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Table 2 PARiHS Framework: Critical success factors to maximise adherence to Exercise Referral Schemes by participants

From: Adherence to exercise referral schemes by participants – what do providers and commissioners need to know? A systematic review of barriers and facilitators

Dimensions LOW implementation (Barriers) HIGH implementation (Facilitators)
Socioecological context of ERS patients (eg personal characteristics, home, work and family)
Concerns about worsening health problems was a barrier to adherence for some participants
Lack of time as a result of personal commitments to work, family, role as a carer or social demands
Loss of social support after the intervention
Lack of external support from family members, particularly a spouse
Not accommodating cultural/religious requirements : eg, language problem and the inability to communicate effectively with providers
External support from family members particularly a spouse
Cultural/religious sensitivity such as women-only activities and consideration of religious holy days
Maintaining routine: Making exercise a habit was viewed as important to ongoing physical activity beyond the ERS scheme
Evidence Could include research evidence, clinical experience, patient experience and local data Participant experience
Perceived poor/negative outcomes of ERS included general and mental health, exacerbation of specific health problems, disappointment over failure to lose weight and not benefitting from increased social engagement
Poor perceptions of the intervention atmosphere and environment: Feeling uncomfortable in an ‘intimidating gym environment‘; Dislike of music/tvs in gyms; Difficulties operating gym equipment; Poor quality facilities
Dislike of gym-based exercise due to boredom, preference for being outside
Participant experience
Perceived improvements: Physical health improvements were the most commonly described; Others included weight-loss and physical activity, mental wellbeing and personal autonomy, social engagement - both during and after the programme
Liking for gym-based activities because of its safe environment and weather independence
Desire for range of different types of physical activities including dance, aerobics, yoga, swimming, or outdoor activities such as walking and cycling
Group activities valued, with participants liking being in the company of like-minded companions rather than solitary exercise
Factors related to the presence or absence of how the ERS scheme facilitates participation and progress
Perceived lack of sufficient support and supervision from providers
High cost of exercise facilities, particularly after a subsidised ERS scheme
Inconvenient scheduling eg activity timings clashing with work hours or child care
Lack of ongoing professional support after the ERS
Venue Location Problems: Long distance to travel, difficulties with public transport, perceptions of venue locations not being safe for women
Support and supervision from providers to help guide safe and efficient exercise, provide equipment, knowledge and motivation
Peer support highly valued, specifically in relation to (i) having a companion/buddy to do the activity with during the scheme; (ii) engagement with others aiding integration and enjoyment
Individualised and personalised service including an exercise programme tailored to user needs, ability, health status, preferences, goals and values
Off-peak scheduling: The gym environmental was perceived to be less intimidating during off-peak hours. However, this was inconvenient for day-time workers
Continuing professional support after the ERS programme was desired and described as a facilitator
  1. The bold highlights the identified themes