Development of REFERQUAL; an Instrument for Evaluating Service Quality in GP Exercise Referral Schemes

Abstract

Evidence concerning the benefits of physical activity to health is well established. Despite this extensive evidence, the vast majority of the population remains insufficiently physically active to elicit meaningful health gain. Exercise Referral Schemes (ERSs) have been operating in this country since the early 1990s. However, despite continuing expansion in the number of schemes nationwide, `success', in terms of long-term adherence to physical activity by clients has not been achieved. Extensive evidence in the literature suggests service quality may impact on clients' decision to adhere. However, this concept has not previously been applied to ERSs, assuring the originality and contributory potential of this investigation
This thesis aims to investigate the factors affecting retention rates in ERSs. Furthermore, this investigation seeks to develop an understanding of the relationship between service quality and adherence in this setting. Five schemes comprising
diverse operational management systems are evaluated via a new assessment tool, completed by 1024 respondents. This quantitative data is supported and extended by qualitative data drawn from a range of key stakeholders collected via 10 interviews and five focus groups.
Results suggest clients do not generally perceive service quality to be problematic; however, significant differences between adherence groups and schemes offer insights into issues affecting retention. The nature of the relationship between client and exercise professional appears to represent one of the most notable `keys' to retention. Many clients seek a medical solution to health problems and perceive an exercise professional to be the poor relation of a GP. The fundamental importance of the potential for other exercisers to contribute to the support of clients is also highlighted and discussed. Site-specific issues, time to exercise and client stereotypes of the gym environment also feature as possible determinants of adherence. Considerable further research is needed to build upon these results. Possible avenues for such studies are
also discussed.