Co-contributors: Graham Moore
|The proposed project will evaluate the post-trial implementation and long-term clinical effectiveness of the Welsh National Exercise Referral Scheme [NERS] across all 22 Local Authorities [LAs] in Wales. Physical inactivity is a major cause of preventable illness and significant cost to the NHS. In Wales, 71% of adults are not sufficiently active. Increasing physical activity at the population level, and among at risk groups, is a public health priority. While an earlier evaluation of NERS revealing promising impacts upon self-reported physical activity and mental health outcome at 12-month follow-up, the ongoing fidelity of implementation and long-term effectiveness on health outcomes is unknown; understanding the longer-term maintenance of implementation and effects of evidence-based interventions is a major empirical gap in the public health literature. What evidence there is to date suggests that evidence-based interventions are often not widely adopted or are adopted with insufficient quality and fidelity following trials of their effectiveness. Furthermore, use of self-reported outcomes may have subjected data to inaccuracies and the follow-up of participants in the longer-term may be necessary to demonstrate significant improvements in a variety of health outcomes. This proposal aligns with Welsh government strategy which identifies physical activity as a priority area. It addresses NICE research recommendations, as well as service delivery recommendations of Public Health Wales’ Health Improvement Review, focused on furthering the impact of NERS through innovation and research.|
This research will consist of two phases; 1) qualitative study investigating the acceptability, adherence, fidelity and dose at which NERS core components are delivered within a LA over time and across LAs and 2) quantitative study examining long-term health outcomes of NERS patients at 3-and 5-year time points following scheme exit. Within phase 1, structured/ semi-structured interviews will be conducted to explore experiences and views of programme implementation. Phase 2 will involve secondary data analysis of routine NERS data and record linkage to anonymised routine health records. The use of propensity-score matching will enable long-term health outcomes to be compared between NERS patients and non-NERS patients. This phase will also involve subgroup analyses to determine effectiveness of NERS within specific populations.
NERS is delivered in a variety of settings across the 22 local authorities in Wales, including council owned leisure centres and private gyms. For this project, we will gather data from scheme implementers (i.e. NERS national coordinator and area coordinators) across all 22 local authorities. Data will also be gathered from exercise professionals in a purposive sub-sample of four case-study areas. Routinely collected data from all NERS participants who were entered into the NERS generic pathway will be used.