Challenges and opportunities for promoting physical activity in health care: a qualitative enquiry of stakeholder perspectives

Relationships among health promotion behaviors, patient engagement, and the nurse practitioner-patient partnership

BACKGROUND

Individuals adopting health promotion behaviors benefit from improved health and reduced risk of chronic diseases. Patient engagement and a strong provider-patient partnership may play a role in health promotion.

PURPOSE

This study examined the relationships between patient engagement, the nurse practitioner-patient partnership and health promotion behaviors among adults in a primary care setting.

METHODOLOGY

A descriptive correlational study using convenience sampling to recruit 85 participants from a nurse practitioner primary care practice. Participants completed questionnaires measuring health promotion behaviors (Health Promoting Lifestyle Profile II), the quality of the nurse practitioner-patient partnership (Patient Reactions Assessment), and a person's capacity to engage in their health care (Person Engagement Index).

RESULTS

Moderate to strong correlations were found among the main study variables. Multiple regression analysis found a person's capacity to engage in health care significantly predicted health promotion behaviors (R2 = 0.362, p < .001) and explained 36.2% of the variance in health promotion behaviors.

CONCLUSIONS

Patient engagement is a significant predictor of health promotion behaviors. The interactive care model can serve as a framework for nurse practitioners to build partnerships and facilitate patient engagement. Nurse practitioners can serve as a coach, navigator, collaborator, and trusted health care partner with their patients.

IMPLICATIONS

Nurse practitioners in primary care may need to restructure the health care encounter to allow for adequate time to communicate, listen, educate, and enlist patients in the shared decision-making process. Nurse practitioners can provide the support patients need to engage in their health care as they accept greater responsibility for their health.

Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom

BACKGROUND

The physician-patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions.

METHODS

A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1-research questions specified; Stage 2-relevant studies identified by searching five electronic databases and manual screening of references; Stage 3-studies screened using Covidence™; Stage 4-study data extracted and charted; and Stage 5-findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion.

RESULTS

In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance.

CONCLUSION

This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients.

Prescribing Physical Activity in Parks and Nature: Health Care Provider Insights on Park Prescription Programs

BACKGROUND

Health care providers (HCPs) promoting physical activity (PA) through programs such as Park Prescriptions (ParkRx) are gaining momentum. However, it is difficult to realize provider PA practices and program interest, and differences in program success exist by provider type (eg, primary vs secondary). This study explored HCPs' (1) PA counseling practices, (2) knowledge/interest in ParkRx, (3) barriers and resources needed to implement PA counseling and ParkRx programs, and (4) differences in primary versus secondary HCPs.

METHODS

An e-survey administered in Spring/Summer 2018 to HCPs in 3 states examined study objectives.

RESULTS

Respondents (n = 278) were mostly primary (58.3%) HCPs. The majority asked about patient PA habits and offered PA counseling (mean = 5.0, SD = 1.5; mean = 4.8, SD = 1.5), but few provided written prescriptions (mean = 2.5, SD = 1.6). Providers were satisfied with their PA counseling knowledge (mean = 3.8, SD = 1.0) but not with prescribing practices (mean = 3.2, SD = 1.1). Secondary HCPs placed higher importance (P = .012) and provided significantly more written PA prescriptions (P = .005). Time was a common barrier to prescribing PA (mean = 3.4, SD = 1.2), though more so for primary HCPs (P = .000). Although few HCPs knew about ParkRx programs, 81.6% expressed interest. Access to park information and community partnerships was an important resource for program implementation.

CONCLUSIONS

HCPs underutilize PA prescriptions. Despite little awareness, HCPs were interested in ParkRx programs.

Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

Background

Inconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels.

Aim

This study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogscotland.

Design & setting

An exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted.

Method

Patient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups.

Results

Three methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients.

Conclusion

For patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.

Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals

Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals' perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development.