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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)
Context 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
Facilitation 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