Exploring the user-centred design of a physical activity pathway in NHS care

Background The UK National Health Service (NHS) has been identified as a key domain for tackling non-communicable diseases through reducing population physical inactivity. Research demonstrates that health professionals struggle to deliver existing physical activity (PA) interventions due to a perceived lack of time and confidence in behaviour change. Evidence also suggests that programmes are being delivered inconsistently. Existing interventions are failing to engage a sufficient range of patients and have not demonstrated a long term impact on patients' PA. As end users, patients and health professionals are fundamental to the success of PA interventions and must be actively involved in their design and evaluation. Method This study adopted a Research through Design methodology using the UK Design Council's Double Diamond framework (Discover, Define, Develop, Deliver; Design Council, 2007) to explore the user-centred design of a physical activity pathway in NHS care. Semi-structured interviews with 'users' (patients and health professionals) were undertaken. This was followed by a series of co-design workshops to identify specific problems and solutions. Users and other stakeholders were consulted via a survey, interviews and face-to-face consultations to test and refine solutions. A case study using one NHS service (Physioworks) was carried out to develop and evaluate implementation recommendations. Data was analysed throughout the process using inductive thematic analysis. Findings Popular solutions focused on making it easier for health professionals to initiate conversations about PA and ensuring that referral options were appropriate for patients. Novel elements of the pathway included priming patients prior to their appointment to normalise PA within the consultation, and feedback from PA providers to inform and positively reinforce health professionals' referral behaviours. Health professionals suggested that the co-designed pathway reflected a model of best practice but that traditional organisational constraints such as time pressures remained a barrier to its consistent use with patients. Further work is needed to refine and test the pathway and to ensure that it is helpful for a broad range of patients and professionals. Conclusions This research extends knowledge about the promotion of PA and the application of user-centred design in this context. Early impact of the research includes improvements within the clinical settings such as environmental prompts, establishment of graded introductory PA groups and streamlined appointment booking with PA providers. Further collaboration is planned with Physioworks NHS service to integrate the pathway into existing caseloads.