Nurses’ perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study (original) (raw)
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Health Education Research, 1999
This study examined the effectiveness of stages of change-based counselling for exercise delivered by nurses in four primary care centres. Twohundred and ninety-four subjects enrolled, recruited from patients attending 30-min health checks. The average age of participants was 42.4 years (SD ⍧ 15.1) and 77% were female. Participants completed a questionnaire assessing stage of exercise adoption, self-efficacy and exercise levels. Each centre was assigned to either one of three experimental conditions or to a control condition. Participants were counselled accordingly, receiving either stage-oriented exercise materials with counselling (stage plus counselling), stage-oriented materials without counselling (stage no counselling), non-staged materials with counselling (counselling only) or the current level of advice (control). Sixty-one percent (n ⍧ 180) returned follow-up questionnaires. When baseline differences in self-efficacy, age and gender were controlled for, there was no significant group or interaction effect for stage. There was a significant time effect (F ⍧ 3.55, P ⍧ 0.031). Post hoc analyses showed that significant differences were between baseline and 2 (t ⍧ -3.02, P ⍧ 0.003) and 6 months (t ⍧ -2.67, P ⍧ 0.009). No changes in self-efficacy and exercise levels were observed. Stage-based
Upgrading physical activity counselling in primary care in the Netherlands
Health Promotion International, 2014
The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative usercentred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A's model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It's LiFe! monitoring and feedback tool. This tool provides feedback on patients' physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology.
BMC Public Health, 2007
Background: Physical inactivity is an independent risk factor for diabetes and heart disease. There is evidence that increasing physical activity can reduce the risk of developing these chronic diseases, but less evidence about effective ways to increase adherence to physical activity. Interventions are therefore needed that produce sustained increases in adherence to physical activity, are costeffective and improve clinical endpoints. Methods: The Women's Lifestyle Study is a two year randomized controlled trial involving a nurse-led intervention to increase physical activity in 40-74 year old physically inactive women recruited from primary care. Baseline measures were assessed in a face-to-face interview with a primary care nurse. The intervention involved delivery of a 'Lifestyle script' by a primary care nurse followed by telephone counselling for nine months and a face-to-face nurse visit at six months. Outcome measurements are assessed at 12 and 24 months. The primary outcome is physical activity measured using a validated physical activity questionnaire. Secondary outcomes include blood pressure, weight, waist circumference, physical fitness (step test), serum HbA1c, fasting glucose, lipids, insulin, and quality of life (SF36). Costs were measured prospectively to allow a subsequent cost-effectiveness evaluation if the trial is positive. Discussion: Due to report in 2008, the Women's Lifestyle Study tests the effectiveness of an enhanced low-cost, evidence-based intervention in increasing physical activity, and improving cardiovascular and diabetes risk indicators over two years. If successful in demonstrating improvements in health outcomes, this randomized controlled trial will be the first to demonstrate long-term cardiovascular and diabetes risk health benefit, in addition to improvements in physical activity, from a sustainable physical activity intervention based in primary care.
Factors that Influence Practice-Nurses to Promote Physical Activity
McDowell, McKenna, and Naylor (1997) research article entitled “Factors that influence practice nurses to promote physical activity”, which appeared in the British Journal of Sports Medicine number 31, pages 308-313 had as objective to investigate what factors may influence practice-nurses to promote physical activity. The study is of paramount importance because there is a worldwide concern about increasing rates of obesity and decreasing population levels of physical activity. Yet, it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities (Douglas et al 2006).Though it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities (Douglas et al 2006), Steptoe et al. (1999) stated that in Catalonia in the United Kingdom, there was a lack of evidence regarding the levels of physical activity promotion. There are various constraints that impede the success of physical activity promotion programmes. Nevertheless, this study showed that the two stage measures (activity promotion and personal behaviour) of the health care professional are associated with important differences in patient and practice factors for physical activity promotion.Their view will be presented in the following order: summary of the article; structure; critique that will focus on: the authority of the authors/ researchers, accuracy of style of writing, relevance of the study subject or topic, objectivity of the research and its stability. Finally, the review will analyze the graph and draw a conclusion on the whole article.
2002
Approximately three-fifths of men and three-quarters of women in England are not active at recommended levels. 1 A sedentary lifestyle is associated with increased risk of coronary heart disease, type II diabetes, hypertension and colon cancer, 2 and the Department of Health recommends 30 minutes of moderate physical activity at least 5 days/week or three 20-minute periods of vigorous activity/week. 3 Most UK-based interventions aimed at increasing individual activity have been based in primary care, 4,5 but there is little evidence that such interventions are effective. 6,7 Despite this, the government continues to promote such initiatives. 8
Mediators of Change in Physical Activity Following an Intervention in Primary Care: PACE
Preventive Medicine, 1997
Background. The current study evaluated the construct validity of a physical activity intervention in primary care by testing whether the intervention changed hypothesized mediators and whether changes in the mediators were associated with behavior change. Methods. Matched physician offices were nonrandomly assigned to intervention or control. Apparently healthy, sedentary, adult patients (N = 255) were recruited from physician offices. The intervention was brief, behaviorally based counseling by physicians, plus a telephone follow-up 2 weeks later. Assessments of physical activity and mediators were collected at baseline and at 4-to 6-week follow-up. Hypothesized mediators were processes of change, self-efficacy, and social support for exercise. Results. Patients who were counseled improved significantly more than those in the control group on behavioral and cognitive processes of change. Other changes in mediators were nonsignificant. Behavioral processes of change and self-efficacy made significant contributions to the multiple regression model explaining self-report and objective measures of physical activity. Conclusions. The intervention affected some of the targeted mediators of physical activity change. Two of three mediator variables were associated with changes in physical activity regardless of experimental condition and other variables. The construct validity of the intervention was partially supported.