Physical activity on prescription in Swedish primary care: a survey on use, views, and implementation determinants amongst general practitioners

Figures & data

Table 1. The four domains in the Normalisation Process Theory explained [31].

Domain	Explanation
Coherence	Understanding the benefits and purpose with an intervention, such as PAP. Also referred to as ‘sense-making work’.
Cognitive participation	The relational work that builds and sustains people’s development together within an area, also called ‘community of practice’.
Collective action	The operational work that is needed to implement an intervention, such as PAP.
Reflexive monitoring	The assessment that is done to understand how an intervention, such as PAP, affect ourselves and others around us.

Figure 1. Participant flow through the study.

Table 2. Respondents’ characteristics.

	n	%
Gender
Women	68	47.6
Men	74	51.7
Does not want to disclose	1	0.7
Professional category
GP	91	63.6
Resident GP	43	30.1
Other licenced physician	9	6.3
Practice location
Fyrbodal	30	21.0
Gothenburg	54	37.8
Skaraborg	10	7.0
Södra Bohuslän	34	23.8
Södra Älvsborg	15	10.5
Years of practice
<1	10	7.0
1-2	16	11.2
3-5	24	16.8
6-10	24	16.8
11-15	25	17.5
>15	44	30.8
Private or public healthcare centre
Private	78	54.5
Public	65	45.5

GP: General practitioner.

Table 3. Associations between likelihood of frequent use of Physical activity on prescription and gender, practice location, and years of practice.

	B	SE	p	OR	95% CI for OR
Gender^1	0.298	0.416	0.474	1.347	0.596 to 3.047
Practice location^2	1.849	0.433	<0.001	6.352	2.720 to 14.834
Years of practice^3	0.935	0.433	0.031	2.547	1.090 to 5.955

1 = Groups defined as ‘woman (ref)’ or ‘man’.

2 = Groups defined as ‘Gothenburg’ (ref.) or ‘other areas in Region Västra Götaland’.

3 = Groups defined as ‘<10 years since receiving medical license’ (ref.) or ‘>10 years since receiving medical licence’.

Analysis: Logistic regression.

R²_Nagelkerke: 0.22.

B: Beta coefficient; OR: Odds Ratio: CI: confidence interval.

Bold numbers indicate significant p-values.

Table 4. Responses for all items in part C of the survey, presented in their respective Normalisation Process Theory domain.

	Agree n (%)	Neutral n (%)	Disagree n (%)	Excluded or missing n
Coherence
I can see how PAP differs from usual ways of working	97 (70)	40 (29)	2 (1)	4
Staff in this organisation have a shared understanding of the purpose of PAP	60 (44)	65 (47)	12 (9)	6
I understand how PAP affects the nature of my work	54 (42)	61 (47)	15 (12)	13
I can see the potential value of PAP for my work	82 (61)	40 (30)	13 (10)	8
Cognitive participation
There are key people who drive PAP forward and get others involved	52 (39)	29 (22)	51 (39)	11
I believe that participating in PAP is a legitimate part of my role	65 (47)	53 (39)	19 (14)	6
I’m open to working with colleagues in new ways to use PAP	115 (82)	20 (14)	6 (4)	2
I will continue to support PAP	96 (70)	37 (27)	5 (4)	5
Collective action
I can easily integrate PAP into my existing work	65 (47)	44 (32)	29 (21)	5
PAP disrupts working relationships	9 (7)	33 (24)	95 (69)	6
I have confidence in other people’s ability to use PAP	91 (65)	41 (29)	9 (6)	2
Work is assigned to those with skills appropriate to PAP	69 (49)	59 (42)	12 (9)	3
Sufficient training is provided to enable staff to implement PAP	30 (21)	52 (37)	60 (42)	1
Sufficient resources are available to support PAP	39 (27)	58 (41)	45 (32)	1
Management adequately supports PAP	57 (41)	68 (49)	15 (11)	3
Reflexive monitoring
I am aware of reports about the effects of PAP	65 (46)	42 (30)	33 (24)	3
The staff agree that PAP is worthwhile	47 (34)	69 (50)	23 (17)	4
I value the effects that PAP has on my work	43 (32)	68 (50)	25 (18)	7
Feedback about PAP can be used to improve it in the future	93 (68)	42 (31)	2 (1)	6
I can modify how I work with PAP	87 (64)	44 (32)	5 (4)	7

PAP: Physical activity on prescription.

Table 5. Associations between dichotomised groups’ composite scores for each Normalization Process Theory domain.

	B	95% CI	p	Adj. R^2
Coherence				0.057
Gender^1	−0.086	−0.427 to 0.256	0.621
Practice location^2	−0.484	−0.836 to −0.133	0.007
Years of practice^3	0.319	−0.024 to 0.633	0.068
Cognitive participation				0.126
Gender^1	−0.402	−0.735 to −0.069	0.018
Practice location^2	−0.624	−0.967 to −0.281	<0.001
Years of practice^3	0.241	−0.094 to 0.576	0.157
Collective action				0.157
Gender^1	−0.056	−0.374 to 0.261	0.726
Practice location^2	−0.738	−1.065 to −0.411	<0.001
Years of practice^3	0.474	0.154 to 0.793	0.004
Reflexive monitoring				0.130
Gender^1	−0.241	−0.572 to 0.091	0.153
Practice location^2	−0.498	−0.839 to −0.156	0.005
Years of practice^3	0.561	0.227 to 0.895	0.001

¹Groups defined as ‘woman’ (ref.) or ‘man’.

²Groups defined as ‘Gothenburg’ (ref.) or ‘other areas in Region Västra Götaland’.

³Groups defined as ‘<10 years since receiving medical license’ (ref.) or ‘>10 years since receiving medical licence’.

Analysis: Multiple linear regression.

B: Beta coefficient; CI: Confidence interval; Adj. R²: Adjusted determination coefficient.

Bold numbers indicate significant p-values.

May C, Rapley T, Mair FS, et al. Normalization process theory on-line users’ manual, toolkit and nomad instrument: NPT; 2015. [Accessed Mar 23, 2023]. Available from: https://normalization-process-theory.northumbria.ac.uk/.

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Data availability statement

The data that support the findings of this study are available from the corresponding author, SB, upon reasonable request.