Implementing Liikumisretsept (Physical Activity on Prescription) in Estonian healthcare

Background: Physical Activity on Prescription (PAP) is a proven way to increase physical activity amongst patients in primary healthcare. Despite the scientific support for the method and the fact that it is being used in several countries (for example Sweden and Finland ), Estonia has not implemented this method in the healthcare system. The aim of the study was to describe Estonian healthcare professionals’ views on Liikumisretsept (Physical Activity on Prescription) and problematize the implementation of Liikumisretsept in the Estonian healthcare system.Methods: Twelve semi-structured interviews with Estonian medical professionals were conducted: four with family doctors, two with specialist doctors, two with physiotherapists, and two with healthcare managers. The transcribed texts were analyzed using inductive content analysis.Results: Key findings were that Liikumisretsept was described as a method that helps to support PA as part of the treatment by giving patients clear directions for PA depending on their condition. There is clear support from medical professionals and from the Health Insurance Fund for this method to be implemented in Estonian healthcare. It was found that it is a prescription that every medical professional should know how to prescribe, including physiotherapists. Secondly, main barriers to implementation were identified like lack of awareness, support, education, and the need for better collaboration between all stakeholders. Solutions identified were that there should be educational trainings for medical professionals on how to prescribe Liikumisretsept, promotion of this method through different channels, and having support for Liikumisretsept from national governing bodies like Healthcare Insurance Fund to guarantee the funding for it. Conclusion: Liikumisretsept is seen as a method to provide individual PA guidelines for patients depending on their condition to raise their physical activity. Awareness about PA should be increased amongst medical professionals to support Liikumisretsept as a suitable treatment option. Educational trainings and supportive collaboration from all stakeholders are needed for successful implementation. Keywords: Physical activity, Physical Activity on Prescription, Estonia, Liikumisretsept, Implementation, Organizational readiness for change, Content analysi