Quality and correlates of physical activity counseling by health care providers in Israel

Physical activity levels and counseling by health care providers in cancer survivors

Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's<0.05). A HCP's recommendation is associated with higher levels of leisure-time aerobic physical activity among cancer survivors and adults without cancer. The communication between cancer survivors and their HCPs may act as a 'window' of opportunity to increase physical activity levels among the U.S. cancer survivors.

The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models

Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs' personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs' PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs' personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs' PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs' PA role-modeling and how it influences patients' PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.

Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review

BACKGROUND

Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired.

PURPOSE

To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices.

METHOD

Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors.

RESULTS

Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants.

CONCLUSION

This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

Impact of an educational intervention on internal medicine residents' physical activity counselling: the Pressure System Model

RATIONALE, AIMS AND OBJECTIVES

Systematic reviews point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing adults' physical activity (PA) levels. This study evaluates the impact of an innovative physician counselling programme on physicians' PA counselling behaviour and their patients' PA levels.

METHODS

A controlled educational study conducted at six Yale School of Medicine hospitals. Sixty-five internal medicine residents and 316 primary care patients were randomized to intervention or control groups. Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model, while control physicians received usual residency training. Intervention and control patients' PA levels and residents counselling behaviour were assessed using a validated questionnaire and compared pre- and post intervention. Data analysis was performed using paired t-tests and repeated measures anova.

RESULTS

At 6-month follow-up intervention, patients' PA levels increased significantly from baseline (1.77 +/- 0.84; P = 0.0376). A similar pattern was observed after 12 months (1.94 +/- 0.98; P = 0.0486). Control patients' PA did not change significantly from baseline at 6 or 12 months (0.35 +/- 1.00; P = 0.7224 and 0.99 +/- 1.52; P = 0.5160, respectively). At 12 months, intervention residents provided PA counselling 1.5 times more than they did at baseline (P < 0.05) compared with no significant changes in the control group.

CONCLUSIONS

The present study has shown that providing residents with a practical tool, enabling them to deal with patients' barriers and previous failure in behavioural change, is efficacious in increasing PA levels of adult patients.

Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system

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.

Adherence to antihypertensive treatment: a critical factor for blood pressure control

BACKGROUND

To compare rates of blood pressure (BP) control with the level of adherence to antihypertensive treatment and factors influencing compliance in Greek patients.

DESIGN

An observational cross-sectional study on 1000 consecutively treated hypertensive patients, admitted to a University department of general surgery in a Greek hospital.

METHODS

Patients were interviewed by the same doctor using pre-coded questionnaires with questions on demographic data, health and treatment status. Blood pressure was measured using a standard mercury sphygmomanometer. Treatment of hypertension was defined as current use of antihypertensive medication. Compliance was defined as an affirmative reply to a number of questions regarding regular use of antihypertensive medication according to the physician's instructions.

RESULTS

Satisfactory BP control (levels <140/90 mmHg) was documented in only 20% of the treated hypertensives. Compliance to antihypertensive treatment was found in only 15% of the patients. Control of BP was positively associated with compliance. Compliance was more common among patients aged <60, city dwellers, the better educated, those more adequately counselled by their physicians and those followed by a private doctor. As regards treatment, compliance was better among those taking one antihypertensive tablet per day, those who had never changed their antihypertensive regimen and those who had never changed their doctor.

CONCLUSIONS

Compliance is associated with more effective BP control. Physicians can enhance patient compliance and hypertension control by devoting more time to counselling, avoiding unnecessary changes in drug regimens and restricting the tablet numbers.

How general practitioners promote 'lifestyle' physical activity

We investigated how General Practitioners (GPs) promote lifestyle physical activity (PA) ('accumulate 30 min of at least moderate PA on 5 or more days per week': PA30 x 5) to patients in the different stages of change, using a range of counselling strategies. These strategies included six 'A' factors (Ask, Assess, Advise, Assure, Arrange a follow-up, and Applaud). In a postal questionnaire (68% return rate), 47% of GPs from a single UK health district reported regularly promoting PA30 x 5. A stepwise logistic regression identified three counselling strategies that predicted regularly promoting PA30 x 5: (1) arrange follow-ups for patient pre-contemplators (OR=4.93), (2) patient contemplators passed to GP exercise referral scheme (OR=2.34), and (3) asking relapsers about their PA30 x 5 (OR=2.61). GPs who regularly promote PA30 x 5 base their counselling on patients' pre-existing PA behaviour, using 'effortful', 'stage-matched' approaches. Since these are acceptable to GPs, in-service training may build on using these three factors.

Personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students

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.

Consumer-oriented evaluation of health education services

The objective of this study was to evaluate the effect of the presence of formal health education units in health plans on the health education reported by the consumer. The research consisted of interviews with health educators in the Israeli health plans and a random sample of telephone interviews with 793 Israeli residents between the ages of 45 and 75. The interviews with consumers included measures of counseling on smoking, physical activity, weight reduction, hypertension and diabetes. Two of the four Israeli health plans have formal health education units. After adjustment for other variables, however, the quality and quantity of counseling reported by the consumers does not differ, in most subjects, between health plans with or without health education units. The presence of a health education unit within a health plan had little effect on the counseling reported by the consumer. The reasons for and implications of the results are discussed.

Managing obesity: a survey of attitudes and practices among Israeli primary care physicians

OBJECTIVES

To document and assess Israeli family physicians' (FPs) knowledge, attitudes and practices regarding the management of overweight and obesity.

METHODS

Anonymous questionnaires were completed by 510 family physicians (82% compliance rate). The questionnaires were distributed in various continuous medical education sites of FPs in Israel. The measures included attitudes to and resources of knowledge on weight management, views regarding the prescription of drugs, approaches to and strategies recommended for weight loss.

RESULTS

In all, 73% of FPs viewed weight management as important and reported that they often treated cases of overweight and obesity, including for patients without concomitant risk factors. The medical advice most frequently offered is: increase physical activity, decrease number of total calories (eat less) and consultation with a dietitian (95, 81 and 58% respectively). However, most responders (72%) believed that they had limited efficacy in treating obesity and considered themselves not well prepared by medical school to treat overweight patients. Some 60% reported feeling that they have insufficient knowledge regarding nutritional issues. Regarding pharmacotherapy for treating obesity, only 66% knew the drugs' prescription indications. However, the vast majority (87%) knew about the gradual increase of weight after stopping drug treatment.

CONCLUSIONS

Knowledge gaps and ambivalent attitudes toward obesity management were found. More education focusing on obesity, from medical school to post-graduate learning, seems warranted based on these findings.