Advertisement

Osteoporosis International

, Volume 29, Issue 5, pp 1081–1091 | Cite as

“Left to my own devices, I don’t know”: using theory and patient-reported barriers to move from physical activity recommendations to practice

  • C. Ziebart
  • C. McArthur
  • L. Lee
  • A. Papaioannou
  • J. Laprade
  • A. M. Cheung
  • R. Jain
  • L. Giangregorio
Original Article

Abstract

Summary

Knowledge exchange with community-dwelling individuals across Ontario revealed barriers to implementation of physical activity recommendations that reflected capability, opportunity, and motivation; barriers unique to individuals with osteoporosis include fear of fracturing, trust in providers, and knowledge of exercise terminology. Using the Behaviour Change Wheel, we identified interventions (training, education, modeling) and policy categories (communication/marketing, guidelines, service provision).

Introduction

Physical activity recommendations exist for individuals with osteoporosis; however, to change behavior, we must address barriers and facilitators to their implementation. The purposes of this project are (1) to identify barriers to and facilitators of uptake of disease-specific physical activity recommendations (2) to use the findings to identify behavior change strategies using the Behaviour Change Wheel (BCW).

Methods

Focus groups and semi-structured interviews were conducted with community-dwelling individuals attending osteoporosis-related programs or education sessions in Ontario. They were stratified by geographic area, urban/rural, and gender, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and interventions were identified.

Results

Two hundred forty community-dwelling individuals across Ontario participated (mean ± SD age = 72 ± 8.28). Barriers were as follows: capability: disease-related symptoms hinder exercise and physical activity participation, lack of exercise-related knowledge, low exercise self-efficacy; opportunity: access to exercise programs that meet needs and preferences, limited resources and time, physical activity norms and preferences; motivation: incentives to exercise, fear of fracturing, trust in exercise providers. Interventions selected were training, education, and modeling. Policy categories selected were communication/marketing, guidelines, and service provision.

Conclusions

Barriers unique to individuals with osteoporosis included the following: lack of knowledge on key exercise concepts, fear of fracturing, and trust in providers. Behavior change techniques may need tailoring to gender, age, or presence of comorbid conditions.

Keywords

Barriers Behavior change Exercise Osteoporosis Physical activity 

Notes

Acknowledgements

We gratefully acknowledge Sospeter Gatobu, Ruchit Patel, Rebecca Clark, and Jaylyn Leighton for their assistance with data collection and transcription.

Funding information

The research was funded by an Ontario Ministry of Health and Long Term Care Health Research System Fund Capacity Award. Dr. Giangregorio received funding from an Ontario Ministry of Health Research and Innovation–Early Researcher Award, CIHR New Investigator Award, and Canadian Foundation for Innovation. Dr. Cheung is supported by a Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health.

Compliance with ethical standards

Informed consent was obtained from all individual participants included in the study, which was approved by the Office of Research Ethics at the University of Waterloo and the McMaster University Research Ethics Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest

None.

Supplementary material

198_2018_4390_MOESM1_ESM.docx (116 kb)
ESM 1 (DOCX 116 kb)

References

  1. 1.
    Giangregorio LM, Papaioannou A, MacIntyre NJ, Ashe MC, Heinonen A, Shipp K et al (2014) Too Fit to Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int 25(3):821–835CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Giangregorio LM, McGill S, Wark JD, Laprade J, Heinonen A, Ashe MC, MacIntyre NJ, Cheung AM, Shipp K, Keller H, Jain R, Papaioannou A (2015) Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporos Int 26(3):891–910CrossRefPubMedGoogle Scholar
  3. 3.
    Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N (2006) Lost in knowledge translation: time for a map? J Contin Educ Heal Prof 26(1):13–24CrossRefGoogle Scholar
  4. 4.
    Tulloch H, Sweet SN, Fortier M, Capstick G, Kenny GP, Sigal RJ (2013) Exercise facilitators and barriers from adoption to maintenance in the diabetes aerobic and resistance exercise trial. Can J Diabetes 37(6):367–374CrossRefPubMedGoogle Scholar
  5. 5.
    Petursdottir U, Arnadottir SA, Halldorsdottir S (2010) Facilitators and barriers to exercising among people with osteoarthritis: a phenomenological study. Phys Ther 90(7):1014–1025CrossRefPubMedGoogle Scholar
  6. 6.
    Rogerson MC, Murphy BM, Bird S, Morris T (2012) “I don’t have the heart”: a qualitative study of barriers to and facilitators of physical activity for people with coronary heart disease and depressive symptoms. Int J Behav Nutr Phys Act 9:140CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Baert V, Gorus E, Mets T, Bautmans I (2015) Motivators and barriers for physical activity in older adults with osteoporosis. J Geriatr Phys TherGoogle Scholar
  8. 8.
    Michie S, Atkins L, West R (2014) The behaviour change wheel: a guide to designing interventions, 2nd edn. Silverback Publishing, SuttonGoogle Scholar
  9. 9.
    Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6(1)Google Scholar
  10. 10.
    Clark R, McArthur C, Papaioannou A, Cheung A, Laprade J, Lee L, et al (2017) “I do not have time. Is there a handout I can use?”: combining physicians’ needs and behavior change theory to put physical activity evidence into practice. Osteoporos Int 1–11Google Scholar
  11. 11.
  12. 12.
    [Internet]. 2014 Available from: http://www.lhins.on.ca
  13. 13.
  14. 14.
    [Internet]. Available from: bonefit.caGoogle Scholar
  15. 15.
    Corbin JM, Strauss A (1990) Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol 13(1):3–21CrossRefGoogle Scholar
  16. 16.
  17. 17.
    Rodrigues I, Armstrong J, Adachi J, MacDermid J (2016) Facilitators and barriers to exercise adherence in patients with osteopenia and osteoporosis: a systematic review. Osteoporos Int:1–11Google Scholar
  18. 18.
    Baert V, Gorus E, Mets T, Bautmans I (2015) Motivators and barriers for physical activity in older adults with osteoporosis. J Geriatr Phys Ther 38(3):105–114CrossRefPubMedGoogle Scholar
  19. 19.
    Simmonds B, Hannam K, Fox K, Tobias J (2015) An exploration of barriers and facilitators to older adults’ participation in higher impact physical activity and bone health: a qualitative study. Osteoporos Int:1–9Google Scholar
  20. 20.
    Jepson RG, Harris FM, Platt S, Tannahill C (2010) The effectiveness of interventions to change six health behaviours: a review of reviews. BMC Public Health 10(1):538CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Van Der Bij AK, Laurant MG, Wensing M (2002) Effectiveness of physical activity interventions for older adults: a review. The full text of this article is available via AJPM Online at www.elsevier.com/locate/ajpmonline. Am J Prev Med 22(2):120–133CrossRefPubMedGoogle Scholar
  22. 22.
    Conn VS, Minor MA, Burks KJ, Rantz MJ, Pomeroy SH (2003) Integrative review of physical activity intervention research with aging adults. J Am Geriatr Soc 51(8):1159–1168CrossRefPubMedGoogle Scholar
  23. 23.
    Blalock SJ, DeVellis BM, Patterson CC, Campbell MK, Orenstein DR, Dooley MA (2002) Effects of an osteoporosis prevention program incorporating tailored educational materials. Am J Health Promot 16(3):146–156CrossRefPubMedGoogle Scholar
  24. 24.
    Sedlak CA, Doheny MO, Jones SL (2000) Osteoporosis education programs: changing knowledge and behaviors. Public Health Nurs 17(5):398–402CrossRefPubMedGoogle Scholar
  25. 25.
    Larson E, George A, Morgan R, Poteat T (2016) 10 Best resources on... intersectionality with an emphasis on low- and middle-income countries. Health Policy Plan 31(8):964–969CrossRefPubMedGoogle Scholar
  26. 26.
    Tannenbaum C, Greaves L, Graham ID (2016) Why sex and gender matter in implementation research. BMC Med Res Methodol 16(1):145CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bušljeta Banks I, Dens N, De Pelsmacker P (2016) The influence of gender on the effectiveness of probability markers in advertising. Int J Advert 35(4):682–705CrossRefGoogle Scholar
  28. 28.
    Stolee P, Zaza C, Schuehlein S (2012) Evaluation of a volunteer-led in-home exercise program for home-bound older adults. Work 41(3):339–354PubMedGoogle Scholar
  29. 29.
    Riva S, Camerini A, Allam A, Schulz PJ (2014) Interactive sections of an Internet-based intervention increase empowerment of chronic back pain patients: randomized controlled trial. J Med Internet Res 16(8):e180CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Brosseau L, Wells G, Brooks-Lineker S, Bennell K, Sherrington C, Briggs A, Sturnieks D, King J, Thomas R, Egan M, Loew L, de Angelis G, Casimiro L, Toupin April K, Cavallo S, Bell M, Ahmed R, Coyle D, Poitras S, Smith C, Pugh A, Rahman P (2015) Internet-based implementation of non-pharmacological interventions of the “people getting a grip on arthritis” educational program: an international online knowledge translation randomized controlled trial design protocol. JMIR Res Protoc 4(1):e19CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Vandelanotte C, Mummery WK (2011) Qualitative and quantitative research into the development and feasibility of a video-tailored physical activity intervention. Int J Behav Nutr Phys Act 8:70CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Vestergaard S, Kronborg C, Puggaard L (2008) Home-based video exercise intervention for community-dwelling frail older women: a randomized controlled trial. Aging Clin Exp Res 20(5):479–486CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • C. Ziebart
    • 1
  • C. McArthur
    • 1
  • L. Lee
    • 2
    • 3
  • A. Papaioannou
    • 4
    • 5
  • J. Laprade
    • 6
    • 7
    • 8
  • A. M. Cheung
    • 9
  • R. Jain
    • 7
    • 8
  • L. Giangregorio
    • 1
    • 9
    • 10
  1. 1.Department of KinesiologyUniversity of WaterlooWaterlooCanada
  2. 2.Centre for Family Medicine Family Health TeamKitchenerCanada
  3. 3.Department of Family MedicineMcMaster UniversityHamiltonCanada
  4. 4.Department of Health and Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
  5. 5.Department of MedicineMcMaster UniversityHamiltonCanada
  6. 6.Division of AnatomyUniversity of TorontoTorontoCanada
  7. 7.Ontario Osteoporosis StrategyTorontoCanada
  8. 8.Osteoporosis CanadaTorontoCanada
  9. 9.University Health NetworkTorontoCanada
  10. 10.Schlegel-UW Research Institute for AgingWaterlooCanada

Personalised recommendations