Implementation success of a physical activity referral scheme in the German healthcare system

Background: The BewegtVersorgt project is the first study to implement a physical activity referral scheme (PARS) in the German healthcare system. The PARS aims to increase physical activity (PA) levels among persons with non-communicable diseases and includes a brief PA advice by physicians, followed by an individualized PA promotion by physical therapists or sports therapists.
Purpose: Based on the RE-AIM framework, this qualitative study evaluates specific dimensions of implementation success of the PARS, all from health professionals’ perspective.
Methods: We conducted semi-structured interviews (n=13) with eight (out of 17) medical practices and with five (out of 14) therapy practices. Following the principles of intensity case sampling, the practices were purposefully selected based on the number of participants treated and dropped-out. The interview transcripts were analyzed using thematic analysis, combining deductive and inductive category building.
Results: Most health professionals report that they would already address PA promotion in some way and see this as part of their job, but in different roles. Eleven out of thirteen interviewees believe that the PARS has added value for the participants. While most physicians did not use intended techniques of motivational interviewing (MI) for PA advice, therapists largely adhered to intervention guidelines and integrated MI. Both, therapists and physicians faced barriers with integrating the process into everyday practice and during intervention delivery. Most interviewees advocate a sustainable implementation of the program, considering adjustments to the intervention concept as well as structural and system-related changes.
Conclusions: Given the intervention adjustments and barriers faced with the implementation in routine care, implementation success was only partially achieved.
Practical implications: These results, in combination with the evaluation of all dimensions of implementation success, will help to adapt the PARS to be more suitable for integration into the German healthcare system.
Funding: Funded by the German Federal Ministry of Health.