Principal Investigator: Dr Kat Bradbury

Project team: Professor Helen Roberts, Dr Max Western, Dr Stephen Lim, Linda Du Preez, Fay Sibley, Dr Judith Joseph, Professor Lucy Yardley, Dr Chloe Grimmett, Dr Neil Langridge, Christian Brookes, Helen Fisher, Cynthia Russel, Asgar Electricwala, Tom Stokes, Professor Maria Stokes, Dr Paul Clarkson, Cherish Boxall, Dr Katherine Morton, Sara Bolton, Dr David Attwood.

Partners: Southern Health NHS Foundation Trust, Dorset County Hospital NHS Foundation Trust , Oxford Health NHS Foundation Trust, Wessex AHSN, University of Southampton, NHS England, Energise Me, Active Partnerships, Live Longer Better.

Starts:

Ends:

Lay Summary 

Many older adults are physically inactive and experience health problems which could be prevented/improved if they were to increase their activity. These problems are costly to individuals, the NHS and social care services. An effective support for increasing physical activity which is easy and cheap to deliver at scale is needed. Older adults are the fastest growing group using the web, so a digital tool could be a solution. In our previous work, we developed a website called ‘Active Lives’ which helps older adults to increase physical activity and maintain this long-term. Active Lives gives support with increasing moderate activity and strength and balance. Active Lives was developed with 59 older adults who were physically inactive and had multiple long-term conditions. The website is tailored to individuals needs and abilities. Our recent trial showed that Active Lives is safe and helped older adults to increase physical activity compared to a control group (who received usual care).

Active Lives is a promising tool that could be rolled-out at scale. However, there can be challenges to rolling out new digital tools. There have been some high-profile failures. There are also anxieties about whether the digital divide might widen inequalities if only some groups are engaged. We take these concerns seriously and therefore propose a project which aims to look at:

1) How many people can be reached with Active Lives. 2) Whether we are able to reach people from different backgrounds (e.g. education level, ethnicity). 3) How individuals use the website and whether they report increases in activity over time. All this data will be captured online through the website. Data will be monitored regularly to allow for adjustment to our approach to roll-out, to promote equality in who Active Lives reaches. We will also seek to understand barriers and facilitators to roll-out by interviewing those who implement Active Lives in practice. We have partnered with the Wessex Academic Health Science Network (AHSN), NHS colleagues and third sector organisations to prepare to roll-out Active Lives. Representatives from these organisations, plus three PPI representatives will form a key stakeholder group. This group will join our study steering group and input into both research decisions and implementing Active Lives in practice. Roll-out will begin in Wessex where we already have agreements in place. This will spread to other areas over time (likely beginning with London, Oxford, Kent, Surrey and Sussex whose AHSNs have already expressed interest) providing real benefit to patients and NHS/3rd sector organisations.  We will disseminate our findings through workshops with stakeholders, press releases in the media/social media, conferences, and an academic publication

Summary

This Active Lives website has been shown to help older people to increase physical activity. This study aimed to roll out Active lives to make it available to older people living in the community. The steps involved in the project included:

• Identify, approach and influence organisations interested in helping older people to be active in order to find places that could help us roll out Active Lives.

  
  

• Monitor how many people used active lives and how many were actively engaged enough to have what we think was a sufficient ‘dose’ of the intervention to be likely to change their behaviour.

  
  

• Interview people implementing Active Lives and study what happens in meetings to formulate a list of barriers and facilitators to the roll out of active lives.

  
  
  
  

Results

• We worked with a wide range of organisations including AHSNs/HINs, charities which serve older people, physical activity organisations, NHS trusts and NHS England.

  
  

• The website reached 5002 people. 1306 people were engaged enough to view the core content necessary to lead to behaviour change.

  
  

• NHS England were instrumental in us achieving traction in several NHS trusts.

  
  

• Six NHS trusts and one charity agreed to help us roll out active lives.

  
  

• One physical activity partnership was helpful in facilitating relationships with their local NHS trust. Their support helped influence local trusts, build clinician confidence in Active Lives and help put in place strategies to maximise uptake of older people to Active Lives.

  
  

• Other physical activity partnerships and the physical activity sector more broadly chose not to support the implementation of Active Lives.

  
  

  Barriers here were especially focused on the belief that older people are not digitally engaged, that older people will only benefit from in person groups, and some viewed this as a threat to the groups that they were locally facilitating or supporting themselves.

  
  

  We appeared in competition with these organisations and it prevented uptake of several NHS trusts that appeared interested at our initial meetings with us (i.e. the physical activity partnerships became a barrier to NHS uptake as they had influence in these NHS trusts).

  
  

• Facilitators to uptake included confidence in the team, believing in an evidence-based approach, the team being able to allay concerns around digital accessibility, providing organisations with figures on how many people used the website and providing support with how to maximise uptake to active lives. Endorsement by NHSE was also very useful in persuading some NHS trusts to take on Active Lives.

  
  

• Things that slowed roll out down: Complexity in the NHS trusts’ chain of command slowed the sign up to Active Lives, this was problematic in a 12-month project. NHS trusts also required complex and nuanced data security and other digital health forms to be completed and trusts were overly cautious with regards to the perceived digital security risks of the intervention. This caused long delays and used valuable resources.

What have we done?

·      We implemented Active Lives in practice across 6 NHS trusts, having direct impact on older people. 5002 used it, of which 1306 were actively engaged to a level which we believe is a sufficient ‘dose’.

·      We’ve written a paper on the barriers/facilitators (submitted, not yet published)

What have we learned?

·      Despite the short nature of this project, it achieved good impact and was able to support a large amount of people in a short amount of time

·      Support from all partners is needed to overcome barriers to implementation.

·      Further roll out would require continued engagement work to allay concerns among the NHS and partner organisations