Exploring stakeholders’ experiences of delivering community-based physical activity and health promotion services: A qualitative study

Purpose: Non-communicable diseases are a major cause of death globally, often caused by modifiable behavioural risk factors, such as insufficient physical activity. Community-based services targeting positive behaviour change have the potential to increase the reach of health promotion to population sub-groups and have gained increasing popularity. However, these services have shown limited effectiveness and stakeholder views on their implementation are unclear. This study aimed to explore the experiences of people delivering community-based physical activity and health promotion services, and to identify perceived barriers, facilitators and gaps in the delivery of these services.
Methods: Semi-structured interviews were conducted with key stakeholders (n=15) from public and voluntary community-based health promotion organisations. These individuals were identified due to their role in the development or delivery of community-based services, using purposive and snowball sampling. Topics addressed in the interview included perceptions of current service provision, practical aspects of service delivery and effectiveness. Interviews were audio recorded, transcribed verbatim and analysed using a thematic framework. Data was stored using NVivo.
Results: Four main themes emerged: service delivery; factors influencing participation; community factors; effective elements of services. Interviewees identified the need for collaborative working with the community and other organisations in delivering services but, engagement with primary care practitioners was reportedly challenging. The need for context-specific services in convenient and familiar community venues was highlighted, and it was suggested that opportunities outside of traditional physical activity settings should be explored. Factors influencing participation in services and healthy behaviours were information dissemination, accessibility, gender-specific needs, and the built environment. Community factors influencing service provision included deprivation, politics and competing priorities. Social support from a group, regular contact with service providers possessing appropriate interpersonal skills, relevant education, and using goals and incentives were all perceived to be effective elements of services.
Conclusions: Many complex, interacting factors influence community-based services. Challenges in inter-service collaboration and in designing services that attract target populations were identified; facilitation of engagement was perceived when the community’s contextual background was recognised and relevant social and educational support was provided. These findings should guide the development of future services seeking to engage users in health-promoting behaviour change.