Prerequisites for implementing physical activity on prescription for children with obesity in paediatric health care: A cross-sectional survey

Charlotte Boman; Susanne Bernhardsson; Katarina Lauruschkus; Stefan Lundqvist; Karin Melin

doi:10.3389/frhs.2022.1102328

Prerequisites for implementing physical activity on prescription for children with obesity in paediatric health care: A cross-sectional survey

Front Health Serv. 2023 Jan 30:2:1102328. doi: 10.3389/frhs.2022.1102328. eCollection 2022.

Authors

Charlotte Boman^{1

2}, Susanne Bernhardsson^{2

3}, Katarina Lauruschkus^{4

5}, Stefan Lundqvist^{1

2

3}, Karin Melin^{6

7}

Affiliations

¹ Centre for Physical Activity, Region Västra Götaland, Gothenburg, Sweden.
² Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
⁴ Faculty of Medicine, Institution of Health Sciences, Lund University, Lund, Sweden.
⁵ Department of Habilitation, Committee on Psychiatry, Habilitation and Technical Aids, Region Skåne, Lund, Sweden.
⁶ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.

Abstract

Background: Physical inactivity is a main driver of childhood obesity that tracks into adulthood, making it crucial to address early in life. Swedish physical activity on prescription (PAP) is an effective intervention for increasing physical activity levels in adults and is being implemented in primary care in Sweden. Before implementing PAP for children, both intervention effectiveness and implementation prerequisites need to be examined. Framed by the Normalization Process Theory (NPT) domains, this study aimed to investigate perceptions of PAP amongst paediatric staff and managers working with children with obesity, as well as acceptability, appropriateness, feasibility, and barriers and facilitators for implementing PAP in paediatric health care.

Methods: Staff and managers in 28 paediatric outpatient clinics in western Sweden were surveyed using validated implementation instruments and open-ended questions. Data were analysed using Mann-Whitney U tests and Kruskal-Wallis tests. Qualitative data were categorised into NPT domains.

Results: The survey response rate was 54% (125/229). Most respondents (82%) reported PAP to be familiar and many (56%) perceived it as a normal part of work; nurses and physiotherapists to a greater extent (p < 0.001). This was anticipated to increase in the future (82%), especially amongst those with the longest work experience (p = 0.012). Respondents reported seeing the potential value in their work with PAP (77%), being open to working in new ways to use PAP (94%), and having confidence in their colleagues' ability to use PAP (77%). Barriers and facilitators were found in all the NPT domains, mainly collective action and reflexive monitoring, where, for example, inadequacies of education, resources, and research on PAP for children were reported as barriers. Most respondents agreed that PAP was acceptable, appropriate, and feasible (71% to 88%).

Conclusions: PAP is familiar and perceived as an acceptable, appropriate, and feasible intervention, and by many viewed as a normal part of clinical routines in paediatric outpatient clinics in western Sweden, especially by physiotherapists and nurses. Barriers and faciliators are mainly related to collective action and reflexive monitoring. The wide acceptance demonstrates receptiveness to PAP as an intervention to promote an active lifestyle for children with obesity.

Keywords: children; determinants; feasability; implementation; normalization process theory (NPT); obesity; physical activity on prescription; survey.

Grants and funding

The study is financed by a research grant from the Swedish research Council for Health, Working Life and Welfare (grant no. 2020-01244), awarded to principal investigator Susanne Bernhardsson. The funder has no influence over the design, conduct or reporting of the trial.