Factors Influencing Patient Enrollment in a Community-based Physical Activity Program After Healthcare Provider Referral: A Mixed Methods Study

Abstract

Introduction and Objectives: Structured physical activity (PA) programs help to prevent and manage chronic diseases, yet systematic approaches to identify and enroll patients in these programs are lacking. Exercise is Medicine Greenville (EIMG) is a novel clinic-to-community model that identifies patients with chronic diseases in primary care settings and connects them to a structured, evidence-informed, community-based PA program. This study assessed influences on PA program enrollment using a mixed methods design. Methods: Data were collected from 12 clinics over 18 months. Electronic health record data were used to quantitively compare the characteristics of referred patients who did versus did not enroll. Semi-structured interviews were conducted with a subset of non-enrollees to elucidate barriers and facilitators to enrollment. Results: Of the 217 referred patients who were eligible, 84 (38.7%) enrolled in the PA program. A greater percentage of enrollees had a history of high cholesterol (73.8%) relative to non-enrollees (57.9%, χ 2 (1, N = 217) = 5.66, P = .02). Twenty-six patients completed qualitative interviews. Three themes emerged from interviews: (1) positive referral experiences with opportunity for enhanced information sharing and improved flow; (2) strong patient motivation, perceived capability, and social support; and (3) external barriers, such as cost and time, that prevented enrollment. Conclusions: Findings can guide improvements to the EIMG model, thus increasing its positive impact on individual- and community-level health. Findings can also inform efforts to build similar clinic-to-community PA models at other health systems.