'Function First' - optimising physical activity prescriptions in primary care

BackgroundAs people age and accumulate long-term conditions, physical activity and physical function often decline. Primary care could contribute to improving this, however the best approach is uncertain.AimTo develop a programme theory explaining how interventions improve physical activity and function, in people with long-term conditions. To co-design a prototype intervention.Design and SettingRealist evidence synthesis and co-design for primary care service innovation.MethodsRealist synthesis combined evidence from a wide range of literature with stakeholder views. The resulting context, mechanism and outcome (CMO) statements informed co-design and knowledgeResults1) GP consultations tend not to prioritise physical activity and function. If the culture of the practice is supportive of physical activity, then encouraging physical activity will become part of usual routine.2) Physical activity promotion is inconsistent and uncoordinated. If physical activity promotion is better resourced, then this will improve opportunities to change behaviour.3) People with long-term conditions have varying physical activity levels, attitudes and opportunities. If physical activity promotion is adapted to individual needs and preferences, then people will be more likely to carry on.4) Many general practice staff lack knowledge and confidence about promoting physical activity. If training makes staff more capable, then they will be better able to promote physical activity.5) If a programme makes sense and is trustworthy, then patients and professionals will engage with it.Resources were co-designed for developing: an environment that encourages physical activity, knowledge about physical activity, and a new role for someone who can encourage people to use local opportunities to be more active.ConclusionsThis product needs further development, consideration alongside current schemes and contexts, including those relevant to the Covid-19 pandemic, and testing in a future study. The integration of realist and co-design methods strengthened this study.