title: Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention.
abstract: BACKGROUND
  The majority of mid-life and older adults in the UK are not achieving recommended physical activity levels and inactivity is associated with many health problems. Walking is a safe, appropriate exercise. The PACE-UP trial sought to increase walking through the structured use of a pedometer and handbook, with and without support from a practice nurse trained in behaviour change techniques (BCTs). Understanding barriers and facilitators to engagement with a primary care based physical activity intervention is essential for future trials and programmes.
  
  
  METHODS
  We conducted semi-structured telephone interviews using a topic guide with purposive samples of participants who did and did not increase their walking from both intervention groups. Interviews were audio-recorded, transcribed and coded independently by researchers prior to performing a thematic analysis. Responsiveness to the specific BCTs used was also analysed.
  
  
  RESULTS
  Forty-three trial participants were interviewed in early 2014. Almost all felt they had benefitted, irrespective of their change in step-count, and that primary care was an appropriate setting.Important facilitators included a desire for a healthy lifestyle, improved physical health, enjoyment of walking in the local environment, having a flexible routine allowing for an increase in walking, appropriate self and external monitoring and support from others.Important barriers included physical health problems, an inflexible routine, work and other commitments, the weather and a mistrust of the monitoring equipment.BCTs that were reported to have the most impact included: providing information about behaviour-health link; prompting self-monitoring and review of goals and outcomes; providing feedback; providing specific information about how to increase walking; planning social support/change; and relapse prevention. Rewards were unhelpful.
  
  
  CONCLUSIONS
  Despite our expectation that there would be a difference between the experiences of those who did and did not objectively increase their walking, we found that most participants considered themselves to have succeeded in the trial and benefitted from taking part. Barriers and facilitators were similar across demographic groups and trial outcomes. Findings indicated several BCTs on which PA trial and programme planners could focus efforts with the expectation of greatest impact as well as strong support for primary care as an appropriate venue.
  
  
  BACKGROUND
  ISRCTN98538934.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Normansell
authors.forename: Jaime
authors.initials: J
authors.lastname: Smith
authors.affiliation: Gerontology and Health Services Research Unit, College of Health and Life Sciences, Brunel University, London UB8 3PH, UK. Christina.Victor@brunel.ac.uk.
authors.forename: Christina
authors.initials: C
authors.lastname: Victor
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
authors.forename: Sally
authors.initials: S
authors.lastname: Kerry
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.forename: Julia
authors.initials: J
authors.lastname: Fox-Rushby
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
mesh_terms: D056044:Actigraphy; D000368:Aged; D001521:Behavior Therapy / Q000458:organization & administration*; D004777:Environment; D015444:Exercise / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011320:Primary Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013997:Time Factors; D006113:United Kingdom; D016138:Walking / Q000523:psychology*