Table 4.
Barriers and enablers to implementation of the intervention (the system and organisational level) and to the uptake of PA (individual-related levels)
| 1. Crone, D., Johnston, L.H., Gidlow, C., Henley, C., James, D.V.B. [33]. |
| A) Barriers |
| i) Organisational & system level |
| • Physical activity referral scheme is less suited to the needs of MMD patients. • Those with mental health problems find that there are barriers impeding their ability to access health services [53]. • Primary health care professionals are insufficiently trained to work with patients affected by mental health issues. |
| ii) Provider/practitioner level |
| • Some healthcare professionals remain skeptical of the role of physical activity as an adjunct treatment for those with mental health problems [54]. |
| iii) Individual level |
| • The uptake of the scheme was significantly lower in the mental health referrals. • Difficulties in access. • Financial constraints. • The side effect(s) of antidepressants [53]. • Lack of social network and support. |
| B) Enablers None listed. |
| 2. Duda, J., Williams, G., Ntoumanis, N., Daley, A., Eves, F., Mutrie, N., Rouse, P.C., Lodhia, R., Blamey, R.V., Jolly, K. [28]. |
| A) Barriers |
| i) Organisational & system level |
| • Insufficient training for practitioners delivering the intervention. • A low training attendance due to work-related commitments. • Lack of infrastructure e.g. limited access to PCs making it difficult for practitioners to watch training videos or receive email reminders sent by the research team. |
| ii) Provider/practitioner level |
| • Poor treatment fidelity (e.g. an inadequate provision of autonomy support). |
| iii) Individual level |
| • Poor engagement with minority ethnic communities, who do not speak English with sufficient fluency. |
| iv) Intervention level |
| • Practicalities of organising an intervention: the use of interpreters proved challenging. |
| B) Enablers: None listed |
| 3 Forsyth A., Deane F.P., Williams P. [24]. |
| A) Barriers |
| i) Organisational & system level |
| • Engaging healthcare staff in the delivery of the intervention. |
| ii) Provider/practitioner level None listed. |
| iii) Individual level |
| • Engaging patients proved difficult and approximately 50% of all appointments were either cancelled or missed. |
| iv) Intervention level None listed. |
| B) Enablers |
| i) Intervention level |
| • Calming effects of PA. • A preferred form of PA was walking. |
| 4 Littlecott, H.J., Moore G.F., Moore, L., Murphy S. [29]. |
| A) Barriers |
| i) Organisational & system level None listed. |
| ii) Provider/practitioner level |
| • Poor treatment fidelity e.g. motivational interviewing and goal setting were not fully delivered [58]. |
| iii) Individual level |
| • Time and costs. • The nature of the intervention. |
| iv) Intervention level |
| • Intervention design: lack of measurable goals might have led to reduced self-efficacy. |
| v) Context level |
| B) Enablers: |
| i) Intervention level |
| • Increased participants’ confidence in using gym equipment and in exercising safely. |
| ii) Social context |
| • Family can positively impact the participants’ engagement with the interventions; friends do not seem to have a similar impact. |
| 5 Mailey E.L., Wójcicki T.R., Motl R.W., Hu L, Strauser D.R., Collins K.D., McAuley E. [25]. |
| A) Barriers |
| i) Organisational & system level None listed. |
| ii) Provider/practitioner level None listed. |
| iii) Individual level |
| • Poor engagement with PApost intervention. • Participants’ self-efficacy declining over time. |
| iv) Intervention level |
| • Inadequate intervention interface design. |
| B) Enablers |
| i) Intervention level |
| • Participants’ satisfaction with a number of intervention components such as meetings with intervention staff or using pedometers. |
| 6 Oeland A.M., Laessoe U., Olesen A.V., Munk-Jørgensen P. [31]. |
| A) Barriers |
| i) Organisational & system level None listed. |
| ii) Provider/practitioner level None listed. |
| iii) Individual level |
| • A low uptake of amongst patients suffering from ill mental health. • In the follow-up period improvement stops. |
| iv) Intervention level |
| • Post-intervention, levels of PA decrease over time e.g. due to the lack of professional instructions. |
| B) Enablers: |
| i) Intervention level |
| • The presence of the instructor. • Mode of deliver: group exercises (which might have heightened motivation as a result of social interactions). |
| 7 Pentecost C., Farrand P., Greaves C.J., Taylor R.S., Warren F.S., Hillsdon M., Green C., Welsman J. R., Rayson K., Evans P.H., Taylor A.H. [32]. |
| A) Barriers |
| i) Organisational & system level |
| • Staff turnover and absences. • Heavy workload. • Clinical work and the service’s performance targets take the priority over intervention delivery |
| ii) Provider/practitioner level |
| • Practitioners and participants’ preference for psychological treatments. • Practitioners not giving information booklets. • Poor treatment fidelity; deviations from the intervention delivery protocol. |
| iii) Individual level |
| • The nature of the condition resulting in unwillingness to engage in PA. |
| iv) Intervention level |
| • Intervention design; information booklets –potentially overwhelming. • Information booklet being too heavy:‘I must admit, because I have so much to carry as a PWP, it was a bit too much’. |
| v) Extraneous circumstances |
| • Illness of a member of the research team. |
| B) Enablers |
| i) Intervention level |
| • Behavioural Activation and PA enhancing recovery rates. • Information booklets.. • The diaries seemed to be one of the most useful tools in the booklets (to plan and monitor PAs). • Preferred types of PA: walking, gardening and exercising in a gym. • Monitoring PA levels with pedometers. |
| i) Individual level |
| • PA promotion was acceptable to patients. |
| 8 Piette J.D., Richardson C., Himle J., Duffy S., Torres T., Vogel M., Barber K., Valenstein M. [26]. |
| A) Barriers |
|
i) Organisational & system level: None listed.
ii) Provider/practitioner level: None listed. iii) Individual level |
| • an initial uptake: 32% of contacted individuals refused participation. |
| iv) Intervention level |
| • Underrepresentation of individuals from various ethnic minorities (16% of the • study population). |
| B) Enablers: |
| i) Intervention level |
| • The use of CBT to increase an uptake of PA. |
| 9 Pomp S., Fleig L., Schwarzer R., Lippke S. [27]. |
| A) Barriers |
|
i) Organisational & system level: None listed. ii) Provider/practitioner level: None listed. iii) Individual level |
| • Individuals with depressive symptoms did not increase their exercise levels. • Individuals’ depleted self-regulatory resources resulting in fewer capabilities to implement health behaviour; they planned less; struggled to set realistic plans and to monitor their PA levels. Also, they did not adhere to their plans. |
| iv) Intervention level: None listed. |
| B) Enablers: |
| i) Intervention level |
| • Participants suffering from depression may benefit from weekly reminders and booster sessions; also, from additional psychotherapeutic support such as Cognitive behavioural therapy (CBT). • Integrated approaches that address the management of depressive symptoms and health behaviour. |
| 10 Suija K., Pechter U., Kalda R., Tähepõld H., Maaroos J., Maaroos H.I. [18] |
| A) Barriers |
|
i) Organisational & system level: None listed. ii) Provider/practitioner level: None listed. iii) Individual level |
| • Lack of time. • The rainy and cold weather. |
| iv) Intervention level |
| • Type of PA intervention: unsupervised home-based exercise. |
| B) Enablers: |
| i) Individual level |
| • Positive PA experience. |