“You're like a salesman or a saleswoman, you're trying to sell that person exercise”: How the socioeconomic position of an area influences General Practitioners’ engagement with physical activity as a treatment pathway for mild to moderate mental health conditions

Abstract

Overview: Mental health problems affect one in four people in the UK (Farmer and Dyer, 2016). Socioeconomic position (SEP) has impacted both lifestyle and the quality of general healthcare (Office of National Statistics, 2016). This study was the first to specifically explore how the socioeconomic area of a General Practitioner’s (GP’s) practice, impacts the use of physical activity (PA) as a treatment for mental health conditions. It aimed to: (i) Explore GPs’ experiences of physical activity and other provisions for mental health, in their local area; (ii) Understand perceived problems regarding access to physical activity to support mental health; and (iii) Understand how existing socioeconomic inequalities may impact the mental health treatment approach of GPs.

Methodology: Participants (n=6) were recruited using convenience sampling. The inclusion criteria for this study were that GPs had to be based in England and currently working in general practice. The participants represented different socioeconomic areas, allowing comparison and contrast across findings. Interviews focused on the provision of and access to mental health treatment pathways, barriers that GPs encountered and the healthcare inequalities that exist. A reflexive thematic analysis was undertaken (Braun and Clarke, 2019).

Results: The first theme, ‘Precedence of pharmaceutical and psychological approaches as treatment pathways’, focused on the growing mental health cases that GPs are experiencing. There were narrow treatment options for GPs, despite acknowledgement of PA benefits. The ‘Insufficient implementation of PA schemes’ theme identified perceived problems with PA schemes and the multifaceted reasons for patients’ lack of engagement. The SEP was perceived to influence the GPs’ and patients’ attitudes to treatment pathways. The ‘Complexity of barriers to PA for GPs and patients’ theme outlined difficulties that lead to restricted PA engagement, with COVID-19 exacerbating these. There was also inadequate interaction between GPs and stakeholders.

Conclusion: GPs working in lower socioeconomic areas experienced greater difficulties in referring and engaging patients in PA; challenges were complex and differed across localities. Findings highlight a training need around PA for GPs who work in higher socioeconomic status areas and a need for improved communication between GPs, external healthcare professionals, providers and patients.