Background: The American College of Sports Medicine's Exercise is Medicine initiative supports promotion of physical activity by health care providers (HCPs). Exercise is Medicine recommends HCPs utilize strategies such as exercise prescriptions to increase and promote regular exercise and referrals to community-based exercise facilities (ExRx+). Research is needed to identify factors that will increase African-American patients' ExRx+ engagement since little is known about factors that serve as facilitators or barriers to adherence.

Aims: Using a community-engaged participatory research approach, the aims are to: 1) examine individual, interpersonal and environmental factors associated with ExRx+ adherence and 2) explore barriers and facilitators related to the referral process that are associated with ExRx+ adherence.

Setting: Healthworks Community Fitness, a non-profit women's fitness facility located in Dorchester, MA. Healthworks is the only gym in the Boston metro area which allows patients to exchange ExRx+ for a 3-month gym membership.

Methods: Based on a socio-ecological framework, the mixed-methods protocol includes qualitative and quantitative methods implemented sequentially in two phases to explore factors associated with ExRx+ adherence. Adherence will be operationally defined as: 1) activation: patient redeems the ExRx+ for membership and 2) utilization: attendance during the 3 month membership. Quantitative data will focus on the patient's individual (i.e, body mass index, self-efficacy) interpersonal (i.e, social support), and environmental (i.e, walkability, transportation) levels. Qualitative data will involve one-on-one interviews with patients, HCPs and Healthworks staff exploring facilitators and barriers to ExRx+ adherence. Results will inform the development of a culturally tailored intervention to promote ExRx+ adherence.