Determinants of attendance in a countrywide physical activity referral scheme.

The evidence of the benefits of physical activity for health is unequivocal. Physical activity referral schemes (PARSs) have grown exponentially in the last decade, and are a popular way for primary care trusts (PCTs) and local councils to meet the growing targets set by the Government to promote physical activity to the increasingly sedentary population. However, the efficacy of PARS to increase physical activity and in turn health has yet to be proven. Little is known about the determinants associated with uptake of referral and progress through schemes, as there is little published data following patients from point of referral. This prospective cohort study aimed to explore the influence of referral scheme processes and participant characteristics upon their access to, and exit from, the scheme. The dataset is unique as it contains a large cohort of participants (n=2958), and follows them from initial point of referral by their health professional until their discharge from the scheme. Scheme process variables were arranged into categories that represented the public health policy and physical activity context of the current study. Logistic regression was used to analyse the data, as it allows the prediction of a discrete outcome, such as scheme attendance level, from a set of variables of mixed data types, such as age and referring health professional. Findings predicted the scheme processes and participant characteristics that were associated with the four stages that marked participants' journeys through the scheme. More women (62.3%, N=1842) accessed the scheme via their health professional than men, while those with mental health and overweight/obesity referral reasons were consistently less likely to progress through contact (mental health OR 0.353 CI 0.188-0.663 P= 0.001, overweight OR 0.586 CI 0.362-0.951 P=0.03), allocation to leisure provider (mental health OR 0.550 CI 0.338-0.896 P=0.016, overweight OR 0.695 CI 0.495-0.975 P=0.035) and attendance of one or more sessions with a leisure provider (mental health OR 0.399 CI 0.275-0.579 P=0.001, overweight 0.639 CI 0.501-0.814 P=0.001). Older participants (OR 1.016 CI 1.010-1.023 P=0.001) and men (OR 1.00 - Reference value) were more likely to complete their planned physical activity sessions than younger or female (OR 0.823 CI 0.681-0.994 P=0.043) participants. Highlighting that PARSs do have a place within public health, but that those with obesity/overweight and mental health referral reasons need greater support to progress through the scheme and access physical activity. This study is the first to explore the impact of scheme processes upon participants journey through PARS, and the contribution of scheme processes upon participants' use (attendance) of PARS. This prospective cohort study marks a move away from previous research designs used to evaluate PARS. Although PARS are not the answer for public health, and the population level behaviour change needed, they should be acknowledged for providing a supported introduction to physical activity for specialist populations and as this study found, can be successful mediums for targeted groups of individuals to accomplish regular attendance to a physical activity programme over a period of time.