Sowden, S.L.; (2009) Is access to and use of Exercise Referral Schemes equitable? Doctoral thesis , UCL (University College London).

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Abstract

Exercise Referral Schemes (ERSs) are a widespread multi-agency intervention in which patients are referred to a programme of supervised sessions of subsidised exercise at a local leisure centre. National guidance states that schemes should employ strategies to engage people from disadvantaged groups. While people from such groups are known to attend primary care more frequently than those from more advantaged socioeconomic groups, research suggests that they are less likely to use preventive and specialist health services. This thesis aims to evaluate whether access to and use of ERSs is equitable through an examination of socioeconomic differences in referral, uptake and completion of the service. Firstly, the thesis presents a case study of key research, policy and practice events concerning the development of ERSs. Secondly, the thesis details findings of a scoping review undertaken across all ERSs in Greater London to identify schemes with suitable routine data collection to participate in the equity analysis. Thirdly, the thesis presents a cross-sectional analysis of 7985 patients referred by general practices to ERSs operating in six PCTs between April 2004 - March 2006. The main outcome measures were i) risk ratios for referral by general practice deprivation quintile ii) odds ratios for uptake of ERSs and iii) odds ratios for completion of ERSs by patient deprivation quintile. Fourthly, an exploration of the added value of using a geodemographic segmentation tool to enhance understanding of socioeconomic inequalities in service utilisation at small-area level is described. This research found that general practices within deprived areas were more likely to refer patients to ERSs than their counterparts in more advantaged areas. There was no evidence of an association between socioeconomic circumstance and likelihood of either taking up or completing the scheme. The implications of this research for policy, practice and future research are discussed.

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