BMJ open sport & exercise medicine · 2025
Priority setting of healthcare provider barriers and facilitators to supporting patient physical activity in rheumatology: a nominal group technique study.
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Ester Manuel, Gillespie Daniel Case, Dhiman Kiran, Githumbi Racheal, Sipley Melissa, Adhikari Kamala, Barber Claire
Аннотация
OBJECTIVE: To determine the most important barriers, facilitators and resources identified by rheumatology healthcare providers (HCPs) to supporting physical activity (PA) among individuals with rheumatoid arthritis (RA).
METHODS: Nominal group technique (NGT) sessions were conducted with rheumatology HCPs following a structured process of idea generation, discussion and independent rating. Determinants and resources were grouped into themes and mapped to the Behaviour Change Wheel.
RESULTS: A total of 14 rheumatology HCPs participated in four NGT sessions. RA HCPs identified 14 facilitators and 14 barriers to PA promotion, along with 12 helpful resources and 13 additional resource needs. The most important facilitators were patient-centred PA discussions, reassurance around movement safety and delegating PA counselling to exercise professionals. Key barriers included limited time, patient information overload and ineffective handouts. Six overarching themes were emphasised after grouping and theoretical mapping: patient-provider conversations, interdisciplinary teamwork, counselling skills, monitoring and feedback, time and capacity and resource quality. The six categories of key resources were tailored programmes, educational handouts, referral tools, exercise professionals, online tools and professional development.
CONCLUSION: This study identified key barriers and facilitators influencing how rheumatology HCPs support PA among RA patients, highlighting the importance of tailored discussions, interdisciplinary teamwork, counselling skills and supportive resources. HCPs emphasised the need for high-quality, RA-specific resources such as allied health networks and RA-specific programmes. Theoretical mapping pinpointed targets within capability, opportunity and motivation to enhance PA promotion. Ongoing work is underway to codevelop evidence-based tools addressing these determinants to improve PA support for individuals with RA.
METHODS: Nominal group technique (NGT) sessions were conducted with rheumatology HCPs following a structured process of idea generation, discussion and independent rating. Determinants and resources were grouped into themes and mapped to the Behaviour Change Wheel.
RESULTS: A total of 14 rheumatology HCPs participated in four NGT sessions. RA HCPs identified 14 facilitators and 14 barriers to PA promotion, along with 12 helpful resources and 13 additional resource needs. The most important facilitators were patient-centred PA discussions, reassurance around movement safety and delegating PA counselling to exercise professionals. Key barriers included limited time, patient information overload and ineffective handouts. Six overarching themes were emphasised after grouping and theoretical mapping: patient-provider conversations, interdisciplinary teamwork, counselling skills, monitoring and feedback, time and capacity and resource quality. The six categories of key resources were tailored programmes, educational handouts, referral tools, exercise professionals, online tools and professional development.
CONCLUSION: This study identified key barriers and facilitators influencing how rheumatology HCPs support PA among RA patients, highlighting the importance of tailored discussions, interdisciplinary teamwork, counselling skills and supportive resources. HCPs emphasised the need for high-quality, RA-specific resources such as allied health networks and RA-specific programmes. Theoretical mapping pinpointed targets within capability, opportunity and motivation to enhance PA promotion. Ongoing work is underway to codevelop evidence-based tools addressing these determinants to improve PA support for individuals with RA.