TY  - UNPB
TI  - Is access to and use of Exercise Referral Schemes equitable?
UR  - https://discovery.ucl.ac.uk/id/eprint/14732/
AV  - public
EP  - 288
N1  - Unpublished
ID  - discovery14732
M1  - Doctoral
PB  - UCL (University College London)
A1  - Sowden, S.L.
Y1  - 2009/01//
N2  - 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.
ER  -