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Smallwood AJ, Neuner JM, Fletcher KE, Walker CM, Schapira MM. Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1684-1690. [PMID: 33904119 DOI: 10.1007/s13187-021-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson's correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21-.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r = - .504, p = .001; quantitative format: r = - .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.
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Affiliation(s)
- Alicia J Smallwood
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Joan M Neuner
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Kathlyn E Fletcher
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Clement J. Zablocki VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53295, USA
| | - Cindy M Walker
- School of Education, Office of the Dean, Duquesne University, 600 Forbes Ave, Pittsburgh, PA, 15282, USA
| | - Marilyn M Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA
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Dietary advice in chronic care: Comparing traditional Chinese and western medicine practiced in mainland China. Soc Sci Med 2021; 292:114621. [PMID: 34883312 DOI: 10.1016/j.socscimed.2021.114621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
The study examines dietary advice-giving in regular consultations for patients with chronic conditions in two types of clinical practices: Traditional Chinese Medicine and Western Medicine practiced in mainland China. Dietary habits are unanimously considered relevant to the patient's health, particularly in chronic conditions. This article reports the differences in where and how dietary advice is occasioned and co-constructed by participants in two settings. One significant finding of this paper is that while Traditional Chinese Medicine doctors take dietary talk to instruct patients and put it into the treatment recommendation, WM doctors may treat it as incidental and only valuable for diagnostic assessment, leaving its treatment opaque and not discussed with the patient. Data are in Mandarin Chinese. Using Conversation Analysis, the article describes the interactional organisation of dietary advice delivery in different medical practices and ascribes their differences to clinical pathology.
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dos Santos LP, da Silva AT, Rech CR, Fermino RC. Physical Activity Counseling among Adults in Primary Health Care Centers in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5079. [PMID: 34064953 PMCID: PMC8151541 DOI: 10.3390/ijerph18105079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
Physical activity (PA) counseling by health professionals has promising results in behavior change. However, few studies have evaluated its prevalence in Primary Health Care in Latin American countries. This study aimed to describe the prevalence and analyze the associated factors of PA counseling in adults in Primary Health Care in Brazil. This is a cross-sectional study with a representative sample of 779 adults (70% women). Counseling was identified among those who reported having received PA counseling during a health professional consultation in the last 12 months. Sociodemographic factors, health conditions, and leisure-time PA were analyzed with Poisson regression. The prevalence of counseling was 43% (95% Confidence Interval [CI]: 39.5-46.4%), higher in people aged ≥40 years (Prevalence Ratio [PR]: 1.44; 95% CI: 1.19-1.75], who are married (PR: 1.27; 95% CI: 1.07-1.59), obese (PR: 1.53; 95% CI: 1.23-1.90), take prescription medication (PR: 1.83; 95% CI: 1.47-2.27), and walk for leisure (PR: 1.28; 95% CI: 1.06-1.54). People with more education were less likely to receive PA counseling (PR: 0.82; 95% CI: 0.68-0.99). In conclusion, 4 out of 10 users reported receiving PA counseling and this was associated with sociodemographic factors, health conditions, and walking for leisure. These results can guide PA promotion in Primary Health Care.
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Affiliation(s)
- Letícia Pechnicki dos Santos
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
| | - Alice Tatiane da Silva
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
- Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil
| | - Cassiano Ricardo Rech
- Physical Education Department, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil;
| | - Rogério César Fermino
- Research Group in Environment, Physical Activity and Health, Federal University of Technology—Parana, Curitiba 81310-900, Brazil; (L.P.S.); (A.T.S.)
- Postgraduate Program in Physical Education, Federal University of Parana, Curitiba 81531-980, Brazil
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Mehta RS, Kochar BD, Kennelty K, Ernst ME, Chan AT. Emerging approaches to polypharmacy among older adults. NATURE AGING 2021; 1:347-356. [PMID: 37117591 DOI: 10.1038/s43587-021-00045-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Polypharmacy is a major health issue for older adults. Entangled with several geriatric syndromes, including frailty, falls and cognitive decline, research focused on polypharmacy has been challenged by heterogeneity in its definition, confounding by comorbidities and limited prospective data. In this Review, we discuss varying definitions for polypharmacy and highlight the need for a uniform definition for future studies. We critically appraise strategies for reducing medication prescriptions and implementing deprescribing as a mechanism to reduce the potential harmful effects of polypharmacy. As we look to the future, we assess the role of novel analytics and high-throughput technology, including multiomics profiling, to advance research in polypharmacy and the development of new strategies for risk stratification in the age of precision medicine.
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Affiliation(s)
- Raaj S Mehta
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bharati D Kochar
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Korey Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Shah MK, Moore MA, Narayan KMV, Ali MK. Trends in Lifestyle Counseling for Adults With and Without Diabetes in the U.S., 2005-2015. Am J Prev Med 2019; 57:e153-e161. [PMID: 31630765 PMCID: PMC6814385 DOI: 10.1016/j.amepre.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. METHODS Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. RESULTS There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. CONCLUSIONS Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia.
| | - Miranda A Moore
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia; Emory Global Diabetes Research Center, Emory University, Atlanta, Georgia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Zwald ML, Kit BK, Fakhouri THI, Hughes JP, Akinbami LJ. Prevalence and Correlates of Receiving Medical Advice to Increase Physical Activity in U.S. Adults: National Health and Nutrition Examination Survey 2013-2016. Am J Prev Med 2019; 56:834-843. [PMID: 31003809 PMCID: PMC7218922 DOI: 10.1016/j.amepre.2019.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care-utilizing adults and differences in associations by age group. METHODS Analyses included 8,410 health care-utilizing adults aged ≥20 years from the 2013-2016 National Health and Nutrition Examination Surveys (analyzed in 2018). Logistic regression was used to examine associations between receipt of medical advice to increase physical activity in the past year and measured health conditions, reported health behaviors, and demographic characteristics. Models were stratified by age group (20-39, 40-59, and ≥60 years). RESULTS Physical activity medical advice was received by 42.9% (95% CI=40.8, 44.9) of adults overall. By age group, 32.7% of younger adults, 46.7% of middle-aged adults, and 48.9% of older adults received advice. Among all adults and across all age groups, receipt of advice was higher among adults with chronic health conditions: obesity (63.0%, 95% CI=60.3, 65.7), hypertension (56.5%, 95%=CI 53.8, 59.2), diabetes (69.8%, 95% CI=66.5, 72.8), hypercholesterolemia (55.6%, 95% CI=52.3, 59.0), and low high-density lipoprotein cholesterol (53.8%, 95% CI=50.1, 57.4). Among all adults, those with obesity, hypertension, and diabetes had significantly greater odds of receipt of advice after adjustment. Stronger associations between diabetes and hypercholesterolemia and receiving physical activity advice were observed among younger adults. CONCLUSIONS Receipt of physical activity medical advice was highest among adults with specific chronic health conditions, and this pattern was stronger among younger adults with diabetes and hypercholesterolemia. However, most health care-utilizing adults did not receive physical activity medical advice.
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Affiliation(s)
- Marissa L Zwald
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; U.S. Public Health Service, Rockville, Maryland.
| | - Brian K Kit
- U.S. Public Health Service, Rockville, Maryland; NIH, Bethesda, Maryland
| | - Tala H I Fakhouri
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Jeff P Hughes
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Lara J Akinbami
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; U.S. Public Health Service, Rockville, Maryland
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Sreedhara M, Silfee VJ, Rosal MC, Waring ME, Lemon SC. Does provider advice to increase physical activity differ by activity level among US adults with cardiovascular disease risk factors? Fam Pract 2018; 35:420-425. [PMID: 29390106 PMCID: PMC6454517 DOI: 10.1093/fampra/cmx140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Regular physical activity (PA) lowers the risk of cardiovascular disease (CVD), but few US adults meet PA guidelines. The United States Preventive Services Task Force (USPSTF) recommends primary care providers offer PA counselling for CVD prevention. We examined the association between adherence to PA guidelines and reported provider advice to increase PA among US adults with overweight/obesity and ≥1 additional CVD risk factor. Methods Cross-sectional data from the National Health and Nutrition Examination Survey (2011-2014) on PA and provider advice to increase PA were analysed for 4158 adults (≥20 years old) with overweight/obesity who reported ≥1 of hypertension, high cholesterol or impaired fasting glucose. Adherence to federal PA guidelines was determined using self-reported PA data from the Global Physical Activity Questionnaire. Meeting PA guidelines was defined as ≥150 minutes/week moderate intensity PA, ≥75 minutes/week vigorous intensity, or an equivalent combination. Participants self-reported provider advice to increase PA. Results In total, 57.7% of US adults with overweight/obesity and ≥1 additional CVD risk factor who did not meet PA guidelines reported provider advice to increase PA compared to 49.7% of adults who met PA guidelines. Adults who did not meet PA guidelines were more likely to report provider PA advice (aOR = 1.21; 95% CI = 1.00-1.47). Conclusions US adults with CVD risk factors who do not meet PA guidelines are more likely to receive provider advice to increase PA, but only half receive such advice. Strategies to increase provider advice are needed to improve adherence to USPSTF guidelines among US adults with overweight/obesity and additional CVD risk factors.
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Affiliation(s)
- Meera Sreedhara
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Valerie J Silfee
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Molly E Waring
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Trends and disparities in the prevalence of physicians' counseling on exercise among the U.S. adult population, 2000-2010. Prev Med 2017; 99:1-6. [PMID: 28161645 DOI: 10.1016/j.ypmed.2017.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/08/2016] [Accepted: 01/29/2017] [Indexed: 11/21/2022]
Abstract
Recognizing the undisputed health benefits of exercise, physicians' counseling has been included in the Healthy People Objectives since 2000. To address the paucity of data on such counseling at the national level, we examined changing trends and disparities in receiving physicians' counseling on exercise among the physically-able, non-institutionalized U.S. adult population. Data from the 2000, 2005, and 2010 National Health Interview Surveys (NHIS) were examined using logistic regression that included race/ethnicity, age, gender, education, insurance status, number of physician visits in the past year, and body mass index. In 2000, only 22.9% of NIHS respondents had received counseling on exercise, increasing to 33.6% in 2010. Compared with non-Hispanic Whites, non-Hispanic Blacks were 27% less likely to receive exercise advice in 2000 (adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.61-0.87). In later years, they were equally likely to receive advice. Although decreased over the years, male respondents were significantly (34% to 23%) less likely to report receipt of exercise counseling than female patients (in 2010: AOR 0.77, CI 0.72-0.83). Uninsured respondents were 35% less likely to report receiving exercise advice from their provider in all study years (2010: AOR 0.64, CI 0.59-0.72). Patients with increasing levels of education were increasingly more likely to report receipt of counseling in each successive survey year. The overall prevalence of physicians' counseling on exercise increased moderately between 2000 and 2010. Some disparities narrowed and even reversed but significant disparities continue to exist across gender, insurance status, and education level.
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Lee JA, Pausé CJ. Stigma in Practice: Barriers to Health for Fat Women. Front Psychol 2016; 7:2063. [PMID: 28090202 PMCID: PMC5201160 DOI: 10.3389/fpsyg.2016.02063] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.
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Affiliation(s)
- Jennifer A. Lee
- College of Arts, Victoria UniversityMelbourne, VIC, Australia
| | - Cat J. Pausé
- College of Humanities and Social Sciences, Institute of Education, Massey UniversityPalmerston North, New Zealand
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Honda K. Factors Underlying Variation in Receipt of Physician Advice on Diet and Exercise: Applications of the Behavioral Model of Health Care Utilization. Am J Health Promot 2016; 18:370-7. [PMID: 15163138 DOI: 10.4278/0890-1171-18.5.370] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose. To identify factors associated with receipt of physician advice on diet and exercise, including patient sociodemographic characteristics, health-related needs, and health care access, using Andersen's model of health care utilization. Design. A cross-sectional analysis was performed using data from the 2000 National Health Interview Survey (NHIS). Setting. NHIS data were collected through personal household interviews by Census interviewers. The overall response rate for the 2000 NHIS adult sample was 82.6%. Subjects. Subjects were a representative sample of the American civilian, noninstitutionalized population aged 18 and older. After eliminating missing data and respondents who reported they did not see a doctor in the past 12 months, sample sizes for physician advice on diet and exercise were n = 26,255 and n = 26,158, respectively. Measures. Using the 2000 NHIS, the prevalence of receipt of physician advice on diet and exercise was assessed. Multiple logistic regression analyses were performed to examine the associations between receipt of physician advice on diet and exercise and potential predictors, adjusting for all covariates. Results. By self-report, 21.3% and 24.5% of respondents received physician advice on diet and exercise, respectively. Being middle-aged (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI], 1.0–1.29 for diet; AOR = 1.55, 95% CI = 1.33–1.79 for exercise) and having a baccalaureate degree or higher (AOR = 1.78, 95% CI = 1.52–2.08 for diet; AOR = 1.75, 95% CI = 1.47–2.07) were associated with a higher likelihood of receiving physician advice on diet and exercise. African-Americans (AOR = .78, 95% CI = .67–.92) and foreign-born immigrants (AOR = .57, 95% CI = .38–.86) were less likely to receive physician advice on exercise. The prevalence of physician advice was higher for persons who chose hospital outpatient departments as a usual source for care (AOR = 2.36, 95% CI = 1.66–3.36 for diet; AOR = 2.39, 95% CI = 1.68–3.4 for exercise) than for adults with other types of usual care sites. Poorer self-rated health status (AOR = 5.2, 95% CI = 4.12–6.57 for diet; AOR = 2.63, 95% CI = 2.04–3.38 for exercise) and obesity (AOR = 2.32, 95% CI = 2.02–2.66 for diet; AOR = 3.01, 95% CI = 2.46–3.69 for exercise) was positively associated with the likelihood of receiving physician advice on diet and exercise. Conclusions. Effective strategies to increase receipt of physician advice should include efforts to improve access to regular source of care and patient-physician communication. Sociodemographic factors remain independent and important predictors of who obtains such advice.
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Affiliation(s)
- Keiko Honda
- Department of Epidemiology, Columbia University, New York City, New York 10034, USA
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Abstract
In response to repeated questions from older adults in the community about health resources, a health promotion directory was created. To enhance the development and distribution of the directory, the authors reviewed the literature and received input from unpaid consultants—both health professionals and a diverse group of older adults. To assess the utilization of the directory, the authors obtained a purposive sample, comparing 43 African American older adults, with low income and educational levels, with 118 mostly Anglo American (96%) older adults with a higher educational level. The African American group members were significantly more likely to contact one of the resources listed in the health directory. This may be due to a variety of factors, including the increased contact time that the authors had spent with these older adults or the greater need that older adults with low income and education levels may have for the information in the directory.
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Affiliation(s)
- David Haber
- Ball State University in Muncie, Indiana, USA
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12
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Taylor SR, DeGeeter M, Wilson JA, Leadon KI, Rodgers PT. Preceptor perceptions of fourth year student pharmacists' abilities regarding patient counseling on therapeutic lifestyle changes. CURRENTS IN PHARMACY TEACHING & LEARNING 2016; 8:353-358. [PMID: 30070245 DOI: 10.1016/j.cptl.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/02/2016] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Advanced pharmacy practice experiences (APPEs) provide an opportunity for students to showcase health and wellness knowledge and skills attained during didactic education. The primary objective of this study was to assess preceptor perceptions of how well pharmacy year four (PY4) students are prepared to provide guideline-based and patient-specific therapeutic lifestyle change (TLC) counseling at onset of an APPE rotation. A secondary objective included assessment of differences in counseling abilities if the preceptor considered the student normal weight versus overweight or obese, or if they were a known smoker. METHODS A questionnaire containing Likert questions about perceptions regarding TLC counseling was distributed electronically in October 2014 to 708 PY4 preceptors from two pharmacy schools. Only preceptors who routinely provided TLC counseling were included in data analysis that were done using descriptive statistics. The project was approved by both universities' institutional review boards. RESULTS The survey was completed by 165 PY4 preceptors (response rate = 23.3%), and 67 met inclusion criteria. Regarding nutrition counseling, a greater percentage of preceptors agreed that students more adequately provided counseling per guidelines (79.1%) versus individual patient needs (62.6%). Preceptors perceived students of normal weight were more likely to provide adequate lifestyle-modification counseling to overweight/obese patients (81%) compared to students that were overweight/obese themselves (69%). Students of normal weight were perceived to be more likely to adequately counsel normal weight patients on lifestyle modifications (81%) compared to students that were overweight/obese (64%). Students who smoked were perceived to adequately counsel about not smoking, though, to a lesser degree than students who were non-smokers. IMPLICATIONS While students are perceived as adequately equipped to provide guideline-based recommendations, there is room for improvement in providing patient-specific counseling. Additionally, it is perceived that student health status related to weight impacts TLC counseling.
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Affiliation(s)
| | | | | | - Kim I Leadon
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Philip T Rodgers
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Rakita V, Homko CJ, Kashem A, Memon N, Bove AA. Factors Influencing Physician Counseling on Cardiovascular Risk. J Prim Care Community Health 2015; 7:65-70. [PMID: 26574567 DOI: 10.1177/2150131915614963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND IMPORTANCE A significant reduction in cardiovascular disease (CVD) mortality is related to aggressive management of modifiable CVD risk factors. Therefore, patients at increased risk for CVD should not only benefit from standard pharmacotherapy but also from counseling regarding lifestyle behavioral changes. OBJECTIVE To determine the patient factors that influence provision of cardiovascular risk reduction counseling from physicians, as well as the frequencies of counseling. DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of a prospective, randomized trial among an underserved inner-city and rural population (n = 388) with a 10% or greater CVD risk (Framingham 10-year risk score). Subjects were followed for 1 year and were seen for quarterly assessments, which included evaluation of weight, blood pressure, lipid, and glucose status. At each of the 4 quarterly visits, subjects were asked if their physician had discussed or made recommendations regarding lifestyle behaviors, specifically diet, weight loss, and exercise. RESULTS The average patient age was 61.3 ± 10.1 years, average A1c was 6.7 ± 1.6%, average total cholesterol was 201 ± 44 mg/dL. The average body mass index (BMI) was 31.8 ± 6.4 kg/m2, and the average blood pressure was 146 ± 18/82 ±11 mm Hg. Using binary logistic regression analysis, BMI (P < .025) was the only clinical factor related to physician lifestyle counseling. All other risk factors showed no statistical relationship. CONCLUSION The data indicate that BMI is the major factor associated with whether or not physicians provide counseling regarding nutrition and weight loss. Physicians may be missing important opportunities to influence behavior in patients at high risk for CVD by limiting their focus to obese patients.
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Affiliation(s)
- Val Rakita
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Carol J Homko
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Abul Kashem
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Nabeel Memon
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Alfred A Bove
- Temple University School of Medicine, Philadelphia, PA, USA
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Burdick L, Mielke GI, Parra DC, Gomes G, Florindo A, Bracco M, Lobelo F, Simoes EJ, Pratt M, Ramos LR, Moura L, Brownson RC, Hallal PC. Physicians', nurses' and community health workers' knowledge about physical activity in Brazil: A cross-sectional study. Prev Med Rep 2015; 2:467-72. [PMID: 26844104 PMCID: PMC4721435 DOI: 10.1016/j.pmedr.2015.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To measure knowledge of current recommendations of physical activity and consequences of physical inactivity among healthcare providers throughout Brazil. METHODS A phone survey of 1600 randomly selected primary healthcare units in Brazil was conducted between January and July 2011. At each unit, a physician, nurse or community healthcare worker (n = 798) responded to a 40-minute survey, eliciting information about demographics, knowledge, and health behaviors pertaining to physical activity. RESULTS Among nurses and community healthcare workers, > 95% reported needing more information on physical activity guidelines. Among physicians this proportion was 80%. Nearly 40% of the professionals incorrectly believed 90-min of moderate-intensity physical activity per week is the recommended amount for health benefits; nearly 30% believed that 90-min of vigorous-intensity activity per week is needed for the same purpose. More than 75% of all groups reported that type II diabetes, hypertension, depression, and coronary heart disease might result from physical inactivity, but on average only 60% from each group are aware of osteoporosis as a possible consequence of physical inactivity. CONCLUSIONS Training health professionals in how to convey all relevant information about physical activity to their patients is critical for health promotion within the primary care system in Brazil.
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Affiliation(s)
- Laura Burdick
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Gregore I. Mielke
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Diana C. Parra
- Washington University in St. Louis, School of Medicine, Program in Physical Therapy, St. Louis, MO, USA
- Gerontology Department, Federal University of Sao Carlos, São Carlos, SP, Brazil
| | - Grace Gomes
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Alex Florindo
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mario Bracco
- Hospital Municipal Dr. Moyses Deutsch, M'Boi Mirim, São Paulo, Brazil
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Felipe Lobelo
- University of Missouri, School of Medicine, Department of Health Management and Informatics, USA
| | - Eduardo J. Simoes
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Pratt
- Department of Preventive Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - Luiz R. Ramos
- Non-communicable Diseases Coordination and Field Epidemiology Training Program EPISUS, Health Surveillance Secretariat, Ministry of Health, Brasilia, Brazil
| | - Lenildo Moura
- Washington University in St. Louis, Brown School, Prevention Research Center in St. Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Pedro C. Hallal
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
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15
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Erlinger TP, Pollack H, Appel LJ. Nutrition-Related Cardiovascular Risk Factors in Older People: Results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc 2015. [DOI: 10.1111/jgs.2000.48.11.1486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Xiang X, Hernandez R, Larrison CR. Provider Advice on Exercise and Diet Among Adults With Comorbid Serious Psychological Distress and Diabetes or Diabetes Risk Factors. DIABETES EDUCATOR 2015; 41:185-93. [DOI: 10.1177/0145721714567234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To examine the lifetime prevalence and correlates of provider advice to increase exercise and reduce dietary fat intake among adults with comorbid serious psychological distress (SPD) and diabetes or diabetes risk factors. Methods Study sample (n = 5942) was selected from the Medical Expenditure Panel Survey Household Component (MEPS-HC) series of 2007-2011. SPD was defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression was used to examine correlates of lifetime provider advice. Results Less than half of adults with SPD had been advised to increase exercise (49.4%) or reduce dietary fat intake (45.6%). The prevalence of receiving provider advice increased in a linear fashion as the number of diabetes risk factors increased and was the highest among those with diabetes. Provision of provider advice was strongly associated with clinical factors rather than individuals’ sociodemographic characteristics and current health behaviors. Conclusions Health care providers are missing opportunities to provide exercise and low-fat dietary advice to patients with SPD before they manifest clinical risk factors associated with diabetes. It is important that providers counsel them as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes.
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Affiliation(s)
- Xiaoling Xiang
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
| | - Rosalba Hernandez
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
| | - Christopher R. Larrison
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
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van Dillen SME, Noordman J, van Dulmen S, Hiddink GJ. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations. Eur J Clin Nutr 2013; 68:50-6. [PMID: 24169459 DOI: 10.1038/ejcn.2013.219] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVE To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. SUBJECTS/METHODS A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices. RESULTS About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices. CONCLUSIONS Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs.
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Affiliation(s)
- S M E van Dillen
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
| | | | - S van Dulmen
- 1] NIVEL, Utrecht, The Netherlands [2] Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [3] Department of Health Sciences, Buskerud University College, Drammen, Norway
| | - G J Hiddink
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
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van Dillen SME, van Binsbergen JJ, Koelen MA, Hiddink GJ. Nutrition and physical activity guidance practices in general practice: a critical review. PATIENT EDUCATION AND COUNSELING 2013; 90:155-169. [PMID: 23246149 DOI: 10.1016/j.pec.2012.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/17/2012] [Accepted: 10/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. METHODS Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria. RESULTS In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality. CONCLUSION We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs' provision of combined lifestyle advice to overweight and obese patients seems to be rather low. PRACTICE IMPLICATIONS Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients.
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Barrett EM, Darker CD, Hussey J. Promotion of physical activity in primary care: knowledge and practice of general practitioners and physiotherapists. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-012-0512-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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20
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Patel A, Schofield GM, Kolt GS, Keogh JWL. General practitioners' views and experiences of counselling for physical activity through the New Zealand Green Prescription program. BMC FAMILY PRACTICE 2011; 12:119. [PMID: 22044577 PMCID: PMC3233500 DOI: 10.1186/1471-2296-12-119] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/02/2011] [Indexed: 11/10/2022]
Abstract
Background Regular physical activity is beneficial in both the prevention and management of chronic health conditions. A large proportion of adult New Zealanders, however, are insufficiently active. To help increase population levels of physical activity in New Zealand the Green Prescription, a primary care physical activity scripting program, was developed. The primary aim of this study was to identify why general practitioners (GPs) counsel for physical activity and administer Green Prescriptions. A secondary aim was to examine GPs' views and experiences of Green Prescription counselling for the management of depression. Methods Individual face-to-face interviews were conducted with 15 GPs. All interviews were audio-taped and transcribed. Data were analysed using an inductive thematic approach. Results Several themes and sub-themes emerged from the data. Notably, GPs counselled for physical activity and prescribed Green Prescriptions for both primary preventive (e.g., weight control) and secondary management (e.g., diabetes management) purposes. GPs reported the benefits of the Green Prescription centred around two main themes: (i) a non-medication approach to a healthier lifestyle and (ii) the support benefits of physical activity. Time constraints within the consultation was the only main theme that emerged regarding the barriers GPs perceived to Green Prescription use. Physical activity in general, and physical activity prescribed through the Green Prescription, were also viewed by GPs as beneficial for the management of depression. Conclusions The results of this study suggest that New Zealand GPs view the Green Prescription program as beneficial for their patients with pre-existing conditions and/or weight problems. While this is encouraging, the Green Prescription may also be used to promote physical activity in currently healthy but low-active and sedentary individuals. Such individuals are currently disease free, but are at risk for future health-related problems because of their inactive lifestyle. It is recommended that time constraints of the consultation in regard to administering Green Prescriptions could be dealt with by delegating the more time consuming tasks to the patient support counsellors that support the Green Prescription program, and having practice nurses assist in the administration of Green Prescriptions. Green Prescription counselling in conjunction with antidepressant medication may be beneficial for the management of depression and warrants further research.
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Affiliation(s)
- Asmita Patel
- Centre for Physical Activity and Nutrition Research, Auckland University of Technology, Auckland, New Zealand
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21
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Dalton WT, Schetzina KE, Holt N, Fulton-Robinson H, Ho AL, Tudiver F, McBee MT, Wu T. Parent-Led Activity and Nutrition (PLAN) for healthy living: design and methods. Contemp Clin Trials 2011; 32:882-92. [PMID: 21777701 PMCID: PMC3335199 DOI: 10.1016/j.cct.2011.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 06/03/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022]
Abstract
Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5-11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices.
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Affiliation(s)
- William T. Dalton
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Karen E. Schetzina
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Nicole Holt
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Hazel Fulton-Robinson
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Ai-Leng Ho
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Fred Tudiver
- Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Mathew T. McBee
- Frank Porter Graham Child Development Institute, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Tiejian Wu
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
- Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Hinrichs T, Moschny A, Klaassen-Mielke R, Trampisch U, Thiem U, Platen P. General practitioner advice on physical activity: analyses in a cohort of older primary health care patients (getABI). BMC FAMILY PRACTICE 2011; 12:26. [PMID: 21569227 PMCID: PMC3115873 DOI: 10.1186/1471-2296-12-26] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 05/10/2011] [Indexed: 01/01/2023]
Abstract
Background Although the benefits of physical activity for health and functioning are recognized to extend throughout life, the physical activity level of most older people is insufficient with respect to current guidelines. The primary health care setting may offer an opportunity to influence and to support older people to become physically active on a regular basis. Currently, there is a lack of data concerning general practitioner (GP) advice on physical activity in Germany. Therefore, the aim of this study was to evaluate the rate and characteristics of older patients receiving advice on physical activity from their GP. Methods This is a cross-sectional study using data collected at 7 years of follow-up of a prospective cohort study (German epidemiological trial on ankle brachial index, getABI). 6,880 unselected patients aged 65 years and above in the primary health care setting in Germany were followed up since October 2001. During the 7-year follow-up telephone interview, 1,937 patients were asked whether their GP had advised them to get regular physical activity within the preceding 12 months. The interview also included questions on socio-demographic and lifestyle variables, medical conditions, and physical activity. Logistic regression analysis (unadjusted and adjusted for all covariables) was used to examine factors associated with receiving advice. Analyses comprised only complete cases with regard to the analysed variables. Results are expressed as odds ratios (ORs) with 95% confidence intervals (95% CI). Results Of the 1,627 analysed patients (median age 77; range 72-93 years; 52.5% women), 534 (32.8%) stated that they had been advised to get regular physical activity. In the adjusted model, those more likely to receive GP advice on physical activity were men (OR [95% CI] 1.34 [1.06-1.70]), patients suffering from pain (1.43 [1.13-1.81]), coronary heart disease and/or myocardial infarction (1.56 [1.21-2.01]), diabetes mellitus (1.79 [1.39-2.30]) or arthritis (1.37 [1.08-1.73]), and patients taking a high (> 5) number of medications (1.41 [1.11-1.80]). Conclusions The study revealed a relatively low rate of older primary health care patients receiving GP advice on physical activity. GPs appeared to focus their advice on patients with chronic medical conditions. However, there are likely to be many more patients who would benefit from advice.
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Affiliation(s)
- Timo Hinrichs
- Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, 44780 Bochum, Germany.
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Kelly IR, Markowitz S. Incentives in Obesity and Health Insurance. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2009; 46:418-32. [DOI: 10.5034/inquiryjrnl_46.4.418] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Physical activity advice to manage chronic conditions for adults with arthritis or hypertension, 2007. Prev Med 2009; 49:209-12. [PMID: 19573554 DOI: 10.1016/j.ypmed.2009.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/12/2009] [Accepted: 06/23/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the prevalence and characteristics of persons with arthritis or hypertension who received advice from their health-care professional to manage their condition. METHODS Data from 9 states were obtained from the 2007 Behavioral Risk Factor Surveillance System. Two modules (Arthritis Management and Actions to Control High Blood Pressure) were analyzed (sample sizes: arthritis 29,698, hypertension 29,783). RESULTS Fifty-five percent of persons with arthritis and 75.8% of persons with hypertension reported that their health-care professional ever suggested physical activity or exercise to help manage their condition. Correlates for being less likely to receive advice were lower levels of education, longer time since last routine doctor visit, being physically inactive, and having lower body mass index. Among inactive, normal weight persons, 43.0% (95% CI: 38.7, 47.4) with arthritis and 50.0% (95% CI: 44.4, 55.6) with hypertension reported receiving advice; among inactive, obese patients, 59.1% (95% CI: 55.8, 62.3) with arthritis and 74.0% (95% CI: 70.5, 77.3) with hypertension reported receiving advice. CONCLUSIONS Findings suggest that health-care professionals may base physical activity counseling more on body mass index than a patient's activity level. To manage chronic health conditions, health-care professionals should assess patient's physical activity and offer all patients appropriate counseling.
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Freburger JK, Carey TS, Holmes GM, Wallace AS, Castel LD, Darter JD, Jackman AM. Exercise prescription for chronic back or neck pain: who prescribes it? who gets it? What is prescribed? ACTA ACUST UNITED AC 2009; 61:192-200. [PMID: 19177524 DOI: 10.1002/art.24234] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe exercise prescription in routine clinical practice for individuals with chronic back or neck pain because, although current practice guidelines promote exercise for chronic back and neck pain, little is known about exercise prescription in routine care. METHODS We conducted a computer-assisted telephone survey of a representative sample of individuals (n = 684) with chronic back or neck pain who saw a physician, chiropractor, and/or physical therapist (PT) in the past 12 months. Individuals were asked about whether they were prescribed exercise, the amount of supervision received, and the type, duration, and frequency of the prescribed exercise. Descriptive and multivariable regression analyses were conducted. RESULTS Of the 684 subjects, 48% were prescribed exercise. Of those prescribed exercise, 46% received the prescription from a PT, 29% from a physician, 21% from a chiropractor, and 4% from other. In multivariable analyses, seeing a PT or a chiropractor were the strongest predictors of exercise prescription. The likelihood of exercise prescription was increased in women, those with higher education, and those receiving worker's compensation. PTs were more likely to provide supervision and prescribe strengthening exercises compared with physicians and chiropractors, and were more likely to prescribe stretching exercises compared with physicians. CONCLUSION Our findings suggest that exercise is being underutilized as a treatment for chronic back and neck pain and, to some extent, that the amount of supervision and types of exercises prescribed do not follow current practice guidelines. Exercise prescription provided by PTs appears to be most in line with current guidelines.
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Affiliation(s)
- Janet K Freburger
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599-7590, USA.
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Näslindh-Ylispangar A, Sihvonen M, Sarna S, Kekki P. Health status, symptoms and health counselling among middle-aged men: comparison of men at low and high risk. Scand J Caring Sci 2008; 22:529-35. [DOI: 10.1111/j.1471-6712.2007.00565.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Nansel TR, Weaver NL, Jacobsen HA, Glasheen C, Kreuter MW. Preventing unintentional pediatric injuries: a tailored intervention for parents and providers. HEALTH EDUCATION RESEARCH 2008; 23:656-69. [PMID: 17906313 PMCID: PMC2562892 DOI: 10.1093/her/cym041] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 06/07/2007] [Indexed: 05/17/2023]
Abstract
The purpose of this study was to determine the efficacy of providing (i) tailored injury prevention information (T-IPI) to parents and (ii) concurrent T-IPI to parents and providers to promote parent adoption of safety practices. During well-child visits, parents of children ages 4 and younger completed a computer assessment and were randomized to receive generic injury prevention information, T-IPI or T-IPI supplemented with a tailored summary for providers. Follow-up assessments were completed by telephone 1 month later. Parents receiving T-IPI alone or with supplementary provider information were more likely to report adopting a new injury prevention behavior than those receiving generic information (49 and 45%, respectively, compared with 32%; odds ratio=2.0 and 1.9, respectively), and these effects were greatest among the least educated parents. In addition, more complicated behavior changes were reported by those receiving tailored information. Provider receipt of feedback did not result in significantly different provider-parent communication or change in parents' safety practices. Providing parents with individually tailored pediatric injury prevention information may be an effective method for delivering injury prevention anticipatory guidance. Tailoring may have particular utility for more complicated behaviors and for communication with less educated parents.
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Affiliation(s)
- Tonja R Nansel
- Division of Epidemiology, Statistics.revention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
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Ely AC, Banitt A, Befort C, Hou Q, Rhode PC, Grund C, Greiner A, Jeffries S, Ellerbeck E. Kansas primary care weighs in: a pilot randomized trial of a chronic care model program for obesity in 3 rural Kansas primary care practices. J Rural Health 2008; 24:125-32. [PMID: 18397445 DOI: 10.1111/j.1748-0361.2008.00148.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. PURPOSE To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary care. METHODS We enrolled 107 participants to a 6-month, 2-armed, randomized trial comparing a CCM for obesity with usual care. The primary outcome was weight change at 90 days. The usual care arm received educational weight loss materials and outcome assessments at day 0, 90, and 180. The active arm received the same elements as the usual care arm plus a multicomponent obesity CCM. FINDINGS The Day 90 mean +/- SD weight change for the active arm (n = 34) and control arm (n = 33), respectively, was -4.5 +/- 7.7 pounds and -2.4 +/- 8.1 pounds (P = .27 for difference). The Day 180 mean +/- SD weight change for the active (n = 27) and control (n = 27) arms, respectively, was -9.4 +/- 10.3 pounds and -2.1 +/- 10.7 pounds (P = .01 for difference). There was no significant change in physical activity, or fruit and vegetable intake at day 90 or day 180. CONCLUSIONS Improving the recognition and treatment of obesity in primary care settings is a critical initiative. Rural populations suffer disproportionately with obesity, and better methods of delivering obesity care are needed for this population. Further research is needed to establish the effectiveness of a CCM approach for obesity care.
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Affiliation(s)
- Andrea C Ely
- Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Larson JS, Winn M. Health Policy and Exercise: A Brief BRFSS Study and Recommendations. Health Promot Pract 2008; 11:268-74. [DOI: 10.1177/1524839908318287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Behavioral Risk Factor Surveillance Survey is used to compare three predictors of self-rated health, specifically exercise, tobacco smoking, and a diagnosis of diabetes (a proxy for obesity). Exercise is found to be the best predictor, and the remainder of the article discusses the role of exercise in disease prevention and the all-important concept of exercise adherence. Government policy in the future needs to promote exercise adherence in a more rigorous way, because it is a key to both individual and societal health. Exercise habits need to be instilled from youth, and physical education requirements in school need to be re-established at all levels through high school. Adults also need encouragement with better neighborhood planning of exercise trails for walking and biking, as well as planned community activities to encourage fitness through one’s lifetime. The article concludes with six recommendations for formal government action to encourage exercise adherence.
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Affiliation(s)
- James S. Larson
- Nelson Mandela School of Public Policy at Southern University in Baton Rouge, Louisiana
| | - Mylon Winn
- Nelson Mandela School of Public Policy at Southern University in Baton Rouge, Louisiana
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Greiner KA, Born W, Hall S, Hou Q, Kimminau KS, Ahluwalia JS. Discussing weight with obese primary care patients: physician and patient perceptions. J Gen Intern Med 2008; 23:581-7. [PMID: 18322760 PMCID: PMC2324159 DOI: 10.1007/s11606-008-0553-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 09/21/2007] [Accepted: 01/23/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN Post-visit survey assessments of patients and providers. PARTICIPANTS Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were recruited at the time of PC visits. MEASUREMENTS AND MAIN RESULTS Percent patient-physician agreement and patient, provider and practice characteristics associated with agreement. Patients (456) and physicians (30) agreed about whether or not they discussed weight, physical activity (PA), and diet for 61% of office visits. There was disagreement on one of the items (weight, PA, or diet) for 23% of office visits, and for 2 or more of the items for 16% of the visits. Agreement was relatively greater for discussing weight than for discussing diet or physical activity. Physicians reported discussing weight issues more often than did patients. Overall patient-physician agreement was 0.51-0.59 (weighted Kappa statistic). In a multivariate analyses of factors associated with patient-physician agreement, health insurance (odds ratio [OR]=3.67, p value = 0.002), physician description of patient weight status (OR = 2.27, p value = 0.002), patient report of how weight relates to health (OR = 1.70, p value = 0.04), and female patient gender (OR = 1.62, p = value = 0.02) were significantly related to agreement. CONCLUSIONS Patients and providers disagreed about whether or not weight issues were discussed in a large number of primary care encounters in this study. Physicians may be able to improve care for their obese patients by focusing discussions on specific details of diet and physical activity behaviors, and by clarifying that patients perceive weight-related information has been shared.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
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Child overweight interventions in rural primary care practice: a survey of primary care providers in southern Appalachia. South Med J 2008; 100:1099-104. [PMID: 17984741 DOI: 10.1097/smj.0b013e3181583949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Child overweight has reached an epidemic level throughout the United States. A total of 65 primary care providers in southern Appalachia were surveyed to understand current issues in addressing child overweight in rural primary care practice. The study shows that while providers realized the importance of child overweight intervention, many were not ready and did little to address child overweight in their practices. The providers' skill levels in addressing child overweight were generally less than sufficient. Common barriers to child overweight treatment included lack of parental motivation and involvement, lack of supportive services, and lack of clinician time. In conclusion, rural primary care is facing many challenges in addressing child overweight. However, with more training in behavioral intervention skills and through establishing a family-based intervention and a group visit approach, primary care providers could play a more active role in the fight against the epidemic of child overweight.
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Hardcastle S, Taylor A, Bailey M, Castle R. A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. PATIENT EDUCATION AND COUNSELING 2008; 70:31-39. [PMID: 17997263 DOI: 10.1016/j.pec.2007.09.014] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 09/13/2007] [Accepted: 09/23/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The aim of the study was to determine if multiple patient-centred lifestyle counselling sessions would be of interest to patients at risk of coronary heart disease (CHD), in a primary care setting, and if such sessions would result in changes in physical activity and diet, and health status. A randomised trial was conducted to compare the counselling intervention with usual care (health promotion leaflet), among 334 mostly obese patients. METHODS Patients were randomised into an intervention group that received standard exercise and nutrition information plus up to five face-to-face counselling sessions with a Physical Activity Specialist (PAS) and Registered Dietitian (RD) over a 6-month period or to a control group that only received the standard information. RESULTS Of those invited, patients randomised tended to be more obese, older and female. The mean (S.D.) sessions attended was 2.0 (1.6) with 50% attending at least 3. At 6 months, the counselling group were more active, particularly with respect to walking, and had reduced weight, blood pressure and cholesterol, but had not changed their diet, compared with the control group. Furthermore, those who did more sessions had greater increases in activity and reductions in weight, blood pressure and cholesterol. CONCLUSION Attending multiple sessions of client-centred counselling in primary care was of interest to patients, and generally reduced CHD risk factors. PRACTICE IMPLICATIONS The primary care setting can be used effectively to promote particularly walking, using physical activity specialists and dietitians trained to use an adapted motivational interviewing (MI) counselling style.
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Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ. Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol 2007; 25:2100-6. [PMID: 17513816 DOI: 10.1200/jco.2006.06.6340] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine provider discussion or counseling of US cancer survivors about diet, exercise, and tobacco use. METHODS We used 2000 National Health Interview Survey data to examine whether US cancer survivors reported that, within 1 year, a provider (1) discussed diet, (2) recommended they begin or continue exercise, or (3) asked about smoking. We included survivors more than 1 year beyond diagnosis (n = 1,600) and adults without cancer (AWCs; n = 24,636) who saw/talked to a provider within 1 year. We used generalized linear contrasts in bivariable analyses and logistic regression to calculate predicted marginals adjusted for age, sex, comorbidity, usual source of care, and number of provider visits in the prior year. RESULTS Few survivors reported discussions or recommendations for all three health behaviors (10% of survivors v 9% of AWCs; P = .57). Although report was more likely than among AWCs, few survivors reported diet discussions (30% of survivors v 23% of AWCs; P < .0001) or exercise recommendations (26% of survivors v 23% of AWCs; P < .005), and a minority were asked about smoking (42% of survivors v 41% of AWCs; P = .41). After adjustment, survivors were less likely to report exercise recommendations than were AWCs (22% v 24%, respectively; P = .02). Colorectal cancer survivors were less likely than were AWCs of similar age range to report exercise recommendations (16% v 27%, respectively; P < .003) or smoking discussions (31% v 41%, respectively; P < .05). Cervical cancer survivors were more likely than AWCs of similar age range to discuss smoking (58% v 43%, respectively; P < .001). CONCLUSION Findings from this nationally representative sample suggest that many providers may miss opportunities to counsel survivors about healthy behaviors, perhaps particularly colorectal cancer survivors.
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Affiliation(s)
- Susan A Sabatino
- Division of Cancer Prevention and Control, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA30341, USA.
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Ribeiro MA, Martins MDA, Carvalho CRF. The role of physician counseling in improving adherence to physical activity among the general population. SAO PAULO MED J 2007; 125:115-21. [PMID: 17625711 PMCID: PMC11014696 DOI: 10.1590/s1516-31802007000200010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 09/15/2006] [Accepted: 03/16/2007] [Indexed: 02/02/2023] Open
Abstract
The regular practice of physical activity at appropriate levels ensures various benefits for the individual over the short, medium and long terms. It is therefore important in health promotion. On the other hand, sedentary behavior has reached alarming levels among the general population, which qualifies it as a serious health problem of endemic proportions. The present review describes public health problems consequent to sedentary behavior and the importance of physician counseling for change their patients behavior and making them more physically active on a regular basis. Models and behavioral theories are presented to facilitate physicians understanding of how to approach patients during clinical practice. We also describe programs conducted in many countries based on physician counseling for reducing sedentary behavior, and we present many tools used to quantify and qualify patients attitudes towards becoming more physically active. Through understanding the barriers faced by patients, we suggest methodologies that will enable physicians to use physical activity promotion appropriately. We hope that this will provide support for physicians in conducting physical activity counseling, as a means for improving the health of the population.
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Affiliation(s)
| | | | - Celso Ricardo Fernandes Carvalho
- Celso Ricardo Fernandes de Carvalho Centro de Promoção da Saúde Serviço de Clínica Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP) Rua Dr. Enéas de Carvalho Aguiar, 455 — 4o andar — Bloco 6 — Prédio dos Ambulatórios São Paulo (SP) — Brasil — CEP 05408-040 Tel. (+55 11) 3069-7691 E-mail:
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Tulloch H, Fortier M, Hogg W. Physical activity counseling in primary care: who has and who should be counseling? PATIENT EDUCATION AND COUNSELING 2006; 64:6-20. [PMID: 16472959 DOI: 10.1016/j.pec.2005.10.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 10/03/2005] [Accepted: 10/23/2005] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To examine the physical activity (PA) counseling literature in primary care in order to identify which intervention provider has been used to date and their relative effectiveness for increasing PA. METHOD MEDLINE and PsycINFO databases were searched for PA intervention studies in primary care settings. RESULTS Of the 19 studies, 37% were conducted solely by physicians, 37% by allied health professionals, while 26% were combined-provider interventions. There was a decline in the number of physician-only interventions and a shift towards interventions offered by allied health professionals as adjuncts or alone. Interventions across all provider categories generated some improvements in physical activity behavior, however, it appears that allied health professionals as adjuncts or alone produced the best results in the long-term (>6 months). There was substantial variation in the location and counseling approach employed by allied health professionals. CONCLUSION We argue for an interdisciplinary model in which physicians recommend PA and provide referrals to allied health professionals such as physical activity counselors. PRACTICE IMPLICATIONS With physical activity counselors' specialized training and greater time available to the patient, they may provide more intensive and effective counseling required for behavior change and maintenance.
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Affiliation(s)
- Heather Tulloch
- School of Psychology, University of Ottawa, P.O. Box 450, Stn. A, Ottawa, Ont., Canada K1N 6N5.
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Jutel A. The emergence of overweight as a disease entity: Measuring up normality. Soc Sci Med 2006; 63:2268-76. [PMID: 16846671 DOI: 10.1016/j.socscimed.2006.05.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Indexed: 11/19/2022]
Abstract
As Charles Rosenberg [(2002). The tyranny of diagnosis. The Milbank Quarterly, 80, 237-260] has recently written, clinical diagnosis contributes to imposing structure on cultural reality in a manner which is not unproblematic. A social power resides in the process of naming diseases-one, which legitimises concerns, explains reality, naturalises deviance and imposes status. But clinical entities are not static, as both the concerns of society, and the technological ability of practitioners change (what Rosenberg refers to as the "iatrogenesis of nosology"), so too do the range of labels available for identifying disease. In this paper, I argue that being "overweight," once predominantly an adjectival descriptor of corpulence, a physical sign or a symptom, and even, in some cultures, a sign of wealth and status, is undergoing the transformation to disease entity. I suggest that evidence of this is present in both the frequency and the way in which the term is being used by the media, the medical establishment and the laity. I argue that this change stems from the convergence of two particular phenomena. The first is the belief in the neutrality of quantification, and the objectivity that measurement brings to qualitative description. The second is the importance attributed to normative appearance in health. I discuss some of the implications of this evolution and its impact on health practices, including the exploitation of this purported disease state for commercial benefit.
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Makoul G, Dhurandhar A, Goel MS, Scholtens D, Rubin AS. Communication about behavioral health risks: a study of videotaped encounters in 2 internal medicine practices. J Gen Intern Med 2006; 21:698-703. [PMID: 16808769 PMCID: PMC1924697 DOI: 10.1111/j.1525-1497.2006.00467.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate. OBJECTIVES To assess the scope of health risk screening and characterize the communication content of counseling for health behavior change in 2 general internal medicine practices. DESIGN AND PARTICIPANTS We studied videotapes of 125 new patient visits to General Internists affiliated with academic medical centers in Chicago, IL (70%) and Burlington, VT (30%). All videotapes were content analyzed to examine (1) the incidence and outcome of screening for diet, exercise, tobacco, alcohol, drugs, sex, seatbelt use, helmet use, firearms, smoke detectors, and sun exposure; (2) the content of counseling for at-risk behaviors, with a focus on 11 counseling tasks associated with health behavior change. RESULTS Patient age in these 125 initial visits ranged from 22 to 85 years. Within the 91 visits that included at least 1 screening attempt, there were a total of 361 distinct screening discussions (mean=3.9, SD=2.2, range=1 to 9). Seventy-four (20.5%) of the 361 screening discussions revealed an at-risk behavior. On average, 2.4 of the 11 counseling tasks were accomplished for each of the 74 behavioral health risks (SD=2.2, range 0 to 9); only education about the problem (56.8%) and general advice about the solution (62.2%) were evident in more than half of the counseling attempts. CONCLUSIONS This observational study reveals that communication tasks associated with successful counseling were relatively infrequent occurrences during initial visits in 2 primary care practices.
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Affiliation(s)
- Gregory Makoul
- Program in Communication and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Choi WS, Ellerbeck EF, Kaur H, Nazir N, Ahluwalia JS. Factors Associated with Physician Discussion of Health Behaviors with Adolescents. J Youth Adolesc 2006. [DOI: 10.1007/s10964-006-9066-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Are health care professionals advising patients with diabetes or at risk for developing diabetes to exercise more? Diabetes Care 2006; 29:543-8. [PMID: 16505503 DOI: 10.2337/diacare.29.03.06.dc05-2165] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE With increased focus on the obesity and diabetes epidemics, and the clear benefit of exercise in disease prevention and management, this study determined the lifetime prevalence of health professional advice to exercise among individuals with or at risk for diabetes. RESEARCH DESIGN AND METHODS The Medical Expenditure Panel Survey is a nationally representative survey of the U.S. population. In the 2002 survey, 26,878 adults responded when asked about ever receiving health professional advice to exercise more. Information on sociodemographic characteristics and health conditions were self-reported. Type 2 diabetes risk factors were age > or =45 years, non-Caucasian ethnicity, physical inactivity, BMI > or =25 kg/m(2), hypertension, and cardiovascular disease. RESULTS A total of 73% of adults with diabetes were told by a health professional to exercise more versus 31% of adults without diabetes. The proportion receiving advice increased as the number of diabetes risk factors increased until reaching similar rates as people with diabetes. After adjustment for sociodemographic and clinical factors, the strongest correlates of receiving advice were BMI and cardiovascular risk factors. Among respondents with diabetes, the likelihood of receiving advice did not vary by age, sex, education, or income level but was less likely in Hispanics. CONCLUSIONS Health professionals advised most patients with or at highest risk for diabetes to exercise, suggesting recognition of its importance for disease management. As risk factors declined, fewer patients were advised to exercise, suggesting missed opportunities for disease prevention. However, exercise has not increased proportional to exercise advice. The challenge remains converting patient awareness into behavior change.
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Affiliation(s)
- Elaine H Morrato
- University of Colorado Health Sciences Center, School of Pharmacy, 4200 East Ninth Avenue, C238, Denver, CO 80262, USA
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Puig Ribera A, McKenna J, Riddoch C. Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system. Eur J Public Health 2005; 15:569-75. [PMID: 16051654 DOI: 10.1093/eurpub/cki045] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In Catalonia a high percentage of the population remains inactive. General practices are an ideal setting to advise on physical activity (PA). However, there is a lack of evidence regarding practices, barriers and predictors of such promotion in the Catalan primary health-care system. This study set out to establish descriptive baseline data for PA promotion in Catalan general practices, and to explore the experiences of doctors/nurses in promoting PA in their day-to-day professional lives. METHODS A mixed-method approach was adopted. A survey was conducted with 245 physicians/nurses (58% response rate). Subsequently, focus groups (n = 5) and semi-structured interviews (n = 7) were conducted with 18 physicians and 15 nurses. After coding for important themes, the final interpretation was confirmed by contributors. RESULTS Eighty-eight percent of physicians/nurses promoted PA at least infrequently. However, work conditions were perceived as unfavourable, with the main barriers being lack of (i) time, (ii) training and (iii) protocols. Qualitative data showed that PA promotion was opportunistic, focused on selected patients, used generalized messages and was highly dependent on personal interests. Regular promotion was encouraged by direct experiences of the benefits of regular exercising, knowing patients well, being supported by medical colleagues and creating links with other community institutions. PA promotion was especially hindered by seeing PA promotion as a secondary task, and patients ignoring recommendations. CONCLUSIONS PA promotion in Catalonia remains to be integrated into practice consultations. Therefore, strategies should be developed within public health. Using a mixed-method approach provided a broader range of evidence than most studies, which rely on quantitative methods.
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Affiliation(s)
- A Puig Ribera
- Departament de Ciències i Ciències Socials, Universitat de Vic, Catalonia, Spain.
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Marshall AL, Booth ML, Bauman AE. Promoting physical activity in Australian general practices: a randomised trial of health promotion advice versus hypertension management. PATIENT EDUCATION AND COUNSELING 2005; 56:283-290. [PMID: 15721970 DOI: 10.1016/j.pec.2004.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2003] [Revised: 03/03/2004] [Accepted: 03/05/2004] [Indexed: 05/24/2023]
Abstract
A randomised controlled trial was conducted to determine if physicians' advice to promote physical activity to patients was more effective if the advice was tailored to the management of hypertension, compared with more general health promotion advice. Participants included inactive 40- to 70-year-old patients visiting the physicians' during study recruitment period. Physicians provided verbal physical activity advice and written materials, both tailored to either general health promotion messages or specifically as a means for treating or managing hypertension. Seventy-five physicians and 98% (767/780) of screened eligible patients participated in the study. Differences between intervention and control groups self-reported physical activity were assessed over 6 months. Follow-up response rates were 92 and 84% at the 2- and 6-month assessments. There were no consistent, significant differences between groups at the 2- or 6-month assessments. Thus, neither intervention strategy resulted in significant changes in patients self-reported physical activity, regardless of the whether the advice was tailored to hypertension management or general health promotion advice.
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Affiliation(s)
- Alison L Marshall
- School of Human Movement Studies, The University of Queensland, Connell Building, St. Lucia, Brisbane, Qld 4072, Australia.
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Simkin-Silverman LR, Gleason KA, King WC, Weissfeld LA, Buhari A, Boraz MA, Wing RR. Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics. Prev Med 2005; 40:71-82. [PMID: 15530583 DOI: 10.1016/j.ypmed.2004.05.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Past research has surveyed primary care physicians (PCP) about their attitudes and practices towards obese patients, yet less is known about the patients receiving advice. METHODS The Primary Care Weight Control Project (PCWC) enrolled 18 PCPs in a randomized clinical trial and asked 255 of their patients who were either overweight or obese at baseline about past weight control advice. RESULTS At baseline, 66.4% of patients reported that their physician previously told them they were overweight. Body mass index (BMI) was a strong predictor of being identified as obese. While 65.1% received information on the health benefits of weight loss, only 36.6% of patients were ever given specific weight control advice, and 28.2% were advised to increase their physical activity. A history of type 2 diabetes, high cholesterol, or hypertension was associated with physician-delivered weight control advice. Stages of change and number of prior visits with the PCP were also associated with physician advice. CONCLUSIONS Patients were more likely to receive education about weight loss than specific behavioral advice on how to lose weight. Physicians were more likely to provide weight control advice to their patients who had obesity-related comorbidities than to patients who were overweight or obese and without risk factors.
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Affiliation(s)
- Laurey R Simkin-Silverman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Frank E, Galuska DA, Elon LK, Wright EH. Personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2004; 75:112-121. [PMID: 15209329 DOI: 10.1080/02701367.2004.10609142] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To determine personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students, we surveyed 1,906 entering freshman medical students (response rate = 87%; average age = 24 years) in 17 U.S. medical schools. Students reported a median of 45 min/day of exercise, 80 min/week each of mild and moderate exercise, and 100 min/week of strenuous exercise. Nearly all students (97.6%) engaged in some moderate or vigorous exercise in a typical week. Sixty-four percent complied with U.S. Department of Health and Human Services exercise recommendations. Most freshmen (79%) believed it would be highly relevant to their future practices to counsel patients about exercise; predictors included intention to provide primary care, excellent health, prevention emphasis by their personal physician, and performing more strenuous exercise.
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Affiliation(s)
- Erica Frank
- Department of Family and Preventive Medicine, Emory University, USA.
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Anis NA, Lee RE, Ellerbeck EF, Nazir N, Greiner KA, Ahluwalia JS. Direct observation of physician counseling on dietary habits and exercise: patient, physician, and office correlates. Prev Med 2004; 38:198-202. [PMID: 14715212 DOI: 10.1016/j.ypmed.2003.09.046] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study documented the frequency and correlates of directly observed physicians' counseling on dietary habits and exercise in private medical practices. METHODS Trained medical students observed physician, office, and patient characteristics in 4344 patient visits in 38 nonmetropolitan primary care physician offices. RESULTS Counseling rates ranged from 0% in some offices to 55% in others. Physicians counseled patients on dietary habits in 25% of visits and exercise in 20% of visits. Physicians counseled new patients 30% more often than established ones (P < 0.05). Dietary counseling was associated with having dietary and exercise brochures in the office (P < 0.05). When counseling occurred, physicians (rather than patients) initiated both dietary and exercise counseling 61% of the time. Counseling for dietary habits was associated with counseling for exercise (P < 0.05); some physicians may be more likely to give preventive counseling. Counseling was not associated with physicians' age, years in practice, or number of patients per week. CONCLUSION Physician counseled patients in 20-25% of visits, and this was not affected by physician characteristics. Results suggest that physician counseling protocols and other office prompts should be developed and promoted. Strategies targeting both physician and the health care system may improve the consistency of physician preventive counseling practices.
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Affiliation(s)
- Nadeem A Anis
- Department of Internal Medicine, University of Missouri in Kansas City, Kansas City, MO 64110, USA
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Abstract
Changes of diet and other lifestyle factors are often highly recommended, but evidence for the effectiveness of behavioral changes in adult lives is limited. In the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study, we investigated the reasons for and the direction of dietary changes as well as factors that are associated with the self-report of a change in diet. About 47% of the 27,548 cohort members reported a dietary change within the first 2 y of the follow-up. Detailed analysis of the type of change showed that public health recommendations are clearly understood. More vegetables and fruit and less fat are the most reported changes. Investigations into the reasons for dietary changes showed that in most instances and in ever shorter intervals, dietary recommendations resulting from progress in science are reinforced or partly modified. The health-conscious individuals in a population try to put these health messages into practice by modifying their behavior; these are the individuals who are particularly attracted to participate in scientifically oriented prospective studies and therefore are likely to be recruited by and retained in these studies. Behavioral changes over time may indicate dietary changes that are related to health and weight problems. The consideration of dietary changes during prospective data collection, therefore, is an important issue in the design and analysis of longitudinal studies-both cohort and intervention studies. Cohort studies in which dietary changes are adequately measured can contribute substantially to the evidence for health benefits resulting from changes in diet.
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Affiliation(s)
- Manuela M Bergmann
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Germany.
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Thomas RJ, Kottke TE, Brekke MJ, Brekke LN, Brandel CL, Aase LA, DeBoer SW. Attempts at changing dietary and exercise habits to reduce risk of cardiovascular disease: who's doing what in the community? PREVENTIVE CARDIOLOGY 2002; 5:102-8. [PMID: 12091752 DOI: 10.1111/j.1520-037x.2002.00565.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to characterize adults in Olmsted County, MN who were attempting to change both their dietary and physical activity habits. A random digit-dial telephone survey was taken of 1232 adults, with questions about lifestyle, medical conditions, demographics, and receipt of previous lifestyle advice from a health care professional. Respondents were grouped in four categories: 1) changing neither diet nor exercise habits (22%); 2) changing diet habits only (20%); 3) changing exercise habits only (9%); and 4) changing both diet and exercise habits (49%). Along with several demographic and behavioral factors, receipt of physician advice to change exercise and dietary habits was a strong predictor of attempts to change both lifestyle habits. Only a minority of the population (23%), however, reported having received such advice. These results support the positive impact of health professional advice on dietary and exercise change in the population. Public health campaigns should be aimed at increasing the provision of such advice.
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Affiliation(s)
- Randal J Thomas
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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Abstract
PURPOSE To test the ability of the theory of planned behavior (TPB) in predicting the stage of change for physical activity promotion by mental health professionals. DESIGN Six-month prospective questionnaire study. SETTING One mental health trust in the East Midlands, United Kingdom. SUBJECTS Three hundred ninety-four mental health professionals (men, n = 131; women, n = 263) of an initial sample of 477 participated in the study (83% response rate). MEASURES Attitudes, subjective norms, intentions, perceived behavioral control, and stage of change were measured at the first wave of data collection. Stage of change was also assessed 6 months later. Data were analyzed using structural equation modeling. RESULTS Intention and stage of change were successfully predicted from TPB variables. Overall, 27% of the variance in self-reported stage of promoting physical activity was explained by the model. Sixty-one percent of the variance in intention to promote physical activity was explained. When included, past behavior was the strongest predictor of both intention and stage of change and attenuated all other path coefficients. Past behavior improved the predicted variance in intention by 11% and stage by 6%. CONCLUSIONS The TPB variables of attitude, subjective norms, perceived behavioral control, and intention predict stage of change of physical activity promotion in a health care setting. However, promoting physical activity in the past had a sizable effect on predicting subsequent promotion. Due to unequal distribution across stages, the stage model's application to understanding the behavior of health professionals may be limited.
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Affiliation(s)
- G Faulkner
- School of Postgraduate Medicine and Health Science, Department of Exercise and Sport Sciences, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Glasgow RE, Eakin EG, Fisher EB, Bacak SJ, Brownson RC. Physician advice and support for physical activity: results from a national survey. Am J Prev Med 2001; 21:189-96. [PMID: 11567839 DOI: 10.1016/s0749-3797(01)00350-6] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey. METHODS A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues. RESULTS Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor. CONCLUSIONS Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.
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Affiliation(s)
- R E Glasgow
- AMC Cancer Research Center, Center for Behavioral and Community Studies, Denver, Colorado 80214, USA.
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Poston WS, Haddock CK, Dill PL, Thayer B, Foreyt JP. Lifestyle treatments in randomized clinical trials of pharmacotherapies for obesity. OBESITY RESEARCH 2001; 9:552-63. [PMID: 11557836 DOI: 10.1038/oby.2001.72] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This meta-analysis evaluated the types of lifestyle treatments used in published obesity drug studies and assessed their contribution to weight losses associated with pharmacological interventions. RESEARCH METHODS AND PROCEDURES Randomized, placebo-controlled, double-blind clinical trials of anti-obesity agents that are/were Food and Drug Administration-approved for the treatment of obesity (both prescription and over-the-counter), and drugs that are Food and Drug Administration-approved and are used off-label for obesity were included. Studies were located by computer searches of databases (e.g., Medline, PsychInfo) and reviewing tables of content/reference sections of journals, abstracts, previous reviews, past empirical studies, relevant book chapters, and recent issues of journals that regularly publish obesity research. In addition, a number of individuals who regularly publish in the obesity literature were asked to provide personal lists of obesity-drug studies. Based on the above criteria, a total of 108 randomized clinical trials were located. RESULTS Balanced-deficit diets, low-calorie diets, and self-monitoring were the most used lifestyle treatments in published obesity studies. They were incorporated into 40.7%, 25%, and 23.1% of pharmacotherapy studies, respectively. Physical activity and other behavioral or psychotherapeutic interventions rarely were used. A substantial portion of weight loss experienced by patients was attributable to both "placebo effects" and to the lifestyle treatments. DISCUSSION Obesity-pharmacotherapy trials do not use lifestyle treatments with the frequency expected based on the official positions of most professional organizations concerned with the comprehensive management of obesity.
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Affiliation(s)
- W S Poston
- Center for the Study of Health Outcomes Research and Evaluation, Mid America Heart Institute, St Luke's Hospital and University of Missouri-Kansas City, Kansas City, Missouri 64110, USA.
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Abstract
BACKGROUND The quantity and quality of physical activity counseling by the health care provider can have a profound impact on improving the physical activity of the older population. This study presents an estimate of the quality and quantity of physical activity counseling and tests the associations of different variables with physical activity. METHODS A random telephone survey of 793 Israeli residents between the ages of 45 and 75 was conducted. Counseling by a health care provider was evaluated using a three-stage approach--assess, advise, and assist. RESULTS Of those visiting a doctor in the last 3 months 22, 16, and 7% were assessed, advised, and assisted, respectively, regarding physical activity by a health care provider. At all three stages, receiving weight reduction counseling was a main variable correlated with receiving physical activity counseling (OR 3.38-2.43). Having a chronic disease was associated with being assessed; smoking and being a recent immigrant were associated with getting assistance on physical activity. Visiting a health care provider in the last 3 months, and being physically active were also associated with counseling. The dietitians and the physicians had the highest quality and rates of counseling in all three stages. CONCLUSION It seems that a sedentary lifestyle is not regarded as an independent risk factor during counseling, but more as an important part of weight reduction. An evaluation of physical activity counseling by the three stages can be used to assess the quality of the counseling.
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Affiliation(s)
- O B Epel
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel.
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