 24 25 We ran searches across the bibliographic databases: Medline, CINAHL, ASSIA, Social Services Abstracts, PsycInfo and Cochrane Library. We used Covidence software to coordinate the review process and apply our initial inclusion and exclusion criteria to identify potentially relevant papers (online supplemental table 3).…”

“…A total of 73 articles were selected for final inclusion because of their relevance and theoretical richness (ie, they contained explanatory information that was detailed enough to contribute to programme theory development). 25 We supplemented the systematic search with forward and backwards citation tracking of key articles and purposive searches of guidelines, grey literature, social prescribing and physical literacy to identify 48 additional articles (figure 2). A total of 121 pieces of evidence were selected and used to develop the CMO statements (see online supplemental table 4 for final list of papers).…”

“…Using the data extracted from the included papers, and through ongoing discussion within the project team and advisory group, we developed initial 'candidate' CMO statements. 25 These CMO statements were continually refined throughout the later workshops.…”

“…Using design-based activities including immersion, ideation and co-design, 25 ideas and recommendations for service innovation, and plans for making the intervention useable, were designed collaboratively and expanded during each workshop. There were key 'deliverables' from each workshop and, in between workshops, designers worked to develop ideas and provocations for the next workshop termed 'design activities'.…”