Barriers and Implementation strategies for Physical Activity on Prescription (PAP): Healthcare personnel and Management Perspectives in Sweden—An Explanatory Sequential Study Design

Background Physical inactivity is a risk factor for noncommunicable diseases and premature mortality. Physical activity on prescription (PAP) is a recommended method for promoting physical activity in Swedish primary healthcare and in other European countries, but its implementation varies across regions. This study aimed to identify barriers and strategies to strengthen PAP implementation in a region with low prescription rates, as perceived by healthcare personnel and managers in primary healthcare. Methods A mixed-methods study with an explanatory sequential design was conducted (spring 2024) in a geographically dispersed region of Sweden. The digital surveys were completed by 75 healthcare personnel and 18 managers. Uni-, bi and multivariate analyses were used for quantitative data, followed by semistructured interviews (n = 14) analysed with qualitative content analysis, guided by normalization process theory (NPT). Results Thirteen percent of healthcare personnel prescribed PAP regularly. Physiotherapists prescribed PAP more often than other professionals did (odds ratio [OR] 4.0, confidence interval [CI] 1.01–15.83). Barriers included time constraints, lack of guidelines, knowledge and low managerial prioritization. Compared with those aged ≤ 45 years, personnel aged ≥ 46 years were more likely to perceive time constraints (OR 3.6, CI 1.27–10.16) when adjusted for gender and profession. Compared with males, females (n = 36/41, 88%) expressed more frequent trust in evidence for PAPs (n = 8/14, 57%), p = .013. Only 38% (n = 28) had received PAP training. Divergent perceptions between personnel and managers were noted regarding leadership engagement, personnel competence and patients’ receptiveness to PAPs. However, a majority expressed a desire to increase physical activity counselling. The areas of improvement included a shared understanding of PAPs, training, clear leadership and support structures, and systematic evaluation. Collaboration with activity providers and access to adapted patient materials were also identified as mitigating measures. Conclusions Strong interest in PAPs among healthcare personnel and managers indicates favourable conditions for sustainable implementation, provided that training to build a shared understanding and agreement around PAPs (coherence), customized resources and structured processes (cognitive participation), clear leadership commitments to facilitate allocated resources (collective action), and PAPs coordinated across organizational levels to support consistent monitoring and evaluation (reflexive monitoring) are all in place.