Abstract
OBJECTIVES: Physical activity referral schemes (PARS) allow healthcare professionals to refer patients for physical activity support. Evidence of effectiveness is equivocal. Public Health Scotland has developed 'physical activity referral standards' that aim to enhance quality, reduce variability in design and delivery and build further evidence of what works. This study evaluated stakeholder perspectives on the initial reach, adoption, implementation and effectiveness of the standards. DESIGN: A qualitative study using individual, online, semistructured interviews to explore stakeholder awareness and willingness to use the standards. We analysed data using the framework method within the context of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. SETTING: Data were collected across 28 local authorities in rural and urban areas of Scotland between December 2022 and June 2023. PARTICIPANTS: 73 stakeholders, including scheme managers (n=34), senior managers from provider organisations (n=9), healthcare professionals (n=19) (general practitioners, nurses, occupational therapists and physiotherapists) and policy stakeholders (n=11). RESULTS: 72.6% of stakeholders were aware of the physical activity referral standards, and they were widely welcomed. Healthcare professionals were the least informed. Participants appeared willing to adopt the standards, and stakeholders reported using them to help with service planning, audit delivery processes, identify service gaps, inform monitoring and evaluation plans and understand and communicate the roles and responsibilities of different partners. Barriers to implementation included lack of healthcare professional awareness, funding and workforce capacity. Views about the minimum dataset (suggested essential or desirable data fields to be collected for monitoring and evaluation) contained in the standards were divided. Some thought it useful, but others considered it onerous or aspirational, and it was unclear whether all service delivery stakeholders would have the resources or capacity to collect and analyse the data. CONCLUSIONS: The delivery of the standards could be enhanced by a comprehensive communication strategy and by addressing the lack of funding, workforce delivery capacity and skills/capacity required to collect and interpret the proposed minimum national dataset.