Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

DOWNEY, John, SHEARN, Katie, BROWN, Nicola, WADEY, Ross and BRECKON, Jeff (2021). Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation. BMC Health Services Research, 21.

12913_2021_Article_6349.pdf - Published Version
Creative Commons Attribution.

Download (805kB) | Preview
Shearn-BehaviourChangePractices(Supp).pdf - Supplemental Material
Creative Commons Attribution.

Download (33kB) | Preview
Open Access URL: (Published version)
Link to published version::


Abstract: Background: Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods: An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results: Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions: The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

Item Type: Article
Additional Information: ** From Springer Nature via Jisc Publications Router ** Licence for this article: **Journal IDs: eissn 1472-6963 **Article IDs: publisher-id: s12913-021-06349-9; manuscript: 6349 **History: collection 12-2021; published 13-04-2021; online 13-04-2021; accepted 03-04-2021; registration 03-04-2021; submitted 22-10-2020
Uncontrolled Keywords: Research Article, Organization, structure and delivery of healthcare, Implementation, Primary care, Mechanisms of action, Knowledge translation, Physical activity, Behaviour change
Identification Number:
SWORD Depositor: Colin Knott
Depositing User: Colin Knott
Date Deposited: 16 Apr 2021 14:46
Last Modified: 16 Apr 2021 14:46

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics