What is the role of primary care in reducing the decline in physical function and physical activity in people with long-term conditions? Findings from realist theory-building workshops using LEGO® SERIOUS PLAY®.

Problem

Declining physical function and physical activity in people with long-term conditions can cause deteriorating physical, social and psychological health, and reduced independence. In line with the renewed WHO declaration, primary care is well placed to empower individuals and communities to reduce this decline. However, current evidence suggests the best approach is uncertain and the complexities of the needs of people with long-term conditions and of primary care service delivery requires further investigation. Therefore, this study aims to unpick this complexity and develop evidence-based recommendations about how primary care can facilitate improved physical function and physical activity for people with long-term conditions.

Approach

We are conducting a realist evidence synthesis as this methodology enables focus on the complexity of optimising physical function and physical activity, and combines evidence from varied sources of literature with the views, experiences and ideas of multisectoral partners and stakeholders. Established realist methods will be used to develop and refine theories about the promotion of improved physical functioning and physical activity for people with long-term conditions, and in particular; what works (or doesn’t work), for whom and in what circumstances. The refined theories will form the basis of co-produced, evidence-based recommendations for primary care service innovation. We have used LEGO® SERIOUS PLAY® as a participatory method for our initial theory-building stakeholder workshops, facilitating expression and creativity through model-building and sharing. We have also incorporated expertise and international perspectives from our external Project Advisory Group. In later phases of this project, plans for making the innovation useable and sustainable will be designed collaboratively with stakeholders through a series of co-design workshops.

Findings

Following a stakeholder analysis, 13 professionals (health, social care, and community-based), 10 people with long-term conditions, and the two lead researchers participated in a facilitated workshop where they created and described individual LEGO® models for incorporation into a shared ‘landscape’. The model-building method enabled this wide range of stakeholders, with different backgrounds and circumstances, to participate successfully and offer in-depth personal explanations. The descriptions and images of the models have been captured audio-visually for analysis. This ongoing research will develop theories relevant to the meaning of physical function, lived experiences of maintaining physical function with a long-term condition (from a patient and professional perspective), and associated barriers and facilitators. These will be used to explain the relationship between contexts, mechanisms and outcomes, as well as inform subsequent literature searching.

Consequences

This work is important because despite perceptible shifts in approach, the priority in primary care remains on diagnosis and categorisation of disease. However, co-producing ways of increasing the emphasis on functional limitations and physical activity, that also address complexity, has the potential to improve the health of people with long-term conditions and subsequently influence practice, primary care education and policy.