Exploring the role of healthcare partners in referrals to a community-based exercise program with a healthcare-community partnership designed for people with balance and mobility limitations

PURPOSE

To explore how healthcare partners in community-based exercise programs for people with balance and mobility limitations perceive and enact referral in the context of their role.

MATERIALS AND METHODS

We conducted a descriptive, qualitative study involving semi-structured interviews and reflexive thematic analysis.

RESULTS

Twelve healthcare partners from the Together In Movement and Exercise (TIMETM) program completed interviews. Seven (58%) participants were clinicians and 5 (42%) held non-clinical roles. The most common professional background of participants was physical therapy (n = 9, 75%). Clinicians made direct referrals while non-clinical participants facilitated referral by promoting the program. The main theme was healthcare partners perceive their role in referrals as secondary to their role as educators and trainers. Subthemes were: (1) healthcare partners fulfill educator and trainer roles when conducting formal training of instructors, educating instructors during program visits, and fielding questions; (2) almost all healthcare partners facilitate referral by sharing program information formally and informally; and (3) healthcare partners in clinical practice make direct referrals depending on the clientele.

CONCLUSIONS

Healthcare partners perceive their roles as educators and trainers as taking precedence over their role in referrals. Findings can be used to guide selection and training of healthcare partners, design of clinical education programs, and research on competencies.

Examining dose-response of an outdoor walk group program in the Getting Older Adults Outdoors (GO-OUT) trial

OBJECTIVE

The Getting Older Adults Outdoors (GO-OUT) randomized trial showed that a 10-week outdoor walk group (OWG) program was not superior to 10 weekly phone reminders in increasing physical and mental health; however, OWG attendance varied. This study examined whether dose-response relationships existed between OWG attendance and improvement in physical and mental health among older adults with mobility limitations.

METHODS

We analyzed data from 76 OWG participants with pre- and post-intervention scores on at least one of seven measures of health outcomes (walking endurance, comfortable and fast walking speed, balance, lower extremity strength, walking self-efficacy, and emotional well-being). Participants were classified as attending 0-9, 10-15, and 16-20 OWG sessions based on attendance tertiles. We adjusted for participant sex and study site in regression analyses.

RESULTS

Among the 76 participants, mean age was 74.9 ± 6.6 years and 72% were female. Compared to those attending 0-9 OWG sessions, participants attending 16-20 sessions exhibited a 56.3-meter greater improvement in walking endurance (95% CI: 17.3, 95.4, p = 0.005); 0.15-meter/second greater improvement in comfortable walking speed (95% CI: 0.01, 0.29, p = 0.034); and 0.18-meter/second greater improvement in fast walking speed (95% CI: 0.03, 0.34, p = 0.020). Higher attendance was associated with greater odds of improvement in comfortable walking speed (OR = 7.1; 95% CI: 1.1, 57.8, p = 0.047) and fast walking speed (OR = 10.1, 95% CI: 1.8, 72.0, p = 0.014). No significant dose-response relationships for the remaining outcomes were observed.

CONCLUSIONS

Higher attendance in a park-based, supervised, task-oriented and progressive OWG program is associated with greater improvement in walking endurance and walking speed among older adults with mobility limitations. Attendance likely impacted walking capacity and not balance, lower extremity strength, walking self-efficacy or emotional well-being due to task-specificity of training. This study highlights the importance of attendance when designing and implementing OWG programs to enhance walking endurance and speed among older adults.

Conditions and strategies influencing sustainability of a community-based exercise program incorporating a healthcare-community partnership for people with balance and mobility limitations in Canada: A collective case study of the Together in Movement and Exercise (TIME™) program

Background

Community-based exercise programs delivered through healthcare-community partnerships (CBEP-HCPs) are beneficial to individuals with balance and mobility limitations. For the community to benefit, however, these programs must be sustained over time.

Purpose

To identify conditions influencing the sustainability of CBEP-HCPs for people with balance and mobility limitations and strategies used to promote sustainability based on experiences of program providers, exercise participants, and caregivers.

Methods

Using a qualitative collective case study design, we invited stakeholders (program providers, exercise participants, and caregivers) from sites that had been running a CBEP-HCP for people with balance and mobility limitations for ≥4 years; and sites where the CBEP-HCP had been discontinued, to participate. We used two sustainability models to inform development of interview guides and data analysis. Qualitative data from each site were integrated using a narrative approach to foster deeper understanding of within-organization experiences.

Results

Twenty-nine individuals from 4 sustained and 4 discontinued sites in Ontario (n = 6) and British Columbia (n = 2), Canada, participated. Sites with sustained programs were characterized by conditions such as need for the program in the community, presence of secure funding or cost recovery mechanisms, presence of community partners, availability of experienced and motivated instructors, and the capacity to allocate resources towards program marketing and participant recruitment. For sites where programs discontinued, diminished participation and/or enrollment and an inability to allocate sufficient financial, human, and logistical resources towards the program affected program continuity. Participants from discontinued sites also identified issues such as staff with low motivation and limited experience, and presence of competing programs within the organization or the community. Staff associated the absence of referral pathways, insufficient community awareness of the program, and the inability to recover program cost due to poor participation, with program discontinuation.

Conclusion

Sustainability of CBEP-HCPs for people with balance and mobility limitations is influenced by conditions that exist during program implementation and delivery, including the need for the program in the community, and organization and community capacity to bear the program's financial and resource requirements. Complex interactions among these factors, in addition to strategies employed by program staff to promote sustainability, influence program sustainability.