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

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.

An ethnographic discourse approach to explore GP-counsellor communication in primary health care settings in Hong Kong

This study aims to explore the nature of GP-counsellor interaction during discussions of patients' mental health issues in primary care services. An ethnographic discourse analysis of audio-recorded GP-counsellor conversations and the participating counsellor's reflective accounts. Two participating GPs and one counsellor were recruited from a private medical clinic in Hong Kong. The GPs and the counsellor mainly discussed their patients' issues in terms of medication management, the counsellor's case conceptualization, the case management, knowledge transfer and acknowledging the partnership. During case discussions, both the GPs and the counsellor used a range of interactional strategies to clarify a patient's condition and treatment plans for mutual understanding. The GPs and the counsellor co-construct an insider discourse that covers a greater diversity of topics, including both medical and non-medical concerns. The research findings have implications for theory and practice, including the potential of ethnographic discourse analysis in understanding the features of participants' behavior and evaluating the effectiveness of communication in a particular setting, as well as the importance of exploring professionalized discourse during GP-counsellor communication in developing training programs aimed at enhancing staff awareness of effective IPC communication.

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.

Cross Sectional E-Health Evaluation Study for Telemedicine and M-Health Approaches in Monitoring COVID-19 Patients with Chronic Obstructive Pulmonary Disease (COPD)

Monitoring COVID-19 patients with COPD has become one of the major tasks in preventing transmission and delivering emergency healthcare services after vaccination in case of any issues. Most COVID-19-affected patients are suggested to self-quarantine at home or in institutionalized quarantine centers. In such cases, it is essential to provide remote healthcare services. For remote healthcare monitoring, two approaches are being considered in this study, which include mHealth and Telehealth. A mixed-methods approach is adopted, where survey questionnaires are used for collecting information from 108 patients and semi-structured interviews are used with seven physicians regarding mHealth and Telehealth approaches. Survey results indicated that mHealth is rated to be slightly more effective than Telehealth, and interview results indicated that Telehealth is identified to be slightly more effective than mHealth in relation to parameters including usefulness, ease of use and learnability, interface and interaction quality, reliability, and satisfaction. However, both physicians and patients opined that both mHealth and Telehealth have a promising future with increasing adoption. Based on the findings, it can be concluded that both mHealth and Telehealth are considered to be effective in delivering remote care for COPD patients infected with COVID-19 at home. Implications of the study findings are discussed.

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.