Edinburgh Napier University

  Objectives: Exercise referral schemes are an internationally widespread physical activity intervention. This study examined narratives of those referred by health professionals to a scheme recognised as emerging best practice to understand whom this service served well, or poorly, and why.

Design: The study employed a qualitative longitudinal approach.

Method: Participants were 11 individuals referred to a northeast England exercise referral scheme, with a range of long-term conditions including cardiovascular disease, mental health issues, diabetes, overweight/obesity and musculoskeletal problems. Participants took part in two interviews, prior to commencing the scheme and 12-20 weeks later. A holistic-form-based mode of analysis focused on the plot of participant narratives and understanding personal constructions of referral experience.

Results: Three narrative typologies emerged. First, success, with engaged participants focused on health outcomes and able to access social support. Second, struggle, short-term success but with concerns regarding continued engagement due to scheme dependency or cyclical needs. Participants focused on regaining structure and control following life events causing a breakdown in their social order. Finally, defeat, where illness, impaired social circumstances, restrictive interpersonal relationships, and/or poor participation experience made engagement difficult.

Conclusion: Participants drew on different narratives to explain engagement/non-engagement with the scheme, providing insight regarding for whom it worked or did not work. Collectively the narrative typologies highlight the complexity within such schemes, and inequality of access for those with challenging health and social circumstances. Improved, or different, behaviour change support is required for those who find engagement difficult, to help them move towards an alternative narrative.