Mixed-method process evaluation of the Welsh National Exercise Referral Scheme
Mixed-method process evaluation of the Welsh National Exercise Referral Scheme
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DOI：
10.1108/he-08-2012-0046
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发表时间：
2013-01-01
期刊：
影响因子：
1.3
通讯作者：
Murphy, Simon
中科院分区：
文献类型：
--
作者：
Moore, Graham;Raisanen, Lawrence;Murphy, Simon
目的 - 在英国，尽管有效性证据有限，但将初级保健转诊给社区运动专家（运动转诊）的情况很常见。最近对威尔士国家运动转诊计划（NERS）进行的一项务实随机试验显示，其对身体活动和心理健康有良好影响。本文提出了一种混合方法的过程评估，以探究成果是如何实现的。
设计/方法/途径 - 通过结构化观察、实施者访谈和常规数据评估了NERS按预期实施的程度。为了分析参与情况和依从性，将基线试验数据与常规监测数据相结合。半结构化的患者访谈探究了变化过程以及对该计划的反应中社会模式的出现。
发现 - NERS为患者提供了一个有监督的、基于团体的优惠运动项目。然而，激励性访谈、目标设定和患者随访方案执行得很差。高度的专业支持被认为有助于患者建立信心并融入运动环境。仅患者参与的课程提供了社交联系、支持性环境和现实榜样。参与情况呈现出一定模式，因获取途径问题，非车主的参与率较低。心理健康患者、年轻患者以及在转诊到NERS之前活动最少的患者依从性较差。
创新性/价值 - 在实践中，尽管NERS随机对照试验显示对身体活动和心理健康有积极影响，但过程评估数据表明干预措施并未完全按预期实施。混合方法的过程评估在理解实施和运作方面起到了关键作用，深入了解了专业支持和运动课程在促进活动和心理健康方面的作用，以及对运动转诊计划的反应中社会模式的出现。
Purpose - Primary-care referral to community-based exercise specialists (exercise referral) is common in the UK despite limited evidence of effectiveness. A recent pragmatic randomised trial of the Welsh National Exercise Referral Scheme (NERS), demonstrated promising impacts upon physical activity and mental health. This paper presents a mixed-method process evaluation exploring how outcomes were achieved.Design/methodology/approach - Structured observation, implementer interviews and routine data assessed the extent to which NERS was implemented as intended. Baseline trial data were combined with routine monitoring data for the purposes of profiling uptake and adherence. Semi-structured patient interviews explored processes of change and the emergence of social patterning in responses to the scheme.Findings - NERS offered patients a programme of supervised, group-based discounted exercise. However, motivational interviewing, goal-setting and patient follow-up protocols were delivered poorly. The high degree of professional support was perceived as helping patients to build confidence and assimilate into exercise environments. Patient-only classes provided social contacts, a supportive context and realistic models. Patterning in uptake emerged from access issues, with uptake lower among non-car owners. Adherence was poorer among mental health patients, younger patients and those who were least active prior to referral to NERS.Originality/value - In practice, although the NERS RCT demonstrated positive impacts on physical activity and mental health, process evaluation data indicate that the intervention was not entirely delivered as intended. Mixed-method process evaluation served crucial functions in understanding implementation and functioning, offering insights into the roles of professional support and exercise classes in promoting activity and mental health, and the emergence of social patterning in responses to an ERS.