Increasing Understanding of Referrals from Healthcare Professionals to Community-Based Exercise Programs with Healthcare-Community Partnerships Designed for Older Adults with Balance and Mobility Limitations

Referrals from healthcare professionals to community-based exercise programs with healthcare-community partnerships (CBEP-HCPs) are important for program sustainability; however, they are inconsistent. Little is known about referrals to CBEP-HCPs, including the referral sources, promotional strategies used to facilitate referral, and the referral practice of healthcare partners (individuals who support programs by prescribing exercise, training and supporting the instructors, monitoring the program, and facilitating referrals). This thesis is comprised of three studies that aimed to: 1) identify the nature, range, and extent of models which guide the development of linkages between healthcare settings and community programs; 2) describe CBEP-HCP providers’ perceptions of the a) type and work setting of healthcare professionals who refer to CBEP-HCPs by community size; b) nature, frequency, and utility of strategies used to promote referral from healthcare professionals to CBEP-HCPs; and c) facilitators and barriers to CBEP-HCP promotion; and 3) explore how healthcare partners in CBEP-HCPs designed for people with balance and mobility limitations understand and enact referrals in the context of their role. Study 1 was a scoping review of healthcare-community linkage models with six models included. Results showed that models most commonly targeted primary care as the healthcare setting and intended users, while there was a paucity of models designed for ambulatory and rehabilitation settings. Almost all models outlined the linkage strategy of coordinating services and referral processes. Study 2 was an interviewer-administered survey of 23 CBEP-HCP providers of 27 programs. Findings revealed that the majority of programs received referrals from hospital-based physical therapists and the majority of healthcare partners were also physical therapists. Study 3 was a descriptive qualitative study employing semi-structured interviews of 12 healthcare partners in a CBEP-HCP. Findings demonstrated that healthcare partners described their role in referrals as secondary to their roles as educators and trainers. They commented that their role with referrals evolved wherein they provided less support as programs became well-established. Thesis findings advance knowledge about referrals by healthcare professionals to CBEP-HCPs. Future research should explore referrals by healthcare professionals other than physical therapists, identify healthcare partner competencies, develop ambulatory and rehabilitation linkage models, and develop interventions to increase referrals.

Department dc:contributor.department

Rehabilitation Science

Year dc:date.issued

2024

Author dc:creator

• Alsbury-Nealy, Kyla

Advisor dc:contributor.advisor

• Salbach, Nancy M.

• balance
• community health services
• exercise
• physical therapists
• referral
• walking

Statement dc:rights

• Attribution 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by/4.0/

Handle dc:identifier.uri

https://hdl.handle.net/1807/149603

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/149603