Co-location of health and leisure to promote physical activity: a realist synthesis

To address the burden of non-communicable chronic disease (NCDs), many initiatives focus on increasing physical activity (PA) through healthcare. In Sheffield, as part of a London 2012 Olympic Legacy programme, the National Centre for Sport and Exercise Medicine - National Health Service (NHS) clinics were co-located within leisure centres. The aim was to promote PA as prevention and treatment option in healthcare and to bring care out of hospitals and into the community. Although policy calls for co-location of healthcare in alternate settings, there is little evidence that leisure centres might represent a suitable environment. It is unknown what impact delivering healthcare in leisure centres might have on promotion of PA within those services. This research seeks to understand how, why, for whom and under what circumstances co-location of healthcare with leisure works (or does not work). This research was grounded in realist methodology in two phases. In Phase 1, initial programme theories were developed through a realist review of academic, grey and policy literature on co-location. Initial rough programme theories from the realist review were subsequently ‘tested’ and ‘refined’ using data from semi-structured realist interviews with stakeholders involved in development of the co-location model in Sheffield. Phase 1 ended with nine theories regarding how, why, for whom and in what circumstances co-locating health and leisure services might work (or not). In Phase 2, theories were tested through semi-structured interviews with ten healthcare professionals and ten patients across four clinical services based in the co-located sites. Subsequently, five refined programme theories emerged. These theories suggest that colocation works best for patients with NCDs who are motivated but need support. Colocation of health and leisure works best for HCPs that are active, knowledgeable about PA and make time to discuss PA with patients. Co-location of health and leisure creates a salutogenic environment which enables patients and HCPs to become active. Enabling contexts include aligned business models, shared clinical and PA scheduling and teamwork between HCPs and exercise professionals. Logistical challenges and individual motivations serve as barriers to co-location working to promote PA. Co-location, under the right conditions has the potential to result in promotion of PA through healthcare and more individuals with NCDs becoming physically active.