PARS mini project summary of findings.

Clackmannanshire Over 50’s PARS classes

This report was compiled by A.C.Whittaker directly from the undergraduate student 4^th year dissertation project reports from the students who worked on this study, thus we would like to acknowledge Ellie Sime, Katie Goulder, Kirsty Anderson, Isla Sibbald, Jason Wedlock and Aimee Fairburn,  and all of our participants.

Background:

• There have been multiple interventions introduced to try and get sedentary and inactive older adults involved in physical activity in the UK, including Physical Activity Referral Schemes (PARS). Research on PARS has found a lack of recording and reporting of attendance to sessions and that analysis has been unable to reach a diverse population of participants of PARS.
• There is little qualitative research regarding PARS schemes and what works well and what does not work well from the perspective of participants in the schemes. There is even less evidence to present findings from the staff’s perspective.
• Staff within Clackmannanshire and Forth Valley Council schemes have acknowledged difficulties in gathering these data, thus, this project is an initial brief snapshot of data from these PARS schemes as part of a collaboration with the University of Stirling. Data were collected during a three-month period in early 2024 by undergraduate Sport Studies students as part of their major dissertation projects.

Research Aims:

• To gather information on the socio-demographic characteristics and health and wellbeing of current participants of PARS in Forth Valley and Clackmannanshire over 50’s class participants comprising ‘Zone 60’, ‘Sporty Seniors’, ‘Over 60’s’, ‘Mature Movers’, and ‘OTAGO’ classes.
  • Examine whether socio-demographic factors affect how often the participants attend the sessions.
• To examine the PARS for older adults within the Forth Valley area from the staff’ point of view
  • What does and does not work well for the scheme.
  • Identify barriers to participation of PARS within the Clackmannanshire area.
  • Gather suggestions for improvement of the scheme in the near future.
• To examine the PARS for older adults within the Forth Valley area from the participants’ point of view – what works, what does not.
  • How effective is the current PARS program within Clackmannanshire?
  • What do participants feel may be possible barriers or weaknesses regarding the PARS program in Clackmannanshire?
  • What improvements or positive changes could be made to improve the PARS program in Clackmannanshire leading to an increase in participation, effectiveness and/or overall improvement of the scheme?

Methods:

1. Cross-sectional online survey distributed via email invitation. Mixed methods with mainly quantitative questionnaires and a few open-ended questions for more detailed qualitative data. Components included socio-demographics, IPAQ physical activity levels, FES Fear of Falling, UCLA 6-item Loneliness scale, Brief Perceived Social Support Scale and EQ-5D-3L health related quality of life assessment.  Seventy-three older adults completed the online survey.
2. Semi-structured interviews with scheme staff and participants recruited via personal email.  Three staff members and eight older participants were interviewed.

Key Findings: Survey

• Attendance frequency at PARS classes did not significantly differ by age, gender, or relationship status.

Participant interviews: n = 8

Themes identified were:

• Referral
• Staff
• Participants/Community Feeling
• Class Opinions
• Health and wellbeing
• Value
• Possible Improvements

Almost half of the older adults were not referred by a health professional, many had joined the scheme because they felt it would be beneficial, or had heard of its benefits from colleagues, friends or family. Reasons individuals gave for their uptake, and continued participation, within the Clackmannanshire PARS programme were appreciation to the staff that run the classes so that some individuals felt confident within the classes, they said that found confidence within themselves was, “down to the leadership of the classes” (E (F, 64)) and labelled that staff as “essential” (F, 66). There was a strong sense of community feeling of the classes, participants described it as feeling “welcoming” (F, 66) and that there was a feeling and a sense of “camaraderie” (F, 66) within the classes themselves. All participants, regardless of time spent within the scheme, noted an improvement of either their overall physical health, or mental wellbeing, overall including feeling “a lot stronger” (J (F, 64)) and improvements in things they had been struggling with such as:  “My breathing is a little better” (F, 66), and feeling “…like a different person actually” (F, 66).

Possible improvements suggested were a subscription to classes, rather than exchanging cash at the start of every class: “it would be a good idea to have a kind of pass… a yearly (or monthly) pass” (E (F, 64)), this was due to the issue of the slow start to classes due to staff members having to register and take payment from all those in attendance that were required to do so. Another participant also mentioned, “the sheer number of people in the class” (J (F, 64)) as potentially off-putting, suggesting the need for more classes with smaller groups.

Themes from participant interviews are summarised below with number of participants who mentioned each aspect in brackets.

Staff interviews: N = 3

• It was difficult to attract enough staff from the Clackmannanshire programme to take part. Fifteen were contacted but only three took part.

Staff socio-demographics and experience:

Themes found through thematic analysis were the following, shown in the diagramme below with sub-themes associated with each of the four major themes.  Exemplars for each theme are quoted below.

Positive aspects of the PARS

This theme is defined by the aspects of the PARS that the staff feel have a positive impact on both participation rates and the scheme. The staff who participated in the semi-structured interviews knew the scheme very well. The positive aspects of the PARS were discussed within three sub-themes: social aspect; anyone putting work in; and improved health and well-being.

Social Aspect:

The staff that participated in the semi-structured interviews were asked the question “What do successful participants tell you about why they keep coming?” to which participant 3 answered:

“You have people that are enthusiastic that rubs off in the class” (3, Female, 53).

This indicated that both the staff and the participants enjoy a bit of conversation in the classes and that as a member of staff they clearly feel this is important in supporting and motivating participants. This not only motivates them to return to the class but motivates each other to take part in exercises whilst in the class. This links back to previous research indicating the important role of social support in increasing the uptake and maintenance of participation in the PA classes (Smith, Banting, Eime, O’Sullivan, and Van Uffelen, 2017). If the participants are enjoying the class, they are likely to spread the details of the class by word of mouth and making it sound appealing to others, and again increasing the uptake (Hawley-Hague, et.al, 2016). It was also made clear by participant two that some of the participants are there purely for the social side of things:

“People that are there for the social aspect” (2, Male, 22).

Participants only being there for the social side of the class is not necessarily a bad thing as, although they maybe do not have the mindset of using PARS to benefit their health and well-being, they are still showing up and taking part in the classes which, will in turn, benefit their health and well-being. It will also encourage others that maybe are not the type to enjoy exercise and physical activity to keep coming back for the social aspect and to mingle with others.

Anyone Putting Work In:

It was also made clear that another positive of the PARS was that any individual willing to put the work in would feel benefits from the class. This became apparent when asked who the scheme tends to work for, staff made these points:

“You’ve got put a little bit in to get something out of it” (3, Female, 53).

“Got the mindset that exercise will help” (1, Male, 59).

These responses made it easy to understand that the PARS was designed to work for any type of person if they took part and gave their best efforts. Existing literature tends to discuss who attends these classes but not who gets the most out of them (Chen, et.al, 2022). Whereas the participants from this study gave an insight into which participants are getting the most out of the classes.

Improved Health and Well-being:

Another positive aspect of the scheme was the improved health and well-being of the individuals. These aspects were highlighted by the participants:

“Improvement in mobility and mental health” (1, Male, 59).

“Stimulating their mind as well” (3, Female, 53).

“Seeing their confidence grow a bit” (3, Female, 53).

Staff perceived that the scheme does help to improve mental well-being and stimulate the participants’ minds.

Theme 2: Negative Aspects of the PARS

This theme is defined by the aspects of the PARS that the staff feel have a negative impact on both participation rates and the scheme. The negative aspects of the PARS were discussed across three sub-themes: lack of time; need for more classes; and participants with a negative mindset.

Lack of Time:

One of the main aspects of the scheme that the staff identified was the lack of time they had. Not only did they lack the time to gather information on the participants, but it was also apparent that they lacked the time to provide more classes and contact participants who had stopped attending. This aspect was highlighted by the staff:

“Wouldn’t chase anybody up and partly the reason being is time, just not got the time to go through every register and sit and see who’s not been there for a couple weeks and phone them.” (1, Male, 59).

“If somebody never turned up, I’d love to pick up the phone and say we’re still here, is there a problem? Can you tell us why you’ve stopped coming? It’s basically just the time to do that, we only have a couple minutes at the end of the class to speak to them.” (1, Male, 59).

“I would love to spend more time specifically on the scheme” (1, Male, 59).

It is likely that in some cases if the PARS staff had the time to make a phone call to individuals who fail to attend with no reason, then they may feel as though they are wanted at the class. Not only will they feel wanted but it may also make them feel like the class is worth their while. If the participants feel that the class is worthwhile, they may feel it outweighs the downfall of the cost of the classes and their journey to the venue (Franco, et.al, 2016). If the issue was to arise of the venue being difficult for participants to access to carry on attending any of the classes, the staff don’t have the option to provide a new class elsewhere because they do not have any more time to spare. This is a negative aspect of the PARS since the staff think they are losing participants due to this factor.

Need for More Classes:

When staff were asked about what sort of influence the timing of the sessions have, they made it clear that for the targeted age group (65 years of age and up), the classes need to run through the daytime to make it possible for the participants to make it to the classes:

“We’ve just had requests for it to be more frequent” (2, Male, 22).

“For the older age group, it needs to be during the day needs to be in the daylight” (1, Male, 59).

“I think at the start and when they first started the sessions it was a bit quieter cause it took quite a while to get people referred and maybe the people that have stopped coming if they realised it was getting a bit busier” (3, Female, 53).

There is very little past research to suggest that older adults prefer to be physically active during the daytime. However, in this research, it has been made apparent that the classes need to be held whilst it is still light outside. Another reason the classes should be held during daytime, is to make it easier for the participants to get public transport to and from the venue. Although the staff try to make this possible their lack of time contributes to the issue of needing more classes. If the scheme was to have more staff, they may find it easier to carry out more classes throughout the daytime to accommodate their target participants.

Participants with a Negative Mindset:

When staff were asked why they felt people stopped attending classes they had several responses that revealed a sub-theme of participants with negative mindsets:

“I think some people think that it’s not helping quick enough for them” (3, Female, 53).

“Some other ones just feel like they can’t do it anymore” (2, Male, 22).

“He said he felt like he’d reached his peak” (2, Male, 22).

From the staff’ responses there will be individuals within the class who show up with a negative mindset, leading to their eventual drop out of participation in PA.

Theme 3: The Staff’s Perception of the Scheme

In this overall theme, three sub-themes emerged: staff enjoy the classes; the need for another coordinator; lack of information on the participants; and making it enjoyable. This overall theme is an important one when it comes to answering the aims and objectives of the project. Mainly because this study is unique in the way that it pulls on the perspective of the staff rather than the participants point of view. 

Staff Enjoy the Classes

The staff were asked if there was anything else they’d like to tell us about the scheme which led to the discovery of the staff’s enjoyment of the scheme:

“It’s enjoyable for both us coaches and the participants” (2, Male, 22).

“I just think it’s a really good scheme” (3, Female, 53).

“Long may it continue” (3, Female, 53).

It was found that not only do the staff think that the classes are enjoyable for participants but also the staff. They find it helps the participants in a variety of ways; the staff clearly love to see this and to see their participants thriving within the social support context as well as their improvements in physical well-being.

The Need for Another Coordinator

Although the staff enjoy taking the PARS classes the lack of time and lack of classes link together with the fact that there is only one coordinator. The staff themselves have expressed how helpful it would be to have another coordinator to work alongside their current one:

“I’d have somebody working with me” (1, Male, 59).

“Having the time to be able to contact participants who have fell off” (1, Male, 59).

“Just reinforcing the benefits in them attending” (1, Male, 59).

This would then be of benefit both the staff and the participants; they would be able to contact previous participants to reinforce the benefits of attending and encouraging them to return to the classes.

Lack of Information on Participants

The participants were also asked what they would change about the scheme if they had the power to do so. The responses to this revealed another sub theme:

“We don’t get enough information” (3, Female, 53).

“Just more information about participants” (3, Female, 53).

“The information on the PAR Q is probably all we get as we’ve not had anything from the NHS” (1, Male, 59).

“A bit more info from GP’s would be helpful” (1, Male, 59).

“I’ll have the name of the person that referred and a bit of information about what their problem is.” (1, Male, 59).

Staff feel as though they do not have enough information on the participants they are taking within the classes. When asked what information is gathered the staff revealed that they get each participant’s name, date of birth, gender, and underlying health conditions. Although it is important for the staff to know of any health conditions, other information will also be useful to them. For example, if the staff knew what the participants of the class wanted to get out of their time spent in the classes, then they could accommodate this and help them to improve in the areas they want to improve in. This is common within physical activity readiness questionnaire’s (PAR-Q’s) within gyms and training programmes.

Making the Class Enjoyable

The staff were encouraged to share any positive feedback they had received from the participants of the class and what their perception of it was. The staff highlighted the enjoyment of the classes:

“You make it fun” (1, Male, 59).

“Don’t make it too difficult” (1, Male, 59).

The staff have found that the participants enjoy the classes more when they are made fun and easy enough to take part in. Although they make the classes easy enough to participate in, they still have an aspect of challenge to them to push the participants in the direction of improvement. As previous studies have also stated, older adults are more likely to take part in activities they enjoy (Szanton, et.al, 2015).

Theme 4: Barriers to the Participation in Physical Activity Referral Scheme

Three barrier sub-themes are as follows: lack of referrals; lack of funding; and lack of instructor education. Barriers to the participation in PARS is of the upmost importance when it comes to achieving the aim and completing the objective of identifying the barriers to PARS in the Clackmannanshire area.

Lack of referrals

It became apparent that the staff feel they could be taking in more participants with the help of referrals:

“A lot of departments in the NHS are maybe not quite so aware of how much exercise can benefit people even for other illnesses or other problems.” (1, Male, 59).

“In my opinion doctors are still in the mindset of sending patients to the hospital to get checked out as opposed to prescribing exercise” (1, Male, 59).

“Get them to refer more people on” (1, Male, 59).

Local general practitioners and physiotherapist need to be on board with the scheme and understand the benefits in order to refer older people to the PARS.

Lack of funding

A member of staff revealed the following:

“Once the funding finishes the class finishes” (3, Female, 53).

This highlights the issue of a lack of funding to run the classes. The scheme does not receive enough funding to continuously run every class. Unfortunately, some classes do not have as many participants as others. This means that some of the classes may have to increase the fees that existing participants already pay. An increase in cost may lead to drop out in participants.

Lack of instructor education

Another barrier to the participation of PARS may be that some of the instructors lack the knowledge and education needed to encourage and uphold the participation rates of PARS. This sub-theme was drawn after staff stated the following:

“No Behavioural Change Training.” (3, Female, 53).

“If you’ve got good knowledge then you will know how to adapt for them.” (2, Male, 22).

Various instructors confirmed that they currently hold no Behavioural Change Training (BCT). This may be a barrier as BCT can help the instructors to better understand how to change the behaviours of participants which can be used to encourage them to return to the sessions and encourage more PA in their daily lives.

Recommendations:

• Collate socio-demographics, PAR-Q and any information gathered at start of attendance into an Excel file. Pseudoanonymise for analysis.
• Monthly or annual payment scheme.
• More classes to prevent crowding.
• Hiring another coordinator to gather more information on the participants and chase up participants who have fallen out of the routine of attending.

Future Directions:

• Explore whether other socio-demographics relate to wellbeing/health scores
• Does attendance differ by wellbeing/health scores?
• Gather additional survey data for a larger group?
• Follow-up participants who gave contact details with a request to complete the survey again 6 months later to see if any change in outcomes, or any change in attendance.