Physical activity counselling among GPs: a qualitative study from Thailand

Promotion of Physical Activity by Québec Primary Care Physicians: What Has Changed in the Last Decade?

OBJECTIVE

This study aimed to assess the changes in the frequency of physical activity (PA) counseling and in the predictors of primary care PA promotion in Québec primary care physicians (PCPs) between 2010 and 2020.

METHODS

In 2010, we conducted a survey among Québec PCPs. Questions included: frequency of promoting PA to patients, perceived barriers, needs to improve PA promotion practice, frequency of PCPs' PA practice, and sociodemographic information. In 2020, we took over the 2010 questionnaire to document the evolution of the PA promotion practice.

RESULTS

The proportion of PCPs discussing PA with their patients significantly increased (P < .05) in 2020 for the following health conditions: depression, low back pain, chronic obstructive pulmonary disease, and cancer; it declined (P < .05) for overweight patients, those with metabolic syndrome, and in primary prevention. Collaboration with PA professionals was the major need identified, and it increased in 2020. PCPs' own practice of PA was a predictor of PA promotion in 2010 (odds ratio = 6.679; P < .001) and in 2020 (odds ratio = 6.679; P < .001). In both 2010 and in 2020, older or more experienced PCPs were more likely to discuss PA with their patients without diagnosed diseases than younger ones or those with less experience.

CONCLUSIONS

Over the last 10 years, there has been a significant increase in PCPs promoting PA in Québec; however, it has been mainly oriented toward secondary prevention. It is concerning that PA counseling in primary prevention has declined, notably among younger PCPs. The stronger claim for closer collaboration with kinesiologists suggests that PCPs are in favor of an interprofessional strategy, namely collaboration with PA specialists.

Physical Activity with Sports Scientist (PASS) programme to promote physical activity among patients with non-communicable diseases: a pragmatic randomised controlled trial protocol

Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35-70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician's consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3-4: follow-up measurements), visit 3 (months 6-8: end-point measurements) and visit 4 (months 9-12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry. Trial registration number: TCTR20240314001.

Cross-sectional insights into exercise physiology knowledge among medical students in Jordan

Objectives

Exercise physiology is a branch of physiology that studies how physical activity and exercise alter the structure and function of living organisms. Knowledge of exercise physiology is crucial to improve athletic performance, improve people's ability to cope with extreme circumstances and approach chronic diseases. This research aimed to evaluate the knowledge of future healthcare professionals, namely, the medical students in Jordan regarding exercise physiology.

Methods

Responses were collected from 524 undergraduate medical students enrolled in clinical clerkship. An online survey that evaluated participants' basic understanding of various physiological concepts related to physical exercises, such as respiratory exchange ratio, physical fitness, V̇O2 max and exercise at high altitudes was employed in the study.

Results

63.2% of participants had a poor level of exercise physiology knowledge. Misconceptions regarding V̇O2 max definition (93.3%), application (46.4%), significance (35.6%) and related physiological factors (48.7%) were observed. Students had misconceptions about physical fitness evaluation questions (52.5%, 39%, and 41.8%, respectively). Student proportions of 37%, 41%, 80.3% and 73.1% showed misconceptions about muscle groups and energy systems during training, training prescription variables, respiratory exchange ratio, and high-altitude performance, respectively. Significant differences in knowledge levels were found based on respondent characteristics (p < 0.05).

Conclusions

Knowledge of exercise physiology is more than desirable for medical professionals. Therefore, efforts must be made to increase awareness and improve knowledge about basic physiological fundamentals related to exercise physiology among medical students in Jordan, as they represent the backbone of healthcare professionals of the future who will deal with medical conditions related to physical activity and exercise.

Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review

BACKGROUND

Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral.

METHODS

A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The "Tailored Implementation for Chronic Diseases" (TICD) framework was adapted to extract and synthesize barriers and facilitators.

RESULTS

Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals' knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions' cost and financial incentives; tools and materials; and professionals' cognitions and attitudes. "Social, political and legal factors" domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains.

CONCLUSION

The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions' effectiveness.

Psychometric Properties of a Scale Measuring Patients' Perceptions Regarding Physical Activity Counseling by Physicians

This study developed a scale measuring patients' perceptions regarding physical activity (PA) counseling by physicians. Confirmatory factor analysis and multiple linear regression analysis were used to assess psychometric properties. The first factor extracted was "PA recommendation," which accounted for a variance of 45.1% out of total variance of 76.3% and comprises 5 items. The final scale yielded satisfactory psychometric properties including internal consistency (Cronbach's α = 0.75), convergent validity, discriminant validity, and predictive validity. Nine (9) items that makeup two factors (i.e., PA recommendation and follow-up) are potential measures of patients' perceptions regarding PA counseling by physicians in healthcare.

Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care

The new World Health Organization (WHO) 2020 guidelines on physical activity (PA) and sedentary behavior include recommendations for adults with chronic conditions. The guidelines provide adaptable and general recommendations for people living with chronic medical conditions. This article summarizes the content and provides suggestions for the application of the guidelines for patients with essential hypertension in primary care. The WHO 2020 PA guidelines recommend broad advice for adults and older adults with chronic conditions. The key recommendations are consistent with other hypertension guidelines. A systemic approach to promote PA in primary care (i.e., PA assessment, safety considerations, PA prescription, behavioral counseling, and referral) along with applying the WHO guidelines is required. Health risk assessment and safety issues related to hypertension (e.g., current PA levels, level of blood pressure, treatment plans, comorbidities) should be concerned. The FITT Pro (frequency, intensity, time, type, and progression) can be adopted as a framework to break down the guidelines into specific PA prescription. The WHO 2020 PA guidelines address the importance of PA in clinical populations. The guidelines can be adapted for patients with hypertension in primary care settings.

Barriers to and Facilitators of the Use of Digital Tools in Primary Care to Deliver Physical Activity Advice: Semistructured Interviews and Thematic Analysis

Background

Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes, and cancer; therefore, increasing physical activity (PA) is a public health priority. Health care professionals (HCPs) in primary care are pivotal in addressing physical inactivity; however, few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including lack of time, confidence, or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital tools are used to deliver PA advice in primary care consultations and what factors influence their use.

Objective

We aimed to understand the use of digital tools to support primary care consultations and to identify the barriers to and facilitators of using these systems.

Methods

Overall, 25 semistructured interviews were conducted with primary care HCPs. Professionals were sampled based on profession (general practitioners, practice nurses, and health care assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. The data were analyzed thematically to identify the influences on the use of digital tools. Themes were categorized using the COM-B (capability, opportunity, and motivation—behavior) model and the Theoretical Domains Framework to identify the barriers to and facilitators of using digital tools to support the delivery of PA advice in primary care consultations.

Results

The identified themes fell within 8 domains of the Theoretical Domains Framework. The most prominent influence (barrier or facilitator) within psychological capability was having the skills to use digital tools. Training in the use of digital tools was also mentioned several times. The most notable influences within physical opportunity were limited digital tools to prompt/support the provision of PA advice, time constraints, efficiency of digital tools, simplicity and ease of use of digital tools, and integration with existing systems. Other physical opportunity influences included lack of access to digital tools and technical support in the use of digital tools. Within social opportunity, a notable barrier was that digital tools reduce interpersonal communication with patients. Patient preference was also identified. Several important influences were within reflective motivation, including confidence to use digital tools, beliefs about the usefulness of digital tools, the belief that digital tools “are the way forward,” beliefs related to data privacy and security concerns, and perceptions about patient capabilities. About automatic motivation, influences included familiarity and availability regarding digital tools and the fact that digital tools prompt behavior.

Conclusions

A variety of influences were identified on the use of digital tools to support primary care consultations. These findings provide a foundation for designing a digital tool addressing barriers and leverages the facilitators to support PA advice provision within primary care to elicit patient behavior change and increase PA.

The association between nurses’ physical activity counselling and patients’ perceptions of care quality in a primary care facility in Ghana

Many countries including Ghana and Australia have adopted physical activity (PA) counselling in healthcare as a public health improvement strategy. Even so, more evidence is needed to improve clinical PA counselling among clinicians, including nurses. This study examined the association between nurses’ physical activity counselling (NPAC) and patients’ perceptions of care quality. The study adopted a cross-sectional design with a sensitivity analysis against potential confounding. The setting of the study was a public primary care facility in Darkuman, Accra. Participants were 605 patients in wards and the Outpatient Department of the facility. Data were collected using a self-reported questionnaire and analyzed using structural equation modeling. A sensitivity analysis was conducted to select potential confounding variables for the study. The study found that higher care quality was associated with larger scores of NPAC (β = 0.34; CR = 8.65; p = 0.000). NPAC has no significant direct association with patient satisfaction (β = 0.01; CR = 0.22; p > 0.05) and loyalty (β = 0.05; CR = 1.21; p > 0.05), but care quality and patient satisfaction fully mediate the association between NPAC and patient loyalty. It is concluded that NPAC in healthcare can improve care quality and indirectly increase patient satisfaction and loyalty through care quality. The incorporation of PA counselling into clinical nursing may, therefore, be consistent with the core mission of hospitals.

Delivering brief physical activity interventions in primary care: a systematic review

BACKGROUND

Physical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown.

AIM

To examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity.

DESIGN AND SETTING

A mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results.

METHOD

CINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model.

RESULTS

After screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%-100% and 0.6%-100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers - including a lack of time and training/guidelines - remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients' receptivity to advice.

CONCLUSION

PA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals' confidence in their delivery.

Challenges of Implementing an mHealth Application for Personalized Physical Activity Counselling in Primary Health Care: A Qualitative Study

Introduction

A mobile health (mHealth) technology has the potential to facilitate personalized physical activity (PA) counselling. We aimed to explore the feasibility and challenges of implementing a newly developed mHealth application (PAC app) for personalized PA counselling.

Material and Methods

A qualitative design employed a descriptive phenomenology approach. Data were collected through focus group discussions (FGDs) with primary health care (PHC) providers and were analyzed using a deductive thematic approach.

Results

A total of 16 participants participated in four FGDs. Four major themes were found: application for personalized PA counselling, barriers to the use of the application by providers, patient involvement, and impact on PHC services.

Discussion

The results showed that the new mHealth application can potentially facilitate PA counselling. However, its use in PHC settings requires an understanding of the context of service delivery; the challenges faced by providers and patients and effects on services must be considered.

Conclusion

Future research should focus on the long-term use of PAC app and its impact on behavioral and health outcomes.

ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients

BACKGROUND

Exercise prescribing can help patients to overcome physical inactivity, but its use in general practice is limited. The purpose of this narrative review was to investigate contemporaneous experiences of general practitioners and patients with exercise prescribing.

METHOD

PubMed, Scopus, Science Direct and Cochrane reviews were reviewed using the terms 'exercise prescription', 'exercise prescribing', 'family practice', 'general practice', 'adults' and 'physical activity prescribing'.

RESULTS

After screening by title, abstract and full paper, 23 studies were selected for inclusion. Qualitative, quantitative and mixed-methods studies revealed key experiences of general practitioners and patients. Barriers identified included: physician characteristics, patients' physical and psychosocial factors, systems and cultural failures, as well as ambiguity around exercise prescribing. We present a synthesis of the key strategies to overcome these using an ABC approach: A: assessment of physical activity: involves asking about physical activity, barriers and risks to undertaking an exercise prescription; B: brief intervention: advice, written prescription detailing frequency, intensity, timing and type of exercise; and C: continued support: providing ongoing monitoring, accountability and progression of the prescription. Multiple supports were identified: user-friendly resources, workshops for doctors, guidelines for specific illnesses and multimorbidity, electronic devices, health system support and collaboration with other healthcare and exercise professionals.

DISCUSSION

This review has identified levers for facilitating exercise prescribing and adherence to it. The findings have been presented in an ABC format as a guide and support for general practitioners to prescribe exercise.

What Do Academic Physicians Think of Tai Chi? A Qualitative Study

Background: Although there is extensive evidence from randomized controlled trials (RCTs) that Tai Chi maintains health, prevents injury, and mitigates the effects of a number of chronic diseases, it appears that physicians do not commonly recommend it. The objective of this study was to understand academic physicians' views on Tai Chi and why there is an apparent gap between the evidence on Tai Chi and its application in practice. Design: A qualitative study was conducted using purposive and snowball sampling and semistructured interviews with 15 academic physicians in 6 countries: Australia, Canada, France, New Zealand, the Netherlands, and the United States. The interviews were recorded and transcribed and then coded and analyzed with NVivo 12 software. Results: All participants were aware of Tai Chi. More than half had never attended a continuing education event where Tai Chi was mentioned or read a scientific article on it. Most had seen or heard of science-based evidence on it, and a few were well versed in the literature in their area of expertise. Almost three-quarters of physicians interviewed thought Tai Chi could be a therapeutic option; however, when asked how often they recommended Tai Chi, about a third indicated never, about a half said only occasionally, and a few identified it regularly. Three factors-lack of access, lack of both physician and patient awareness, and an anticipated lack of patient receptivity to it-seemed to account for most of the hesitation to recommend it. Some thought Tai Chi may be seen as foreign. All made useful suggestions on how to increase the uptake of Tai Chi, including learning from other physicians and integrating more of the evidence into knowledge products, as well as learning more about Tai Chi in undergraduate and continuing medical education. Conclusions: This exploratory study found that although all the academic physicians interviewed had heard about Tai Chi, most were unaware of the extent of evidence from RCTs supporting its therapeutic effects. To apply this evidence in their practice, they wanted to learn more about it from other physicians, have better integration of the evidence into medical knowledge products, and know that there was access, and patient receptivity, to Tai Chi classes in the communities where they practiced.

Primary Health Care Providers' Perspectives on Developing an eHealth Tool for Physical Activity Counselling: A Qualitative Study

Purpose

Physical inactivity is a global health concern. Physical activity (PA) counselling is an effective intervention for promoting PA in primary health care (PHC) settings. The use of electronic health (eHealth) technology has the potential to support PA counselling. This study aimed to explore PHC providers’ perspectives on the development of an eHealth tool to aid PA counselling in the resource-limited settings.

Methods

This qualitative study employed interpretive phenomenology. The study was conducted at hospital-based PHC clinics among physicians and registered nurses. Data collection involved in-depth interviews (IDIs) and focus group discussions (FGDs). An inductive thematic approach was used to analyze the data.

Results

Three physicians participated in three IDIs and 12 nurses participated in four FGDs at three hospitals. The median age of the participants was 43 years. Participants saw 15–100 patients/day (median 40) and spent 2–20 min with each patient (median 5). Three themes emerged. Theme 1: requirements for PA counselling: the participants reflected the needs and characteristics of eHealth tool that may support PA counselling. Theme 2: enabling an eHealth tool for PA counselling: the eHealth should be easy to use, provide PA prescription function, and support follow-up PA counselling. Theme 3: reducing barriers to PA counselling: the eHealth tool was expected to help reduce service and workforce barriers and patients’ limitations.

Conclusion

A well-designed and practical eHealth tool has the potential to improve PA counselling practice in PHC settings. The eHealth tool may affect an indirect mechanism to reduce barriers to PA counselling. Future research should focus on the usability and utility as well as the process evaluation of the PA counselling eHealth tool that will be implemented in resource-limited settings.

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review

Background

Physical activity (PA) counselling is an effective approach to promote PA in primary health care (PHC). Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills of providers, and systemic barriers. Using electronic health (eHealth) has the potential to promote PA. This scoping review aimed to identify usability and utility of eHealth for tailored PA counselling introduced in PHC settings.

Methods

A scoping review included primary research articles. The authors systematically searched six databases (Cochrane Library, CINAHL Complete, Embase, PubMed, Scopus and Web of Science) from the inception of the databases. The search terms consisted of three search components: intervention (PA counselling), platform (eHealth), and setting (PHC). Additional articles were included through reference lists. The inclusion criteria were research or original articles with any study designs in adult participants.

Results

Of 2501 articles after duplicate removal, 2471 articles were excluded based on the title and abstract screening and full text review. A total of 30 articles were included for synthesis. The eHealth tools had a wide range of counselling domains as a stand-alone PA domain and multiple health behaviours. The included articles presented mixed findings of usability and utility of eHealth for PA counselling among patients and providers in PHC settings. Technical problems and the complexity of the programmes were highlighted as barriers to usability. The majority of articles reported effective utility, however, several articles stated unfavourable outcomes.

Conclusions

eHealth has the potential to support PA counselling in PHC. Facilitators and barriers to eHealth usability should be considered and adapted to particular settings and contexts. The utility of eHealth for promoting PA among patients should be based on the pragmatic basis to optimise resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01304-9.

The Influence of Physicians' Physical Activity Prescription on Indicators of Health Service Quality

INTRODUCTION

Many researchers are of the opinion that the incorporation of physical activity prescription (PAP) into healthcare is a move that can add value to healthcare, but there are others who think this move would rather disrupt clinical practice. This study, therefore, examined the influence of physicians' PAP (PPAP) on healthcare quality indicators.

METHODS

The study adopted a correlational approach and was performed at a primary care facility. Participants were 605 patients in wards and the outpatient department of a district healthcare facility. A self-reported questionnaire was used to gather data. Structural equation modeling was used to present findings.

RESULTS

The study found that PPAP has a positive influence on care quality (β = 0.4, critical ratio = 10.59, and p = .000), patient satisfaction, and patient loyalty. Physical activity prescription also has a positive indirect influence on patient loyalty through patient satisfaction.

CONCLUSIONS

Physicians' physical activity prescription in healthcare can improve healthcare quality indicators. A key implication of our results is that the incorporation of PPAP into healthcare could be in harmony with the key mission of hospitals. Physical activity prescription in healthcare could be a way to satisfy and retain patients.

Overview of Physical Activity Counseling in Primary Care

Physical inactivity is a global health burden. Promoting physical activity in primary care through physical activity counseling is an effective intervention. This article provides an overview of and perspectives on physical activity counseling in primary care. The identification of physical inactivity as a health problem may increase the awareness of physical inactivity among patients and primary care providers, which will lead to an action plan. The contents of physical activity counseling should be based on evidence-based recommendations. Safety issues should be evaluated appropriately to optimize the utilization of primary care services. Physical activity counseling methods should be "tailored" for an individual using appropriate counseling methods and setting-specific resources. Multilevel barriers to physical activity counseling in primary care (i.e., healthcare providers, patients, and systems) must be addressed. Setting-specific strategies to overcome these barriers should be implemented to maximize the effectiveness of physical activity counseling in primary care.