Influencingprofessionalsonphysicalactivity:theRichmond

Groupapproach.David Terrace – Sports and

Physical activity Lead

Who are the Richmond Group?

• The Richmond Group of Charities is a coalition of 14 of the leading health and social care organisations in the voluntary sector.

• We work together as a collective voice to better influence health and social care policy and practice, with the aim of improving the care and support for the 15 million people living with long term conditions we represent

Why physical activity?

Richmond Group and Sport England Partnership

• A Sport England funded post to strengthen the relationship between Sport England and Richmond Group aiming to develop propositions to enable more people at risk of or with a long term condition to be active

• Shared outcomes between Sport England and Richmond Groups include– Increase in physical activity in under–represented groups who

could benefit the most– Increase in physical and mental wellbeing of people through

physical activity – Increase in volunteering and increased focus on the mental

wellbeing of volunteers

Thechallengeofphysicalactivitypolicy

Living longer living well: How can we achieve the World Health Organisation’s 25 by 25 goals in the UK. Report by the Richmond Group of Charities.

Untapped potential

What do charities do?

Added value of charities

Recommendations on VCS/Healthcare engagement

• Collate and manage data that is useful to partners

• Find ‘good enough’ common messages and co-ordinate the communication of these messages at a local and national level

• Be clear on strengths of organisations

• Frame the conversation in terms of added value not asking for more resources

What our insight tells us

Both exercise and physical activity are seen as “not for people like me” amongst inactive participants with multiple long-term conditions

However, whilst the broad understanding of both are similar, the negative connotations (e.g. pain) of “exercise” are more top-of-mind, whilst “physical activity” has associations with tasks such as housework and gardening

Even the most incapacitated people we spoke to say that they want to be more physically active – indicating a valuable messaging opportunity for the Richmond Group

The strongest barriers to physical activity are internal and relate to the symptoms experienced by those with LTCs (e.g. pain, breathlessness)

However, the most commonly identified benefits (e.g. preventing conditions from deteriorating) do not address these barriers. Consequently, messages claiming to improve symptoms are dismissed

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What our insight tells usSuccessful messages have 3 key attributes:• They speak to everybody, regardless of their demographic or current levels of

activity• They combine positivity about the benefits of physical activity with realism

about what is achievable, giving them credibility • They speak to people’s aspirations for their own lives, for example spending

time with their grandchildren, or being independent

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5Weaker messages also have 3 key attributes:• They challenge the lived experiences of those with LTCs• They are interpreted as patronising (e.g. by making assumptions about

individuals’ conditions or assuming that their life is in some way circumscribed)

• Their tone is bossy, with language that instructs rather than encourages

The messenger is key

Q. Which of the following people, if any, do you think would be best to talk about why people with long-term conditions should engage in physical activity? Base: All with a long-term condition (n=216)

Best-placed people to talk about why people with LTCs should do physical activity

“[Someone with LTCs would be good] because it is someone who is suffering as well you can relate to them.”

Multiple LTCs, Female, Focus Group

“[Jeremy Clarkson] No! He’s a fat slob. He’s arrogant. He would be saying the message and another thing under his breath.”

Multiple LTCs, Male, Focus Group

WhatdoesitmeanfortheRichmondGroup?

• Thereisanopportunitytosupportinactivepeopleasthereisanappetitetodomore,butit’scomplicatedandencompassesmorethanindividualbehaviourchange

• Clearopportunityforcollaborationanda‘collectivevoice’giventhebarriersaresymptomsbasedwhicharepresentinmanyconditions

• Interventionsneedstobedevelopedwithanawarenessofthebarriers,aswellasrecognisingthegeneralfatiguetowardshealthmessagingthatwasexhibitedinfocusgroups

• Healthprofessionalarethegatekeeperstoexplainthatexerciseis‘safe’butmaintenancehelpmightbebettercomingfrompeersorcharitiesthatunderstandthecondition

• Theprovisionneedstobeaccessible,welcomingandfunotherwisepeoplewillgiveuponactivity

TheRichmondGroupapproach

Theoreticalframeworkthatdemonstratesaclearlinkbetweenevidenceandinsight,the

model/sadopted,andtheproposedbenefittoserviceusers.

Enablehealthandcareprofessionalstoprovidetimelybriefadvicetoencourage

physicalactivity

Provideevidencebasedsupporttotheindividualbasedonneed

Influencephysicalactivityprovisiontoensureit’saccessibleforinactivepeople

Supportthosewhoareclosetoinactivepeopletoenablethemto

changebehaviour

Consistentevaluation

Consistentapproachtocommunicatingonphysicalactivityforpreventionandconditionmanagement

Socio-ecologicalmodelofphysicalactivity

Richmond Group Services

Advise/Partner

Influence

Behaviourchangeapproachtoinfluencing

ApplyingCOM-Btoprofessionalinfluencing

Providing information and evidence so professionals have the knowledge to implement the change. Illustrate the benefits of the change to build a logical case.

Enabling the process by making it easy for the professional. Generate a culture so it becomes the ‘done’ thing.

Appeal to professional identity.Ensure the change in behaviour becomes a habit with the expectation of an emotional reward

Thechallenge:Touseasystematicbehaviourchangeapproachwithprofessionalsandpolicy

makers,notjustwiththebeneficiaries.

RichmondGroupkeyaimsinthisarea

Physicalactivitypromotedas‘thenorm’forpeoplewithlongtermconditionsbyhealthcareprofessionals

Policymakerstoensurephysicalactivityisakeyconsiderationforplanningandregenerationofcommunities

Physicalactivitytobeaccessibleandenjoyableforpeoplewithlongtermconditions

Proposedapproach

RichmondGroupinterventionDemand Supply

Work with PHE/Sport England to influence HCPs to provide brief advice on physical activity

Work with physical activity providers to make activity accessible and welcoming

Support individuals and support network to find something they enjoy, that’s local and appropriate to their financial situation. Behaviour change approach, through most appropriate means (face to face, remote, through groups). Identifying gaps in provision and filling if necessary.

Exampleofgoodpractice

Very brief advice on physical activity for cancer patients from nurses

• Professional influencing approach using the behaviour change wheel

• Systematic approach coding barriers to behaviours and then assessing suitability of these behaviours

• Training delivered on multiple formats followed up at eight weeks after the training

• The training and follow up featured seven behaviour change techniques as identified through stakeholder engagement and use of the behaviour change wheel

• These included goal setting (‘I will’ statements), demonstration of behaviours and environmental prompts (such as cards etc)

Webb, J., J. Foster, and E. Poulter. "Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel.“ Public health 133 (2016): 45-56.

Summaryofkeypoints

Our influencing positions are built on combining insight (through qualitative and quantitative research) with behaviour change technique

We will work with a collective voice, with clear messaging and solutions that create value not require new resources. Show not

tell.

Our work will consider systems, from national to local as well as individual behaviour change, recognising the complexity in implementing

change.

Contact us...

David Terrace• David.terrace@ageuk.org.uk• 020 30331374• 07850950584

www.richmondgroupofcharities.org.uk@richmondgroup14