Patients’ experiences of physical activity on prescription with access to counsellors in routine care: a qualitative study in Sweden

Abstract

Background Physical 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. Methods We conducted individual semi-structured interviews using a topic guide with a purposively selected sample of 13 adult PAP recipients 1.5 to 2.5 years 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). Results Ten 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 individual’s physical capacity and taking into account the individual’s 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. Conclusions PAP 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 individual’s need of support. Electronic supplementary material The online version of this article (10.1186/s12889-019-6535-5) contains supplementary material, which is available to authorized users.

Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas

“…If they were and the informants forgot about it, this suggests that the TCP prescription form itself did not have a direct impact on tobacco cessation from the patients' perspective. This is consistent with the findings from a study on patients' experiences of PAP in Sweden, showing that the PAP prescription form was forgotten by patients and mainly had a symbolic value compared to the subsequent support provided [43]. Previous studies have shown that advice may be taken more seriously when combined with a prescription form [20,43] but this was not reported by the informants in this study.…”

Long-term physical activity on prescription intervention for patients with insufficient physical activity level—a randomized controlled trial

“…After continuing PAP treatment for 2 years, a majority of patients in both the PT and HCC groups increased their PA level and improvements in TotalMET, BMI, HDL, and MCS over time were shown for both groups. Possibly the results would have been more pronounced if we had allowed the patients to choose the study arm, instead of randomly assigning them to the interventions as we acknowledge the importance of an individualized process for the patient [ 10 – 12 ]. The results should be considered in light of the fact that discontinuing PAP treatment at 6 months could risk adherence deterioration and a return to the baseline levels of PA and risk markers.…”

“…A recent systematic review presented high-level evidence, which showed that PAP can increase the PA level in patients being insufficiently active in the healthcare setting [ 9 ]. The individualized parts of PAP treatment may be crucial in influencing the patient’s capability and motivation to increase PA [ 10 – 12 ]. Swedish PAP studies have shown that, among subjects that increased their PA levels, compliance declined over time.…”

Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support

“…Nearly two-fifths of the participants in this study took up the offer of counsellor support. Some patients may feel reluctant to seek support [ 34 ] and, therefore, it is likely that a PAP model in which patients are contacted by a counsellor leads to a higher proportion of counsellor use. For some, the reason for not utilizing the support of a physical activity counsellor might be related to factors that could be facilitated by the counsellors, such as low motivation to start physical activity [ 35 ] or insufficient self-efficacy and low expectations concerning one’s own ability to engage in physical activity [ 36 ].…”