The Active Hospital pilot: A qualitative study exploring the implementation of a Trust-wide Sport and Exercise Medicine-led physical activity intervention

Abstract

Background In 2017 Public Health England and Sport England commissioned a Consultant-led Sport and Exercise Medicine (SEM) pilot to test the feasibility and acceptability of embedding physical activity interventions in secondary care clinical pathways. The aim of this paper is to report qualitative findings exploring the experience of healthcare professionals (HCPs) and patients involved in the Active Hospital pilot. Methods Qualitative data was collected by semi-structured interviews with Active Hospital pilot SEM Consultants, and staff and patients involved in three clinical pathways. Interviews with SEM Consultants explored the experience of developing and implementing the pilot. Interviews with staff and patients explored the experience of delivering and receiving Active Hospital interventions. Data were analysed thematically. Results Interviews identified the importance of the Active Hospital pilot being Consultant-led for the following reasons; i) having trusting relationships with decision makers, ii) having sufficient influence to effect change, iii) identifying champions within the system, and iv) being adaptable to change and ensuring the programme fits within the wider strategic frameworks. HCPs emphasised the importance of the Active Hospital interventions fitting easily within existing work practices, the need for staff training and to tailor interventions for individual patient needs. The Active Hospital pilot was well received by patients, however a lack of dedicated resource and capacity to deliver the intervention was highlighted as a challenge by both patients and HCPs. Conclusion The SEM Consultants’ ability to navigate the political climate of a large National Health Service (NHS) Trust with competing agendas and limited resource was valuable. The interventions were well received and a valued addition to usual clinical care. However, implementation and ongoing delivery of the pilot encountered challenges including lack of capacity within the system and delays with recruiting to the delivery teams in each pathway.

“Exercise Is My Medicine”: A Qualitative Study Exploring the Experiences of Non-admitted Patients Receiving Physical Activity Promotion From Hospital Surgeons

“…This was exemplified in the Healthy 4U-2 study where surgeons co-designed PA information material for patients and this enabled them to engage patients in discussions on PA change, confident that they had a dedicated program that they could point patients toward to manage their PA needs (20). Hospitals keen to increase preventive health in routine clinical care should undertake a mapping exercise to examine the options available to clinicians that enable preventive health interventions to occur, and what is being done well in the hospital (19). Following this, hospitals need to consult with clinicians and relevant stakeholders to explore and where possible co-design pathways to integrate preventive health recommendations into routine practice.…”

“…Hospitals seeking to encourage PA promotion should consider how to implement pathways to facilitate systematic PA screening and promotion. For example, PA calculators have been incorporated into electronic medical records to ensure that a baseline PA measure is taken at the initial consultation of a pregnant woman's contact with the hospital (19). This baseline measure encourages discussions around PA and subsequent referrals to PA promotion programs (19).…”

“…For example, PA calculators have been incorporated into electronic medical records to ensure that a baseline PA measure is taken at the initial consultation of a pregnant woman's contact with the hospital (19). This baseline measure encourages discussions around PA and subsequent referrals to PA promotion programs (19). Clinicians seeking to encourage patients to increase PA should consider the style of communication that the patients felt influenced their decision to change, and how preventive health conversations and recommendations can be simultaneously directive toward change and supportive of patient autonomy (38).…”

“…The time required to compete these steps has been highlighted as a significant barrier, and doctors would rather refer to other professionals to promote PA change (18). Public Health England examined the feasibility of embedding PA interventions in secondary hospital care, using Sport and Exercise Medicine consultants in the program design (19). Patients were recruited by PA "champions" who were nurses or physiotherapists, not by the consultants.…”

“…Patients were recruited by PA "champions" who were nurses or physiotherapists, not by the consultants. Interviews from participants (n = 4) focused on their experience of participating in the behavior change intervention and did not discuss the potential influence of being recruited into the program from the secondary care setting (19).…”