Stakeholder perspectives on referral processes to local authority healthy lifestyle programmes: a mixed methods study

Wilkinson, Amy Marie Yvonne

Abstract

Background: The profound but often non-specific case for physical activity (PA) in population health and the wider economy provide strong rationale for promotion in primary care settings. However, there is limited acknowledgement towards the need for refined referral pathways to community-based PA programmes based on the perspectives of all relevant stakeholders involved in the overall referral process. Consequently, such programmes are underutilised in primary care, and struggle to deliver intended health outcomes at the community level. This study makes a novel contribution to existing research by using mixed methods to elicit the perspectives and experiences of multiple stakeholders involved in referral operations to healthy lifestyle programmes (HLP) in the East Riding of Yorkshire (ERoY), to highlight areas of improvement and inform more streamlined referral processes. Methods: A convergent mixed methods design was adopted comprising of two distinct but equally important data collection phases. Phase I used semi-structured interviews with Primary Care Personnel (PCP; n = 28), which were analysed using inductive thematic analysis. Phase II adopted online surveys and semi-structured interviews to obtain data from Leisure Professionals (n = 48) and Leisure Customers (n = 20). Phase II data were analysed through a combination of descriptive statistics and inductive thematic analysis. Findings of research phases I and II were combined during the interpretation phase of this study, through the triangulation protocol. Results: Key findings from Phase I: Whilst many PCP saw value in PAP, they lacked the necessary skills and training to engage with it and were not well-informed about the HLP operating in local leisure centres. Due to systemic challenges on primary care and cumbersome referral processes, PCP struggled to make time for PAP or completion of HLP referrals. Assumptions about the barriers patient face to changing problematic lifestyle behaviours represented another pertinent finding, which contributed to PCP limited capacity to support change. Suggestions for improvement included enhancing HLP awareness, improving feedback provision, and simplifying referral processes through interoperability. Key findings from Phase II: Referral documentation provided to Leisure Professionals from PCP was a major source of criticism. Feedback mechanisms were also largely criticised by Leisure Professionals and Leisure Customers, as they fail to capture and report novel lifestyle behaviour changes of HLP participants. It was a common perception that PCP and patients lacked adequate understanding of the HLPs, which was a key area suggested for development. Standardising how referrals are managed and what feedback is provided to PCP were other suggestions for improvement from Leisure Professionals. Key findings from Triangulation Protocol: Two overriding meta themes were identified: ‘Poor Understanding’ and ‘Inadequacies of HLP Referral Processes’. Areas of agreement, partial agreement, silence, and dissonance were found within and across stakeholder groups. Recommendations and Conclusion: Eight context-specific and needs-driven recommendations to support the advancement of HLP referral processes are presented. These are centered around improving understanding and addressing inadequacies of the referral pathway. The most pressing recommendations were: (1) to push for interoperability between primary care and leisure systems to address issues inherent in HLP referral processes; and (2) to increase workforce capacity to meet unprecedented demands associated with the COVID-19 pandemic. To put research findings to use in the ‘real world’, future research would benefit from the application of implementation science.

Citation

Wilkinson, A. M. Y. (2021). Stakeholder perspectives on referral processes to local authority healthy lifestyle programmes: a mixed methods study. (Thesis). University of Hull. https://hull-repository.worktribe.com/output/4430682

• Thesis Type: Thesis
• Deposit Date: Nov 3, 2023
• Publicly Available Date: Mar 31, 2025
• Keywords: Sport, health and exercise science
• Public URL: https://hull-repository.worktribe.com/output/4430682
• Additional Information: Department of Sport, Health and Exercise Science; University of Hull
• Award Date: Sep 1, 2021