Motivations, delivery, perceived benefits, and barriers to delivery of the parkrun practice initiative in general practices across the UK: a national cross-sectional online survey of healthcare professionals and event organisers

Abstract

Background

Physical activity offers significant health benefits, yet many people in the United Kingdom do not meet recommended guidelines. Primary care plays a crucial role in physical activity promotion, but barriers can hinder implementation. The parkrun practice initiative, launched in 2018, aims to address these barriers by linking general practices with local parkrun events.

Aim

This study aimed to evaluate the parkrun practice initiative from the perspective of staff at general practices and parkrun event organisers, exploring the motivations for joining, the variety of ways in which the initiative was delivered, perceived benefits on patients and staff, and barriers to implementation.

Methods

A cross-sectional online survey was distributed via email to 1,852 registered parkrun practices and 800 ‘linked’ parkrun event organisers. Descriptive statistics were used to present quantitative data. Content analysis was used to analyse qualitative data.

Results

Responses from 416 staff at parkrun practices (22% of registered practices) and 439 event organisers (55% of all events organisers) were included in the analysis. Attendance of staff at the local parkrun and sharing of information with patients were the main means of initiative implementation. Our findings highlight the perceived benefits of the initiative on staff and patient health and wellbeing, parkrun practice staff morale, and community engagement. A discrepancy is noted between what is being done by practices and what is being perceived by event organisers. Major barriers to implementation included: a lack of time; a lack of engagement of practice staff; the COVID-19 pandemic; and access to the nearest parkrun.

Conclusion

To address the barriers in implementing the parkrun practice initiative in primary care, our findings indicate that future initiatives should look to include: (1) clear and ongoing communication to ensure widespread engagement of patients, staff and event organisers; (2) ease of implementation (minimising time demands); and (3) adequate resource allocation to facilitate implementation (e.g., financial, educational, personnel). Further research is required to increase understanding of the impact on patient outcomes, staff morale, and the behavioural mechanisms influencing initiative implementation.

Introduction

Evidence shows that physical activity (PA) is associated with physical, psychological, and social health benefits [1,2,3], including reduced risk of all cause and cause specific mortality [4]. Due to the widely reported benefits of PA, it is upheld as an essential tool for both the prevention and management of Non-Communicable Diseases (NCDs). NCDs are accountable for approximately 41 million deaths globally per year, constituting ~ 74% of global deaths [5]. Notably, four disease categories—cardiovascular (~ 17.9 million annually), cancer (~ 9.3 million annually), chronic respiratory disease (~ 4.1 million annually), and diabetes (~ 2.0 million annually, inclusive of diabetes-induced kidney disease deaths)—contribute to over 80% of premature fatalities from NCDs [5]. In 2019, the Chief Medical Officers (CMOs) for the United Kingdom (UK) introduced updated PA guidelines, recommending that adults should aim to accumulate at least 150 min of moderate intensity aerobic exercise per week, including at least two weekly sessions aimed at muscle strengthening and balance [6]. However, approximately one-third of adults in the UK do not meet these PA guidelines [7].

Primary care is a key point of influence for addressing physical inactivity as it is the first point of contact individuals have with the health system– providing greater exposure to the whole population than any other health professional [8, 9]. Primary care professionals also regularly see those in need of PA advice and are viewed by the public as a trusted source of information [8, 9]. Growing evidence supports the effectiveness of PA promotion delivered in primary care at increasing PA in patients [10,11,12,13]. PA promotion in primary care has also been shown to be one of the most cost-effective approaches to promote PA at a population level [14]. Despite this, research has repeatedly evidenced a lack of PA promotion across primary care in the UK [15, 16]. Previous work has explored the reasons for this [17, 18], including the identification of four main barriers to the delivery of PA promotion faced by staff in primary care. These relate to a lack of: (1) time to promote PA; (2) resource/support to deliver promotion; (3) knowledge of how to deliver PA promotion, particularly in disease specific population; and (4) financial reimbursement.

Community-based interventions exist that promote PA participation at the individual and population level. One example is parkrun– a charity that delivers free, weekly, and timed five-kilometre walks or runs for all ages in parks and green-spaces across the UK (and in 21 other countries around the world). The events are non-competitive and focus on participation and inclusion. To help address low levels of PA promotion in primary care in the UK, the parkrun practice initiative was launched in 2018, in affiliation with Sport England. This collaboration between the Royal College of General Practitioners (RCGP) and parkrun UK is a social prescribing project that encourages practices of all sizes to link with their local parkrun events to improve physical activity levels in both patients and staff.

The parkrun practice website hosts information related to the parkrun practice initiative, including a toolkit with ideas for activities that practices can undertake in order to encourage patients and staff to become more active [19]. These suggested activities include (but are not limited to): sharing written information with staff and patients, presence of a noticeboard, delivering talks and presentations, advertising in waiting rooms and regularly talking to colleagues and patients about parkrun and the benefits of participating. Event organisers (EOs) are also provided with a bespoke toolkit, enabling them to support general practices in the delivery of the initiative. A practice is registered as a parkrun practice following approval from an RCGP representative in response to submission of appropriate paperwork. As documented in previous research [20], the benefits of parkrun practices are wide ranging, and include improved mental and physical health and an enhanced sense of community. At the time of writing approximately 1,900 practices are signed up to the initiative, representing ~ 31% of all UK practices.

An early evaluation of the initiative was conducted in 2019 and published in 2020 [21]. This mixed-methods study of 306 parkrun practices identified several key motivators for participation (e.g., improving patient and staff health and wellbeing and facilitating community engagement) and several key barriers (e.g., lack of time and engagement). Since then, the number of parkrun practices (and parkrun events) has continued to grow (i.e., the number of parkrun practices more than doubled from 780 to over 1,900). Given the proliferation in numbers, passage of time, and increasing burden on primary care in the UK– due to the COVID-19 pandemic, funding shortfalls, and staffing shortages across practices– there is a need to re-evaluate the parkrun practice initiative. Furthermore, given its widespread adoption in the UK (31% of all GP practices), it can also provide lessons to help inform other PA promotion initiatives in healthcare settings (e.g., the Active Practice Charter [22]).

This study aimed to evaluate the parkrun practice initiative from the perspective of both general practices and parkrun event organisers, exploring the motivations for joining, means of delivery, the perceived benefits on patient and staff physical activity, and barriers to implementation.

Methods

Survey design and distribution

Two surveys were developed for this study– one aimed at practice staff, and one aimed at parkrun EOs. These surveys were developed by an advisory panel of experts including academics (n = 3), General Practitioners (GPs) with a special interest in PA (n = 2), and parkrun representatives (n = 2). The surveys included a mixture of Likert scale, closed, and free-text response questions (see Supplementary File 1). Question development was informed by the toolkit provided by the RCGP and parkrun to practices to support them setting up and delivering the initiative [23]. Once developed, an online version of each survey was created using the Jisc Online Survey (JOS) tool.

Specifically, the survey for practice staff was designed to assess: (1) practice population demographics; (2) motivations for practices joining the initiative; (3) their means of implementing the initiative; (4) the perceived benefits of the parkrun practice initiative on patients and staff, and (5) barriers to implementation. The EO survey was designed to assess: (1) demographics (2), perceived benefits of the initiative on the parkrun event (3), the EO perceptions of how the initiative is delivered by practices and (4) barriers to implementation.

The parkrun practice staff survey was distributed via email by a RCGP Senior Project Manager to the contacts registered in the RCGP database for all practices that had achieved parkrun practice status. This represented 1,852 practices at the date of distribution (5th April 2024).

The EOs survey was sent to all parkrun UK events via email by the communications team at parkrun Global (n = 800). The surveys were also shared via RCGP and parkrun social media channels and newsletters.

One representative from each practice or parkrun event was asked to complete the survey. Reminder emails were sent by the same RCGP Senior Project Manager and the parkrun team at both two (19th April 2024) and four weeks (3rd May 2024) following initial contact, with the surveys closing after six weeks (17th May 2024). Informed consent was obtained prior to participation in the survey. Participation was voluntary and unpaid, with completion of the survey being possible via desktop or mobile devices. All participants were invited to be included into a prize draw (prizes were 1 pair of running shoes, 2 pairs of headphones and 3 parkrun t-shirts) on completion of the survey.

Ethics for non-clinical research was sought and approved by the University of Dundee’s Research Ethics Committee (UOD-SMED-SLS-Staff-2023-23-98).

Participants

Only parkrun EOs or employed staff (both clinical and non-clinical) of accredited parkrun practices in the UK were invited to participate. Responses from practices that did not have parkrun practice status were ineligible, with any responses from these practices deleted. In the event of multiple responses from the same individual, the first response was retained and the remainder removed from the final analysis. Similarly in the event of multiple responses from different individuals at the same parkrun event or practice, the first response was retained and the remainder removed from the final analysis.

Data analysis

Data were downloaded and cleaned in Microsoft Excel (Version 2402) before descriptive statistics were used to present demographics data, closed question responses, and Likert scale question responses.

Survey responses for the free-text (open-ended) questions were analysed using a content analysis approach, as described by Hsieh and Shannon [24]. A predominantly inductive and semantic style of content analysis was employed. The analysis involved the following five stages: (1) all free text responses were read by two authors (CL, RC) to ensure familiarisation with the data; (2) data were divided into responses to three areas (motivation for joining, barriers to implementation and perceived benefits) identified at the survey creation and directed by the research question (CL); (3) a coding framework was developed for each subordinate area by two authors (CL and RC) in collaboration; (4) the free text was analysed line by line and coded into sub-categories by one author (RC or CL) with a 10% check by the other author; (5) generated codes were categorised into themes according to similarities and differences by one author (RC) and discussed and agreed upon by another (CL); (6) a frequency analysis of generated themes was conducted to explore whether certain barriers were experienced more frequently than others. At each stage of the data analysis two authors (RC and CL) met to discuss interpretations and congruence of these in relation to the themes being generated. Any unresolved congruences were discussed with additional authors (EC, RM, and RCr) during regular meetings at key stages.

Results

Sample characteristics

At the time of survey distribution, there were 1,852 registered parkrun practices and 800 parkrun events in the UK. There were 855 responses to the survey, after 28 duplicates were removed. Fifteen of these were removed due to responses being from the same practice, and 13 removed due to responses being from the same individual.

Demographics

439 EOs were included in the analysis, representing 55% of total parkrun events in the UK. Of these respondents, 207 reported that their event was linked with one or more GP practice. Of the parkrun events who stated that they were knowingly linked to a practice, the majority were linked with only one practice (n = 100, 48%), whilst 25% were linked with two practices (n = 52), 10% with three practices (n = 22), and 16% with four or more (n = 33).

The remaining 232 EOs that responded reported that their event was not (as far as they were aware) linked with a local GP practice. Sixty-five of these responders (28%) reported having tried unsuccessfully to link with a GP practice.

Responses from 416 practices were included in the final analysis. This represents 22.5% of all parkrun practices at time of dissemination of survey. Practice and practice staff demographics are shown in Table 1.

Table 1 Practice and healthcare responder characteristics

Motivation for joining the initiative

Table 2 summarises the reasons identified by practice staff for registering their practice as a parkrun practice.

Table 2 A summary of the qualitative content analysis for the survey assessing the motivation of practice staff for joining the parkrun practice initiative

Alongside the motivation of improving patient (65.4%, n = 272) and staff (43.0%, n = 179) wellbeing, and personal advocacy of already being an active parkrun participation (38.5%, n = 160), respondents highlighted several other motivations. Community engagement (10.8%, n = 45) reflects a desire to meet patients and fellow colleagues outside the work environment, acknowledging the power of socialisation, as well as benefits on staff morale which was also independently expressed as a motivation (6.0%, n = 25):

“[…] very sociable and good to meet everyone away from work with a purpose– we all look forward to it” (HCW431).

Respondents also cited the role of the RCGP advocacy (5.5%, n = 23). The RCGP have a wide distribution network and are a trusted organisation. This platform was used to deliver the initiative and advertise the initiative:

“I organised it [active practice charter] having seen a talk at RCGP conference years ago” (HCW235).

Implementation of parkrun practice initiative

Practice staff were asked how they delivered the initiative, with EOs asked how they perceived that it was being delivered. Table 3 represents the delivery of the initiative to patients and staff (as reported by practice staff and as perceived by EOs).

Table 3 Activities adopted by parkrun practices to promote the initiative (separated by patients and carers and practice staff) compared against event organisers perceptions of adopted activities

Figure 1 shows the implementation of key elements of the parkrun practice initiative, as perceived by practice staff via a Likert scale.

Fig. 1

implementation of key elements of the parkrun practice initiative, as perceived by healthcare workers (represented via a Likert scale, number of respondents = 416)

Perceived benefits of parkrun practice initiative

Figure 2 represents the perceived benefits (as judged by EOs) of the parkrun practice initiative on attendance and the event generally, alongside the perceived benefits (as judged by practice staff) of the parkrun practice initiative on patient and staff wellbeing.

Fig. 2

Likert scale assessment of the perceived impact of the parkrun Practice Initiative. This related to perceived impact by event organisers (n = 207) on overall event impact and attendance, and perceived impact by practice staff (n = 416) on colleagues and patients

Practice staff that responded highlighted four main benefits of the parkrun practice initiative (Table 4). These were: (1) improvements to staff health and wellbeing (25.4%, n = 107); (2) improvements in patient health and wellbeing (22.8%, n = 95); (3) community engagement (13.9%, n = 58); and (4) improvements in staff morale (11.3%, n = 47).

Table 4 A summary of the qualitative content analysis for the survey assessing the perceived impact of parkrun practice initiative as experienced by practice staff

Respondents highlighted the physical (improving physical function and fitness) and mental benefits (managing stress, improved mood) for staff alongside improved staff morale and social benefits from meeting together in a non-work environment.

“I think it’s been positive for staff and a shared bond between different members of the team that don’t usually work together day to day” (HCW28).

“Great opportunity to get team together in sport activity” (HCW18).

Responding practice staff also highlighted the role of the parkrun practice initiative in facilitating community engagement. Community engagement refers to both the health benefits of socialisation and feeling of belonging to a community, but also giving the practice a platform to have a visible presence within their community.

“Great to help those who buy into it creating community, purpose, belonging, conversation, as well as exercise” (HCW9).

“[…]We have an older demographic here and we believe building a stronger community and offering a chance for our older patients to socialises with other people will massively benefit the ones struggling with loneliness for example.” (HCW160).

Barriers to implementation

Several barriers to delivery of the parkrun practice initiative were experienced by EOs. These are shown in detail in Table 5.

Table 5 A summary of the qualitative content analysis for the survey assessing the challenges experienced by event organisers (EOs) and practice staff in implementation of parkrun practice initiative

The three most frequently cited challenges were: (1) a lack of time to aid delivery of the initiative (38.0%, n = 167); (2) a lack of engagement from local GP practices (21.9%, n = 96); and (3) a lack of awareness of the initiative amongst practice staff (14.6%, n = 64). Other barriers include a lack of resources/training, lack of a formal referral process and the impact of the COVID-19 pandemic.

Practice staff (Table 5) cited similar barriers, including: (1) a lack of engagement from colleagues (30.0%, n = 125), and (2) a lack of time to deliver the initiative (13.7%, n = 57).

A lack of engagement cited by practice staff was related to the barriers of (1) persuading practice managers and GPs to link the practice to a parkrun; (2) convincing staff of the benefits both for themselves and those they care for; and (3) the ongoing ‘buy-in’/enthusiasm to ensure longer term successful delivery.

“It is so hard to motivate the staff to join in. Many are very sedentary and overweight and have no desire to change.” (HCW24).

Practice staff also cited geographical limitations (9.6%, n = 40) and the COVID-19 pandemic (5.8%, n = 20). Many practice staff described the linked parkrun being out of the practice catchment or staff not living near their practice (and therefore parkrun), with distance acting as a barrier.

“[staff] often have to commute significant distance to work & hence parkrun, our practice location not ideal as not that close to parkrun” (HCW303).

Finally, respondents cited the profound impact of the COVID-19 pandemic on both personal and working lives, with an ongoing impact on workload. This has led a loss of momentum and prioritisation of the parkrun practice initiative:

“[Challenge is] Covid!! Still in process of getting things back up and running since we lost that momentum in 2020 (and focus had to turn to purely clinical work)” (HCW367).

Discussion

Summary

This study provides an overview of the parkrun practice initiative in the UK, particularly related to motivations for registering as a parkrun practice, means of delivery, perceived benefits and barriers to delivery. Overall, parkrun practices felt the initiative positively impacted staff and patient health and wellbeing, whilst also highlighting improved staff morale and engagement with the local community.

47% (207/439) of EOs that responded reported their parkrun was paired with a GP practice. Despite guidance asking practices to contact the event team and get their consent prior to signing up, in reality this does not always take place and GP practices can sign up to the initiative without first contacting the local parkrun event team. Therefore, EOs may be unaware that their event has been linked to a practice through this initiative. A lack of clear communication between EOs and practices may also exist in established connections. Although, nearly 40% of EOs said that the initiative had positively impacted their event, this may have been greater if there had been better awareness of the activities being undertaken by linked practices (over 20% of parkrun events were not aware of what activities the practice had undertaken).

Two major challenges to implementation were noted across both groups: a lack of time, and a lack of engagement. EOs highlighted a lack of engagement by primary care staff in general, whilst practice staff highlighted a lack of engagement (initial and ongoing) by colleagues in the initiative. Practice staff also highlighted the impact of distance to the nearest parkrun (both personally and as a patient representative) and the disruptive effect of the COVID-19 pandemic (with subsequent increased workload) on healthcare delivery as barriers to implementation.

Strengths and limitations

Although qualitative analysis of free text responses in this survey helped generate additional insight, particularly related to barriers and perceived benefits of the initiative, these were relatively superficial and a more in-depth understanding through semi-structured qualitative interviews or focus groups would have been able to expand upon the findings of this study in greater depth.

Although the response rate in both groups was relatively high (55% of all parkrun events and 22.5% of all parkrun practices), responder bias may have led to the inclusion of practices and EOs who were more committed to the initiative. Given the unprecedented pressures on healthcare professionals (especially at the time of the survey distribution), response rates and/or responder bias may have been amplified in these results. This may explain why, despite the involvement of incentives for participation, the response rate of practices was lower than the 2019 analysis (22.5% v 39.2%) [21].

Comparisons to existing literature

Our findings highlight engagement and time constraints/workload as the main barriers to the implementation of the parkrun practice initiative. Lack of time has repeatedly been highlighted as a major challenge to PA promotion in primary care [17, 18]. The COVID-19 pandemic exacerbated this lack of time, leading to a crisis within primary care, facilitating rapid change: remote working, less face-to-face delivery, increased workload (vaccination roll out delivery, for example), and a worsening of the pre-existing staffing shortage [25]. Responders also directly highlighted the impact of COVID-19, with the pause in parkrun events breaking routine and the change in work patterns leading to a subsequent fall in engagement. The impact of the COVID-19 pandemic may also have affected sign-up to the parkrun practice initiative. The initiative started in 2018, with an initial larger number of earlier adopters (39.9% pre-April 2020, see Table 1), and subsequent recruitment was slower (aligns with the COVID-19 pandemic).

The parkrun practice initiative provides an opportunity for PA promotion, but there is potential that the lack of time and high workload (impacted by the pandemic) leave little capacity for healthcare workers to engage in delivering the initiative. Recent work evaluating another national initiative (RCGP Active Practice Charter) to promote PA in primary care settings [22] identified time, engagement, and costs as the main barriers to implementation– suggesting these factors as important considerations to address when refining current initiatives or developing new ones.

Practices reported undertaking a broad range of activities (as recommended within the ‘Toolkit’) to deliver the initiative (Table 3). However, the percentage of practices undertaking recommended activities to implement the initiative was fewer in our findings than those reported by Fleming and colleagues in 2020 [21]. This is particularly noticeable with reference to: (1) encouraging patients to take part in parkrun in consultation (40% v. 79%); sharing of flyers (34% v. 57%); (2) practice website pages (28% v. 40%); and (3) displaying information regarding parkrun on television screens in practice (19% v. 35%). As the first to sign up, the early adopters of the initiative evaluated in 2020 may have been more motivated, and this may explain some of the differences. However, given these changes, our findings provide insight into implementation in the current primary care context and highlight a possibility to reform the parkrun practice offering. The previous evaluation [21] did identify the two major barriers to implementation: (1) a lack of time; and (2) a lack of interest and enthusiasm by practice staff. Fleming and colleagues highlighted a need to determine ways to engage the wider practice team and engage with practices not familiar with parkrun or its benefits.

This study shows the wide variety of ways in which the parkrun practice initiative is implemented between practices. This flexibility is in-keeping with the Toolkit [19] and allows for inter-practice variations in needs, priorities and working-styles. Despite this, the key means of delivery were attendance at parkrun, discussion with patients/carers and colleagues, and sharing of information across a variety of media (e.g., social media, SMS, webpages). There appears to be a discrepancy between what practices report as being done and what EOs perceive as being done (Table 3). Except for “regularly speaking to patient +/- carer”, “delivering a presentation to patients” and “sharing parkrun and stories on social media platforms”, practice staff report implementing activities to promote parkrun much more frequently that EOs perceive it to be happening. This ‘perception gap’ may be explained by the lack of engagement of practice staff and communication failures which are cited as barriers to the initiative delivery by EOs, with steps to address these barriers providing potential for improving the initiative.

Almost 40% of EOs (Fig. 2) regarded the initiative as having a positive influence on their event, but a much smaller number (15%) identified a positive impact on attendance. Given the complexity of decision making, it is likely that a number of influences affect an individual’s decision to attend parkrun, making it very hard to ascertain the exact impact of the initiative on attendance (or PA more generally) [26]. At present, there is also no way of measuring referrals to parkrun, and so perceived impact on attendance is observational. Encouraging practice staff to code referrals/discussion may go some-way to addressing this. It is in this context of complexity that the International Society of Physical Activity for Health (ISPAH) highlight a need for a systems-based approach to PA [27], of which healthcare system engagement is an important part. Initiatives, like the parkrun practice initiative, are therefore important.

A 2019 evaluation (published in 2022) also explored EOs perceptions of the parkrun practice initiative [28]. In this study, EOs that had engaged in the initiative reported being motivated by wanting to positively impact the health and wellbeing of their community. In seeking to address the main barriers experienced by EOs in delivering the initiative (making initial contact with practices, lack of time and lack of clarity around responsibilities), Fleming and colleagues identified two key areas needing to be addressed: (1) establishment of clear communication pathways, and (2) developing support systems to minimise resource implications for EOs and practices to delivery of the initiative. Our study found that engagement of practice staff remained the biggest challenge. Further qualitative work, utilising behaviour change principles, would allow exploration of these barriers in more detail.

Implications for research and practice

This work identified that the parkrun practice initiative is well received, but significant barriers to its successful delivery exist. These barriers align with those identified in evaluations of other initiatives to promote PA in primary care [22]. Future initiatives therefore need to address these, including: (1) clear and ongoing communication to ensure widespread engagement and adoption; (2) ease of implementation, minimising time and resource demands on practice staff and volunteers alike; and (3) adequate resource allocation to facilitate implementation (including financial, educational support, personnel). The National Health Service’s Long-Term Plan committed all primary care networks (PCNs) in England and Wales to provide a proactive social prescribing service [29]. Given the organisational intention of parkrun to address social isolation and loneliness, it presents an opportunity for social prescribing, and the parkrun practice initiative should seek to evolve to ensure social prescriber in PCNs have a central role in delivery. This may in turn minimise time demands on practice staff and volunteers and, if specifically addressed, help facilitate improved communication and engagement. The need to address these challenges moving forward, is particularly important given the value placed on prevention and community health within the recent report on the National Health Service by Lord Darzi [30].

With a further accumulation of evidence to support parkrun practices, including research to explore patient perspectives of the initiative, a targeted campaign could be adopted to support future expansion (and re-invigoration) of the initiative. With the inclusion of an educational element, this may address several identified barriers (including lack of engagement and lack of knowledge) but will benefit from an evidence-based co-production approach. Future iterations should be planned in accordance with a systems theory, with the soft-systems methodology (as an example) allowing for an individual and stakeholder driven approach [31].

Given the declining morale within the NHS workforce and the current ‘crisis’ in general practice [32, 33], the perceived benefits of the parkrun practice initiative on staff wellbeing and morale is promising. Alongside further research exploring this and patient outcomes, work is required to explore the psychological and behavioural mechanisms (of practice staff and EOs) influencing implementation. Finally, given the evidence that ‘active doctors make active patients’ [34,35,36], future initiatives should look to target (at least in part) healthcare professionals, and how to best utilise the potential of primary care staff as PA ‘advocates’.