Abstract
Purpose: While formative research has identified healthcare providers (HCPs) as an avenue for exercise behaviour change in persons with multiple sclerosis (MS), with some work developing initial theories, no research has examined HCPs’ perceptions and expectations about their training needs to promote exercise behaviour change. Therefore, we aimed to undertake an exploratory realist analysis to build initial program theories regarding HCP training on home-based exercise prescription and behaviour change support for persons with MS; to understand how training works, for whom and under what circumstances.
Methods: Four online focus groups were conducted with fifteen HCPs who were either in public or private practice, including physiotherapists (PT; n=8), accredited exercise physiologists (AEP; n=4) and occupational therapists (OT; n=3). Two independent researchers conducted a realist evaluation with realist analysis of interview transcripts through identifying and developing CMOCs (context, mechanism and outcome configurations) codebooks, synthesised as demi-regularities (DRs).
Results: We identified 14 recurring patterns (DRs) illustrating multiple perceived outcomes of training (e.g., engagement, utilisation, satisfaction, and knowledge) generated by various mechanisms (e.g., training program content, delivery, mixed pedagogies, inclusion of content related to other health conditions and time constraints). Interestingly, these mechanisms were triggered by all three professional contexts (PTs, AEPs and OTs).
Conclusions: Preliminary theories from this realist evaluation indicate that online training for exercise behavioural change prescription can be a feasible part of HCPs’ professional development and routine care for persons with MS. Training incorporating evidence-based principles and benefitting HCP’s knowledge and skills facilitates participation. However, several extrinsic factors (e.g., client adherence, content limited only to MS) are barriers requiring attention to allow for the broader implementation of HCP training on exercise promotion as part of routine MS care.