Insight from health professionals on physical activity promotion within routine diabetes care (original) (raw)
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European Journal of Physiotherapy
Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA.
Physical activity promotion in general practice
2007
This case study aimed to generate explanations for the lack of integration of physical activity (PA) promotion in general practices of Barcelona, the capital of Catalonia. This explanatory study adopted a qualitative approach, based on three techniques; focus groups (n 5 3), semistructured (n 5 25) and short individual interviews (n 5 5). These approaches explored the wider environment surrounding primary care from a range of distinctive professional and personal perspectives. Participants were recruited as patients (n 5 20), policy makers (n 5 6), academics (n 5 5), PA professionals (n 5 3), medical doctors (n 5 3), researchers (n 5 2), media employees (n 5 2) and one social worker. Phenomenological techniques were used for data coding and interpretation. Contributors confirmed the final interpretation. Three main factors underpinned the lack of integration of PA promotion approaches. PA promotion delivery rarely accounted for either patients' individual needs or the circumstances that influenced their interest in PA promotion. This was a missed opportunity in promotional consultations. There was also a lack of official support for general practitioner-based PA promotion. Finally, primary care staff intentionally isolated their practice from other professionals and/or services in the community. Communitybased PA promotion could be better integrated by (i) introducing stage-based strategies, (ii) creating top-down approaches and (iii) connecting primary care with other professionals and institutions in the community.
Heliyon, 2017
As part of formative work to inform an interventional design to increase physical activity (PA) in patients with type 2 diabetes in Oman, this qualitative study aimed to determine health professionals' perception of barriers and opportunities, personnel responsibilities and plausible PA promotional approaches. Four focus group discussions were carried out with groups of health care professionals (family physicians, dieticians and health educators, managers and general practitioners). All discussions were audio recorded and transcribed. Responses were analysed using a thematic analysis. Barriers to PA reported by participants (n = 29) were identified at three levels: health care system (e.g. deficient PA guidelines); individual (e.g. obstructive social norms) and community (e.g. lack of facilities). Participants felt that a multilevel approach is needed to address perceived barriers and to widen current opportunities. In the presence of various diabetes primary care providers, th...
Physical activity promotion in general practice: patient attitudes
This case study aimed to generate explanations for the lack of integration of physical activity (PA) promotion in general practices of Barcelona, the capital of Catalonia. This explanatory study adopted a qualitative approach, based on three techniques; focus groups (n 5 3), semistructured (n 5 25) and short individual interviews (n 5 5). These approaches explored the wider environment surrounding primary care from a range of distinctive professional and personal perspectives. Participants were recruited as patients (n 5 20), policy makers (n 5 6), academics (n 5 5), PA professionals (n 5 3), medical doctors (n 5 3), researchers (n 5 2), media employees (n 5 2) and one social worker. Phenomenological techniques were used for data coding and interpretation. Contributors confirmed the final interpretation. Three main factors underpinned the lack of integration of PA promotion approaches. PA promotion delivery rarely accounted for either patients' individual needs or the circumstances that influenced their interest in PA promotion. This was a missed opportunity in promotional consultations. There was also a lack of official support for general practitioner-based PA promotion. Finally, primary care staff intentionally isolated their practice from other professionals and/or services in the community. Communitybased PA promotion could be better integrated by (i) introducing stage-based strategies, (ii) creating top-down approaches and (iii) connecting primary care with other professionals and institutions in the community.
Feasibility and acceptability of a physical activity promotion programme in general practice
Family Practice, 2004
Background. Physical activity promotion in general practice is advocated though not incorporated into daily practice. Several barriers must be overcome to develop a feasible and acceptable programme. Objective. The aim of this study was to conduct a process evaluation of a physical activity promotion programme in general practice (PACE), in which patients visited their provider (GP or practice nurse) twice. Methods. Process evaluation was conducted by means of telephone-administered, semistructured interviews with providers and practice assistants. The main topics of the interviews were overall impression of PACE, PACE training, content and usability of the intervention materials, counselling, implementation of the intervention, and opportunities for future use. Results. In the 15 participating general practices, a total of 17 providers and 12 practice assistants were interviewed. The overall impression of the PACE programme was positive. Most providers experienced the provided material and training as helpful. Some problems concerning the number of forms used and patients having difficulties completing the forms were mentioned. Most providers (70.6%) spend 10 min or more discussing PACE during the first consultation. The second consultation mostly was completed within 10 min. Patients overestimating their level of physical activity was mentioned as the main barrier in providing the counselling. PACE was evaluated as suitable for implementation in Dutch general practice, and 60% of the providers actually intended using PACE in the future. Conclusion. The PACE programme was evaluated as being both acceptable and feasible in a selection of Dutch general practices. Positive adaptations will be made in order to implement PACE successfully in general practice at a wider scale.
Health education journal, 2015
Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. Qualitative semi-structured group interviews. General practice premises. Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smokin...
International Journal of Environmental Research and Public Health
Despite strategies to enable Health Care Professionals (HCPs) to give physical activity (PA) advice to patients, this appears to be rarely done in consultations. The aims of the present study were to gain an understanding of doctors’ awareness of current PA guidelines and to explore their opinions on barriers and solutions. A qualitative approach using semi-structured interviews was adopted. This study included 15 doctors currently working in the UK’s National Health Service (NHS). A thematic analysis approach was used to analyse the transcripts. Four themes and twelve sub-themes were deciphered. Intrinsic factors limiting the delivery of PA advice included a lack of knowledge of PA guidelines and PA being an afterthought. Barriers to delivering PA guidance included a lack of PA education, time pressures, and patient engagement. Solutions included staff training, incorporating PA into undergraduate training, and encouraging staff to be physically active. Methods to optimise PA guida...
Physical activity promotion in primary careBridging the gap between research and practice
American Journal of Preventive Medicine, 2004
Background: While a growing literature supports the effectiveness of physical activity interventions delivered in the primary care setting, few studies have evaluated efforts to increase physician counseling on physical activity during routine practice (i.e., outside the context of controlled research). This paper reports the results of a dissemination trial of a primary care-based physical activity counseling intervention conducted within the context of a larger, multi-strategy, Australian community-based, physical activity intervention, the 10,000 Steps Rockhampton Project.
BMC Family Practice
Background: Self-management support is widely accepted for the management of chronic conditions. Selfmanagement often requires behaviour change in patients, in which primary care nurses play a pivotal role. To support patients in changing their behaviour, the structured behaviour change Activate intervention was developed. This intervention aims to enhance physical activity in patients at risk for cardiovascular disease in primary care as well as to enhance nurses' role in supporting these patients. This study aimed to evaluate nurses' perceptions towards the delivery and feasibility of the Activate intervention. Methods: A qualitative study nested within a cluster-randomised controlled trial using semistructured interviews was conducted and thematically analysed. Fourteen nurses who delivered the Activate intervention participated.