Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention

Abstract

BackgroundThe 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.MethodsWe 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.ResultsForty-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.ConclusionsDespite 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 registrationISRCTN98538934.

Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial

“…Our interventions did not affect anxiety or depression scores, consistent with other primary care pedometer-based interventions, suggesting either no effect or insensitivity of these measures to change, particularly when levels are in the normal range for most people [19, 21]. However, whilst a few participants mentioned negative effects from overdoing walking, most intervention participants talked about feeling fitter, sleeping better, improved mood, having more energy and less pain, and keeping more active into older age [26]. There is a lack of data comparing individual, couple, or household participation in walking studies [15, 21].…”

“…A systematic review suggested that step-count diaries were common to successful pedometer interventions [16], and approximately 80% of both of our intervention groups returned completed step-count diaries. Also, our qualitative findings suggest that participants from both groups valued the handbook and diary as well as the pedometer [26]. …”

“…Qualitative evaluations from nonparticipants [25], participants [26], and practice nurses [27] are already published. An additional paper comparing trial participants and nonparticipants is also in progress.…”

“…All publications relating to the trial are provided on the website. The burden of the intervention was assessed by all participants in the nurse group with a questionnaire as part of the process evaluation and by samples of both intervention groups as part of the qualitative evaluation [26]. …”

Mental health and quality of life benefits of a pedometer-based walking intervention delivered in a primary care setting

“…Despite that, one group of authors indicated that during qualitative research conducted alongside the trial, most of their intervention participants verbally expressed that they were feeling better, sleeping better, had an improved mood, and had more energy and less pain (Normansell et al, 2014).…”