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Article ; Online: Putting function first: redesigning the primary care management of long-term conditions.

Williams, Nefyn H / Law, Rebecca-Jane

The British journal of general practice : the journal of the Royal College of General Practitioners

2018 Volume 68, Issue 673, Page(s) 388–389

MeSH term(s)	Aged ; Cognition ; Cost-Benefit Analysis ; Frailty/diagnosis ; Humans ; Long-Term Care/economics ; Middle Aged ; Primary Health Care/economics ; Primary Health Care/organization & administration ; Primary Prevention/economics ; Primary Prevention/organization & administration ; Stakeholder Participation ; State Medicine/economics ; State Medicine/organization & administration ; United Kingdom
Language	English
Publishing date	2018-07-24
Publishing country	England
Document type	Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/bjgp18X698249
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Article ; Online: The time course and mechanisms of change in biomarkers of joint metabolism in response to acute exercise and chronic training in physiologic and pathological conditions.

Roberts, Harry M / Law, Rebecca-Jane / Thom, Jeanette M

European journal of applied physiology

2019 Volume 119, Issue 11-12, Page(s) 2401–2420

Abstract: Purpose: The benefits of exercise across the lifespan and for a wide spectrum of health and diseases are well known. However, there remains less clarity as to the effects of both acute and chronic exercise on joint health. Serum biomarkers of joint ... ...

Abstract	Purpose: The benefits of exercise across the lifespan and for a wide spectrum of health and diseases are well known. However, there remains less clarity as to the effects of both acute and chronic exercise on joint health. Serum biomarkers of joint metabolism are sensitive to change and have the potential to differentiate between normal and adverse adaptations to acute and chronic load. Therefore, the primary objective of this review is to evaluate how serum biomarkers can inform our understanding of how exercise affects joint metabolism. Methods: A comprehensive literature search was completed to identify joint biomarkers previously used to investigate acute and chronic exercise training. Results: Identified biomarkers included those related to joint cartilage, bone, synovium, synovial fluid, and inflammation. However, current research has largely focused on the response of serum cartilage oligomeric matrix protein (COMP) to acute loading in healthy young individuals. Studies demonstrate how acute loading transiently increases serum COMP (i.e., cartilage metabolism), which is mostly dependent on the duration of exercise. This response does not appear to be associated with any lasting deleterious changes, cartilage degradation, or osteoarthritis. Conclusion: Several promising biomarkers for assessing joint metabolism exist and may in future enhance our understanding of the physiological response to acute and chronic exercise. Defining 'normal' and 'abnormal' biomarker responses to exercise and methodological standardisation would greatly improve the potential of research in this area to understand mechanisms and inform practice.
MeSH term(s)	Biomarkers/metabolism ; Cartilage Oligomeric Matrix Protein/metabolism ; Cartilage, Articular/metabolism ; Cartilage, Articular/physiology ; Exercise/physiology ; Humans ; Knee Joint/metabolism ; Knee Joint/physiology ; Synovial Fluid/metabolism ; Synovial Fluid/physiology
Chemical Substances	Biomarkers ; Cartilage Oligomeric Matrix Protein
Language	English
Publishing date	2019-10-24
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	124793-1
ISSN	1439-6327 ; 1432-1025 ; 0301-5548 ; 1439-6319
ISSN (online)	1439-6327 ; 1432-1025
ISSN	0301-5548 ; 1439-6319
DOI	10.1007/s00421-019-04232-4
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Article ; Online: Impact of COVID-19 pandemic on incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records.

Qi, Cathy / Osborne, Tim / Bailey, Rowena / Cooper, Alison / Hollinghurst, Joe P / Akbari, Ashley / Crowder, Ruth / Peters, Holly / Law, Rebecca-Jane / Lewis, Ruth / Smith, Deb / Edwards, Adrian / Lyons, Ronan A

The British journal of general practice : the journal of the Royal College of General Practitioners

2023 Volume 73, Issue 730, Page(s) e332–e339

Abstract: Background: The COVID-19 pandemic has directly and indirectly had an impact on health service provision owing to surges and sustained pressures on the system. The effects of these pressures on the management of long-term or chronic conditions are not ... ...

Abstract	Background: The COVID-19 pandemic has directly and indirectly had an impact on health service provision owing to surges and sustained pressures on the system. The effects of these pressures on the management of long-term or chronic conditions are not fully understood. Aim: To explore the effects of COVID-19 on the recorded incidence of 17 long-term conditions. Design and setting: This was an observational retrospective population data linkage study on the population of Wales using primary and secondary care data within the Secure Anonymised Information Linkage (SAIL) Databank. Method: Monthly rates of new diagnosis between 2000 and 2021 are presented for each long-term condition. Incidence rates post-2020 were compared with expected rates predicted using time series modelling of pre-2020 trends. The proportion of annual incidence is presented by sociodemographic factors: age, sex, social deprivation, ethnicity, frailty, and learning disability. Results: A total of 5 476 012 diagnoses from 2 257 992 individuals are included. Incidence rates from 2020 to 2021 were lower than mean expected rates across all conditions. The largest relative deficit in incidence was in chronic obstructive pulmonary disease corresponding to 343 (95% confidence interval = 230 to 456) undiagnosed patients per 100 000 population, followed by depression, type 2 diabetes, hypertension, anxiety disorders, and asthma. A GP practice of 10 000 patients might have over 400 undiagnosed long-term conditions. No notable differences between sociodemographic profiles of post- and pre-2020 incidences were observed. Conclusion: There is a potential backlog of undiagnosed patients with multiple long-term conditions. Resources are required to tackle anticipated workload as part of COVID-19 recovery, particularly in primary care.
MeSH term(s)	Humans ; Wales/epidemiology ; COVID-19/epidemiology ; Incidence ; Diabetes Mellitus, Type 2 ; Retrospective Studies ; Pandemics ; Secondary Care ; Information Storage and Retrieval
Language	English
Publishing date	2023-04-27
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2022.0353
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Article ; Online: A lifestyle management programme focused on exercise, diet and physiotherapy support for patients with hip or knee osteoarthritis and a body mass index over 35: A qualitative study.

Law, Rebecca-Jane / Nafees, Sadia / Hiscock, Julia / Wynne, Cathy / Williams, Nefyn Howard

Musculoskeletal care

2019 Volume 17, Issue 1, Page(s) 145–151

Abstract: The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences ... ...

Abstract	The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences of the LMP among patients and professionals, and offers insight for future programmes. Five referring clinicians and six delivering professionals participated in focus groups. Three referring GPs and nine patients who attended the LMP took part in semi-structured interviews. Topics included: referral, reasons for taking up and continuing the programme or not, and experiences and outcomes. Framework method was used to analyse the qualitative data. Overall, patients and professionals valued the multidisciplinary nature of the LMP. However, professionals explained feeling guilty about delaying patients on the orthopaedic waiting list and believed that the programme should be redirected to those with less severe OA and a lower BMI. Referring clinicians differed in their interpretation of the referral criteria and expressed varying levels of autonomy when making referrals. Patients referred after a consultation with their general practitioner appeared to be more satisfied with the referral process. Patients were also encouraged by the opportunity to improve health, their likelihood of surgery and social benefits. However, patients were discouraged by inconvenience, cost, lack of readiness to change and embarrassment. In conclusion, shared decision-making about lifestyle management without delaying orthopaedic opinion is preferable, and more psychological support may increase participation. Importantly, the programme may be better focused on rehabilitation for patients with a lower BMI and less severe symptoms.
MeSH term(s)	Attitude of Health Personnel ; Attitude to Health ; Body Mass Index ; Diet ; Exercise ; Female ; Focus Groups ; General Practitioners ; Humans ; Life Style ; Male ; Osteoarthritis, Hip/rehabilitation ; Osteoarthritis, Hip/surgery ; Osteoarthritis, Knee/rehabilitation ; Osteoarthritis, Knee/surgery ; Physical Therapy Modalities ; Qualitative Research ; Referral and Consultation
Language	English
Publishing date	2019-01-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171452-6
ISSN	1557-0681 ; 1478-2189
ISSN (online)	1557-0681
ISSN	1478-2189
DOI	10.1002/msc.1382
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Article ; Online: Effect of the COVID-19 pandemic on incidence of long-term conditions in Welsh residents: a population linkage study.

Qi, Cathy / Osborne, Timothy / Bailey, Rowena / Hollinghurst, Joe / Akbari, Ashley / Cooper, Alison / Peters, Holly / Law, Rebecca-Jane / Lewis, Ruth / Edwards, Adrian / Lyons, Ronan

Lancet (London, England)

2022 Volume 400 Suppl 1, Page(s) S69

Abstract: ... between Jan 1, 2000, and Dec 31, 2021. LTC's include mental health conditions, respiratory diseases, and ... Jan 1, 2020, to Dec 31, 2021, were predicted using overall trends and seasonal patterns ... 992 individuals diagnosed with at least one LTC between Jan 1, 2000, to Dec 31, 2021. Across multiple ...

Abstract	Background: The COVID-19 pandemic had direct and indirect effects on health. Indirect effects on long term medical conditions (LTCs) are unclear. We examined trends in recorded incidences of LTCs and quantified differences between expected rates and observed rates from 2020 onwards. Methods: This is a population data linkage study using primary and secondary care data within the Secure Anonymised Information Linkage Databank. We included data of Welsh residents diagnosed with any of 17 identified LTCs for the first time between Jan 1, 2000, and Dec 31, 2021. LTC's include mental health conditions, respiratory diseases, and heart conditions among others, generally chosen in line with the Quality and Outcomes Framework. The primary outcome was incidence rates (monthly number of new cases per 100 000 population). For each LTC, we did interrupted time series analysis of incidence rates from 2015 to 2021. Expected rates from between Jan 1, 2020, to Dec 31, 2021, were predicted using overall trends and seasonal patterns from the preceding 5 years and compared with observed rates. Findings: We included 5 476 012 diagnoses from 2 257 992 individuals diagnosed with at least one LTC between Jan 1, 2000, to Dec 31, 2021. Across multiple long-term conditions, there was an abrupt reduction in observed incidence of new diagnoses from March to April 2020, followed by a general increase in incidence towards prepandemic rates. The conditions with the largest percentage difference between the observed and expected incidence rates in 2020 and 2021 were chronic obstructive pulmonary disease (38·4% lower than expected), depression (28·3% lower), hypertension (25·5% lower), and anxiety disorders (24·9% lower). The condition with the largest absolute difference between observed and expected incidence rates was anxiety disorders, with 830 per 100 000 less in 2020 and 2021 compared with observed rates. Interpretation: The reduction in incidence rates of LTCs suggests an underreporting of LTCs, especially during 2020 and early 2021. The emergence of these yet undiagnosed cases could result in a surge of new patients in the near future. Funding: This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Incidence ; Pandemics ; Anxiety Disorders ; Pulmonary Disease, Chronic Obstructive
Language	English
Publishing date	2022-11-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(22)02279-6
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Article ; Online: Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data.

Parsonage, Rachel K / Hiscock, Julia / Law, Rebecca-Jane / Neal, Richard D

The British journal of general practice : the journal of the Royal College of General Practitioners

2017 Volume 67, Issue 654, Page(s) e49–e56

Abstract: Background: Earlier cancer diagnosis is crucial in improving cancer survival. The International Cancer Benchmarking Partnership Module 4 (ICBP4) is a quantitative survey study that explores the reasons for delays in diagnosis and treatment of breast, ... ...

Abstract	Background: Earlier cancer diagnosis is crucial in improving cancer survival. The International Cancer Benchmarking Partnership Module 4 (ICBP4) is a quantitative survey study that explores the reasons for delays in diagnosis and treatment of breast, colorectal, lung, and ovarian cancer. To further understand the associated diagnostic processes, it is also important to explore the patient perspectives expressed in the free-text comments. Aim: To use the free-text data provided by patients completing the ICBP4 survey to augment the understanding of patients' perspectives of their diagnostic journey. Design and setting: Qualitative analysis of the free-text data collected in Wales between October 2013 and December 2014 as part of the ICBP4 survey. Newly-diagnosed patients with either breast, ovarian, colorectal, or lung cancer were identified from registry data and then invited by their GPs to participate in the survey. Method: A thematic framework was used to analyse the free-text comments provided at the end of the ICBP4 survey. Of the 905 patients who returned a questionnaire, 530 included comments. Results: The free-text data provided information about patients' perspectives of the diagnostic journey. Analysis identified factors that acted as either barriers or facilitators at different stages of the diagnostic process. Some factors, such as screening, doctor-patient familiarity, and private treatment, acted as both barriers and facilitators depending on the context. Conclusion: Factors identified in this study help to explain how existing models of cancer diagnosis (for example, the Pathways to Treatment Model) work in practice. It is important that clinicians are aware of how these factors may interact with individual clinical cases and either facilitate, or act as a barrier to, subsequent cancer diagnosis. Understanding and implementing this knowledge into clinical practice may result in quicker cancer diagnoses.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Attitude to Health ; Delayed Diagnosis ; Early Detection of Cancer ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/diagnosis ; Neoplasms/therapy ; Physician-Patient Relations ; Qualitative Research ; Referral and Consultation ; Registries ; Surveys and Questionnaires ; Time-to-Treatment ; Wales ; Young Adult
Language	English
Publishing date	2017-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/bjgp16X688357
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Article ; Online: The efficacy, effectiveness and safety of SARS-CoV-2 disinfection methods (including ozone machines) in educational settings for children and young people

Edwards, Deborah / Csontos, Judit Katalin / Gillen, Elizabeth / Lewis, Ruth / Cooper, Alison / Gal, Micaela / Law, Rebecca-Jane / Edwards, Adrian

medRxiv

Abstract: While evidence for the importance of transmission of SARS-CoV-2 from contaminated surfaces is limited, ozone disinfection methods have been considered for surface cleaning as a response to stopping the spread of the virus in educational settings. This ... ...

Abstract	While evidence for the importance of transmission of SARS-CoV-2 from contaminated surfaces is limited, ozone disinfection methods have been considered for surface cleaning as a response to stopping the spread of the virus in educational settings. This rapid evidence summary aimed to search the available literature and summarise findings on the surface survival of SARS-CoV-2, efficacy and effectiveness of ozone machines against SARS-CoV-2, and benefits and harms caused by using these cleaning technologies, including their impact on health. Alternative cleaning technologies, such as light-based technologies and hydrogen peroxide vapour, were also investigated. Findings indicate that gaseous ozone can inactivate different bacteria and viruses, although there is a lack of direct evidence investigating the effect of these cleaning methods on SARS-CoV-2 in real-world settings, specifically in schools. However, regarding harm, ozone is a highly reactive oxidising agent, and high concentrations can contribute to decay of building materials, and health issues (mainly respiratory) by direct exposure or by-product formation. Therefore, leading environmental health organisations do not recommend the use of ozone cleaning technologies in real-world settings, such as schools. Research and policy focus may need to shift towards other interventions that could help reduce transmission, and consequently minimise disruption to education.
Keywords	covid19
Language	English
Publishing date	2022-02-22
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2022.02.21.22271281
Database	COVID19

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Article ; Online: ‘Function First’

Rebecca-Jane Law / Julia Hiscock / Christopher Burton / Lynne Williams / Joseph Langley / Beth Hall / Val Morrison / Andrew Lemmey / Candida Lovell-Smith / John Gallanders / Nefyn Williams / Jennifer Kate Cooney

BMJ Open, Vol 11, Iss

how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods

2021 Volume 7

Abstract: Objectives To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by ... ...

Abstract	Objectives To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.Design Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.Results A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions.Abridged realist programme theory Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.Co-design The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change.Conclusions Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside ...
Keywords	Medicine ; R
Subject code	796
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Promoting physical activity and physical function in people with long-term conditions in primary care

Rebecca-Jane Law / Joseph Langley / Beth Hall / Christopher Burton / Julia Hiscock / Lynne Williams / Val Morrison / Andrew B Lemmey / Candida Lovell-Smith / John Gallanders / Jennifer Cooney / Nefyn H Williams

Health Services and Delivery Research, Vol 9, Iss

the Function First realist synthesis with co-design

2021 Volume 16

Abstract: Background: As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this ... ...

Abstract	Background: As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain. Objectives: To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention. Data sources: Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews. Design: Realist evidence synthesis and co-design for primary care service innovation. Setting: Primary care in Wales and England. Participants: Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers. Methods: The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation. Results: Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change. Limitations: Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts. Conclusions: We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention. Future work: A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial. Study registration: This study is registered as PROSPERO CRD42018103027. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
Keywords	exercise ; functional capacity ; chronic disease ; general practice ; realist review ; design ; co-production ; Public aspects of medicine ; RA1-1270 ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	National Institute for Health Research
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: 'Function First': how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods.

Law, Rebecca-Jane / Langley, Joseph / Hall, Beth / Burton, Christopher / Hiscock, Julia / Williams, Lynne / Morrison, Val / Lemmey, Andrew / Lovell-Smith, Candida / Gallanders, John / Cooney, Jennifer Kate / Williams, Nefyn

BMJ open

2021 Volume 11, Issue 7, Page(s) e046751

Abstract: Objectives: To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by ... ...

Abstract	Objectives: To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory. Design: Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation. Results: A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions. Abridged realist programme theory: Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy. Co-design: The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change. Conclusions: Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.
MeSH term(s)	COVID-19 ; Exercise ; Humans ; Primary Health Care ; SARS-CoV-2
Language	English
Publishing date	2021-07-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-046751
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