Abstract
Depression is one of the most common mental disorders worldwide, increasing in prevalence in recent years. Physical activity (PA) has been shown to be an effective, evidence-based treatment for depression that is recommended in clinical practice by national and international health bodies such as the UK National Institute for Health and Care Excellence (NICE), and the World Health Organisation (WHO). General Practitioners (GPs) are often the first point of contact for patients and are very important in managing and treating depression. However, research indicates that many GPs in the UK don’t promote physical activity to patients for depression, or any health condition. We need to identify the barriers and facilitators GPs experience to better understand why they don’t engage in promoting physical activity for depression. Therefore, the overall aim of this thesis was to improve the promotion of PA as a treatment for depression in primary care through identification and exploration of the barriers and facilitators that GPs experience when promoting PA for depression, and development of pragmatic recommendations.A mixed methods sequential explanatory design guided by a pragmatic research philosophy and underpinned by the Theoretical Domains Framework (TDF) was used, with four phases. The first phase was a systematic review of published literature relating to Healthcare Professionals’ (HCPs) barriers and facilitators to PA promotion for depression. Key themes identified which influenced HCPs’ PA promotion behaviours were: HCPs’ assumptions about patients, HCP beliefs about PA as a treatment and their capability of delivering this, and contextual influences. Findings from the systematic review informed development of the second phase, which was a quantitative cross-sectional questionnaire with GPs across England using the TDF to explore the behavioural factors underpinning GPs’ promotion of PA as a treatment for depression. Our findings suggested that GP’s demographics including gender, PA levels, age and years of experience were positively related to their beliefs and attitudes around promoting PA for depression. The third phase was a qualitative semi-structured interview study with a sub-sample of GPs who had completed the questionnaire, to further investigate GPs’ views and experiences of promoting PA for depression, which generated three main themes: the context of PA promotion, patient-centred treatment and PA promotion in the patient consultation. In the fourth phase, findings from the systematic review, quantitative questionnaire, and qualitative interview studies were synthesised using the triangulation protocol to develop an overall understanding of GPs’ PA promotion for depression. There were many barriers and facilitators identified and explored across the mixed methods, however three themes were consistently identified: GPs have not been adequately trained in promoting PA, GPs need and want more training, and that GPs’ belief in the evidence supporting PA as a treatment varies. The triangulated key overall findings were used to inform the development of nine pragmatic recommendations to improve the promotion of PA for depression through collaborative reflection with GPs. These included recommendations for: training and education content and delivery, GP practices, individuals (GPs), and tools to improve PA promotion. Future research is now needed to implement and evaluate these recommendations in general practice, to identify the most effective strategies for improving the promotion of PA as a treatment for depression.
| Date of Award | 26 Jun 2025 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Jeffrey Lambert (Supervisor) & Fiona Gillison (Supervisor) |