Edinburgh Napier University

  Background: Physical activity (PA) benefits physical and mental health and is effective in the prevention and treatment of non-communicable diseases. Globally, one in four adults are insufficiently active to benefit health and levels of physical activity are in decline. Brief behaviour change interventions by healthcare professionals (HCPs) effectively increase patients’ PA, yet levels of promotion by HCPs remain low. Therefore, research in this thesis aims to explore the factors that influence the promotion of physical activity practices by HCPs.

Methods: The research is comprised of three phases – 1) A systematic review of 65 studies, representing 11,236 HCPs from 17 countries, that examines HCPs’ perceptions about what influences promotion of physical activity for adults. 2) A qualitative study using semi-structured interviews that explores the perspectives of 14 HCPs who regularly refer patients to a PA referral scheme about what influences their promotion practices. 3) An explanatory mixed methods study that examines the engagement of pre-registration nursing and physiotherapy students (n=39) with an online physical activity promotion education programme, the resultant change in self-perceived motivational interviewing skills, and programme acceptability.

Results: The systematic review and qualitative study show that HCPs believe that physical activity is beneficial to health and consider promotion of physical activity to be important, but it can be limited due to patient health issues and low motivation. HCPs reported mixed levels of knowledge, education and confidence to promote physical activity. The practice of physical activity promotion was influenced by knowledge about the health benefits of exercise, role-specific perceptions, personal physical activity levels, patient factors, and knowledge and feedback from the referral scheme. In the mixed methods study, 35.7% of those starting the online course completed it, with no significant change in self-perceived motivational interviewing skills. Physiotherapists were significantly more likely to complete the course than nurses (p=0.006). Personal factors, difficulties with the online platform and the Covid-19 pandemic led to dropout.

Conclusion: HCPs consider promotion of physical activity to be important, but there are notable challenges in engaging patients in discussions of physical activity. More HCP education is required to enable effective patient behaviour change.