Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in the PACE-UP randomised controlled trial, a primary care based walking intervention

Abstract

Background: The majority of mid-life and older adults in the UK are not achieving recommended physical activity levels and inactivity is associated with many health problems. Walking is a safe, appropriate exercise. The PACE-UP trial sought to increase walking through the structured use of a pedometer and handbook, with and without support from a practice nurse trained in behaviour change techniques (BCTs). Understanding barriers and facilitators to engagement with a primary care based physical activity intervention is essential for future trials and programmes. Methods: We conducted semi-structured telephone interviews usi ng a topic guide with purposive samples of participants who did and did not increase their walking from both intervent ion groups. Interviews were audio-recorded, transcribed and coded independently by researchers pr ior to performing a thematic analysis. R esponsiveness to the specific BCTs used was also analysed. Results: Forty-three trial participants were interviewed in early 20 14. Almost all felt they had benefitted, irrespective of their change in step-count, and that primary care was an appropriate setting. Important facilitators included a desire for a healthy lifesty le, improved physical health, enjoyment of walking in the local environment, having a flexible routine allowing for an increase in walking, appropriate self and external monitoring and support from others. Important barriers included physical hea lth problems, an inflexible routine, work and other commitments, the weather and a mistrust of the monitoring equipment. BCTs that were reported to have the most impact included: prov iding information about behaviour-health link; prompting self-monitoring and review of goals and outcomes; providing feedback; providing specific information about how to increase walking; planning social support/change; and relapse prevention. Rewards were unhelpful. Conclusions: Despite our expectation that there would be a diff erence between the experiences of those who did and did not objectively increase their walking, we found that mos t participants considered themselves to have succeeded in the trial and benefitted from taking part. Barriers and faci litators were similar across demographic groups and trial outcomes. Findings indicated several BCTs on which PA tr ial and programme planners could focus efforts with the expectation of greatest impact as well as strong s upport for primary care as an appropriate venue. Trial registration: ISRCTN98538934.