Moving Healthcare Professionals Programme evaluation

The assessment of the Phase Two of the Moving Healthcare Professionals Programme (MHPP) was carried out by the National Centre for Sport and Exercise Medicine, a research hub at Sheffield Hallam University and, global leader in market research, Ipsos.

The evaluation left us with a series of findings, which were split into two areas – education, training and learning resources and creating system change – on how the promotion of physical activity influenced the workforce and the overall system and stakeholders.

The below gives a brief explanation of these two areas and the key findings for each one, with the next two tabs going into further detail on each.

Education, training and resources

The first series of conclusions refer to engagement by the healthcare professionals (HCPs) that were part of the programme and how this has influenced their promotion of physical activity among their patients.

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Below is a list of the key findings from this part of the programme.
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- The programme increased the HCPs awareness and knowledge of the importance of the promotion of physical activity to patients.
- Approximately 157,400 professionals have been trained or have accessed a training tool by the MHPP.
- Overall, the programme's workstreams have succeeded at helping to increase the capability and motivation of HCPs to promote physical activity among their patients.
- Many HCPs reported improvements in their knowledge, skills and confidence to promote physical activity following their participation in the training provided by the MHPP, which has also led to a greater capability and motivation to start conversations with patients.
- Qualitative evidence shows that some HCPs engaged by the programme are discussing physical activity more often with patients, and those conversations are felt to be of higher quality and more effective.
- HCPs from across the workstream evaluations were able to provide anecdotal evidence of patients becoming more physically active following these conversations.
- HCPs provided examples of patients reporting better aerobic fitness, reduced pain, improved mental health/mood, better management of fatigue, and greater enjoyment of physical activity.
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Creating system change

Another series of findings are related to how the promotion of physical activity has influenced the wider health system and its different partners.

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Below is a list of the key findings from this part of the programme.
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- There’s evidence from qualitative interviews with stakeholders that the programme has contributed positively to a whole-system change.
- Stakeholders have seen a greater recognition and value associated with physical activity across the system.
- Greater traction has been seen by stakeholders in the conversations and connections to support a whole-systems approach to physical activity.
- Stakeholders felt that the system has changed and that, in places, it’s more ready to embed physical activity ('the tide is turning').
- Some stakeholders reported observing that the work of the programme has successfully placed physical activity higher up the agenda of other organisations that we sought to influence e.g. Primary Care Networks, Integrated Care Systems and Hospital trusts. They also observed a broadening of organisations involved in the discussions around the importance of physical activity.
- The programme signalled and facilitated an increased collaboration between the health and physical activity sectors.
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A network of Physical Activity Clinical Champions - made up of GPs, nurses and allied healthcare professionals (HCPs) - delivered free, peer-to-peer training to over 40,549 HCPs across England.

There were 22,000 in Phase One and 18,459 in Phase Two, which took place between April 2019 and December 2022.

Their aim was to improve awareness, knowledge and skills to promote physical activity among patients to prevent and manage ill health and reduce inactivity.

During Phase Two, an additional 3,581 members of the wider health care workforce supporting the health and well-being of patients were trained. This included social prescribing link workers, health coaches and healthcare navigators.

Independent evaluations have shown that the programme was successful in increasing knowledge, confidence and skills.

An old gentleman exercises the upper side of his body by copying the exercises performed by a health professional sitting on a chair on his living room.

The below information demonstrates the improvement of the knowledge, confidence and the quality of discussions between HCPs and their patients.

Phase One

Increasing knowledge – one in four of those who didn’t know the guidelines recalled them correctly at four and 12 weeks post-training.
Increasing confidence – those ‘extremely confident’ in discussing physical activity increased from 16% to 30% in four weeks.
Increasing regularity of discussions – 40% of those trained had more physical activity conversations with patients post-training.

Phase Two

Increasing knowledge – following training, 72% said that they had good or advanced knowledge about how to promote physical activity (a significant increase from 41% pre-training).
Increasing confidence – following the training, 94% of attendees felt 'very confident' or 'somewhat confident' about raising the subject of physical activity with their patients (a significant increase from 75% pre-training).
In-depth interviews revealed the training helped to improve the quality of conversations with patients.

Resources we used

The below are a collection of resources employed during the Moving Healthcare Professionals Programme (MHPP) and the key outcomes achieved, based on the feedback provided by the HCPs who used them.

E-learning

The MHPP supported two different kinds of online learning to assist the learning needs and preferences of the HCPs involved in the study.

The first e-learning resources appeared on the British Medical Journal’s learning hub in 2014 and have been updated since.

The second set of resources were developed for Health Education England (through elfh - their online training sessions hub) and were launched in 2019.

Resource	Who used it?	Phase One	Phase Two
British Medical Journal’s eight Physical Activity modules.	Used predominantly by GPs and primary care teams.	Accessed by more than 177,000 professionals, who together completed 900 modules.	More than 38,000 modules were completed.
Health Education England through their elfh online hub, with 10 modules on physical activity and health.	Used predominantly by allied HCPs.		22,101 session launches and 3,391 active users accessing modules.

Key outcomes:

Nine in 10 survey participants reported that the e-learning modules positively impacted their confidence to have brief conversations with patients about physical activity (89%).
88% of users surveyed said the Health Education England e-Learning modules increased their knowledge on how to have brief conversations about physical activity.
86% reported that the modules increased their skills to engage in brief conversations about physical activity with patients.
92% of survey participants attributed feeling motivated to promote physical activity to patients to the modules (at least to some extent).

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Moving medicine

Moving Medicine is a free online resource designed for HCPs to promote and support patients with long-term conditions to get more active.
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Led by the Faculty of Sport and Exercise Medicine UK (FSEM) in partnership with the Office for Health Improvement and Disparities and us, the toolkit provides what’s needed for a one-minute, a five-minute and for longer conversations between HCPs and their patients along with step-by-step guides, behavioural change insights and the evidence to back these up.

The online resource was officially launched in October 2018 at the International Society of Physical Activity and Health Congress.

Key outcomes:
- Phase Two generated +136,500 unique users (April 2019 to August 2022), attracting approximately 3,300 users per month.
- The evaluation has shown that the resources helped to increase the capability and motivation of HCPs to have conversations about physical activity with patients, specifically their knowledge, skills (as reported by 94% of survey participants) and confidence (as reported by 96% of survey participants).
- The quality of the resources was rated highly by professionals, with almost three quarters of those surveyed giving a score of nine out of 10, with 10 being they’d definitely recommend it to others.
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E-advice

A digital resource was developed to support the delivery of brief advice for physical activity in primary care.
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During Phase One, a paper-based physical activity clinical advice pad, similar to a prescription, was developed and piloted.

The evaluation of this workstream identified the need for the electronic version of this resource.

This was developed as part of Phase Two of the programme.

The digital resource had two aspects to it:
- An e-prompt for HCPs to encourage them to raise the topic of physical activity with their patient.
- A patient-facing resource with recommendations about physical activity to be printed or sent electronically to the patient.
A small-scale pilot in one practice was completed during Phase Two and provided a better understanding of how to embed a digital tool within primary care.

It also highlighted the need for a larger-scale pilot to understand the impact of digital interventions such as an e-Prompt to help with the promotion of physical activity.
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Upskilling the next generation

Evidence gathered suggested that HCPs had a perceived lack of knowledge about physical activity guidelines when leaving their undergraduate studies.

To address that gap, the MHPP team worked with 17 medical schools and five schools of health to test methods for embedding physical activity within the curriculum during Phase One.

An independent evaluation was conducted by researchers at Loughborough University with the resulting recommendations emphasising the importance of working with key stakeholders during strategy development and identifying local champions in each school.

Two men jump while playing basketball on and indoors court.

The recommendations from the review in Phase One were carried forward into Phase Two.

An audit of professional standards in 2021 identified that physical activity is often omitted from undergraduate training and, when mentioned, it’s usually in conjunction with weight management.

Two national roundtable events were convened in May 2021 and June 2022 to develop a collaboration of stakeholders from across the health, education and physical activity sectors who are now creating an action plan to drive this work forward.

The work to date has identified a range of good practice, where medical and health schools have already begun to embed physical activity into their curricula, highlighting the importance of the student population in leveraging change.

This area of the Moving Healthcare Professionals Programme (MHPP) is focused on the embedding of physical activity into the wider health system around the activation of NHS systems with NHS Horizons and local hospital trusts through the Active Hospitals area of the programme.

Active Hospitals

In Phase One, Oxford University Hospitals NHS Foundation Trust also developed an Active Hospital Toolkit.

The purpose was to ensure ideas and resources generated in this project would be available for other hospitals and trusts across England to access and encourage patients to move more.

The interactive toolkit, currently hosted on the Moving Medicine website, includes several templates, resources, documents, case studies and processes support to implement an Active Hospital approach.

More information about the Active Hospitals pilot is available on the government's website.

In Phase Two, the promotion of physical activity was incorporated into 18 care pathways across four Active Hospital pilot sites:

More than 560 members of staff across the four pilot sites received formal training on physical activity promotion.

This area of the MHPP focusing on the implementation of physical activity into the wider health system left us with a series of key findings.

Key outcomes

The below are a series of findings from the promotion of physical activities in the Active Hospital pilot sites.
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- There’s qualitative evidence to suggest that conversations about physical activity are now happening more routinely with over 7,300 patients having received advice by their HCPs about physical activity, and these conversations being considered of better quality and more productive than in the past.
- Over 2,900 patients were signposted to resources or support services relating to physical activity (such as leaflets and links to local services).
- Over 910 patients were referred to a specialist or support service to increase their levels of physical activity.
- These figures significantly underestimated the extent of signposting and referrals that were actually made, due to some pathways and trusts, being unable to capture this data.
- A Community of Practice was set up to share learning and best practice and helped to provide motivation and support, with 24 NHS Hospital Trusts providing each other with solutions and ideas of how to embed physical activity promotion into their routine practice.
- Many of the activities at the pilot sites have already become embedded as “business as usual”, and there’s an intention to continue to spread this work through the development of the Community of Practice and work with NHS Horizons.
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An old gentleman exercises on a walking machine indoors under the supervision of another man.

Activating NHS Systems

Since July 2021, we and the Office for Health Improvement and Disparities (OHID) have been working with NHS Horizons to develop a whole-systems approach to the promotion of physical activity, and explored new approaches to maximise the impact of our work together.

In phase two, a number of events, roundtables, and networking opportunities led to the development of a co-produced plan and 'Theory of Change'.

The aim of this plan is to raise the visibility and to embed the importance of physical activity as part of a whole-system approach consistently across the NHS and its Integrated Care Systems, in order to make physical activity part of the prevention and management of long-term conditions.

Key outcomes

The below is a list of findings from this plan.
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- The evaluation showed that the programme contributed positively to whole-system change.
- The challenges identified to successfully deliver a whole-systems approach included aligning local and national organisations’ agendas across different sectors to ensure that there’s a consistent approach towards physical activity promotion.
- The whole-systems approach relies on greater connectivity and collaboration between organisations – particularly those working at the local level – and between the physical activity sector and the health sector, and ensuring organisations are linked in with their local active partnerships.
In 2023 we published three blogs to share our learning from the work we have done so far:

Why working with health systems is key to Uniting the Movement

Taking a bold leap to embed physical activity in health systems

Innovation, movement and health: driving change and impact

We will be working with NHS Horizons to share more about the approaches we are taking and the learning from this work during 2024.
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Find out more

Full evaluation reports for the Moving Healthcare Professionals Programme

Moving Healthcare Professionals Programme evaluation

Education, training and resources

Headlines

Creating system change

Headlines

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