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Evaluation of a tactic to engage hard-to-reach patients during the exercise referral process: a longitudinal qualitative study

Martyn Queen, Diane Crone, Andrew Parker


Objectives General practitioners (GPs) have been reluctant to promote physical activity with overweight and obese patients, due to concerns about damaging the GP patient relationship. A longitudinal qualitative study was conducted to evaluate a small group of health professionals (HPs) and their patients’ perspectives of the referral process for exercise in a Primary Care setting.

Methods 12 patients aged 55-74 and their 6 referring HPs, including 5 GPs and 1 Practice Nurse. Semi-structured interviews took place on two occasions over an 8 month period in a Primary Care Health Centre. Transcripts of recorded interviews were coded and thematically analysed using a grounded theory approach.

Results HPs and patients identified difficulties associated with broaching the subject of obesity. HPs identified that tensions could arise when discussing weight management and exercise. Patients identified disliking the way that their HP had introduced the subject of obesity and the need for physical activity. The patients later acknowledged that the consultation where a direct approach was used (shock tactic), was the motivation necessary to engage them with the exercise referral scheme.

Conclusion Shock tactics by HPs can be an effective method of engaging hard-to-reach patients with a physical activity intervention. NHS service commissioners should consider training HPs to identify and engage patients that would benefit from such an approach.


Doctor-patient relationship, grounded theory, longitudinal study design, person-centered healthcare, physical activity, primary care, qualitative research

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