Osteoporosis International

, Volume 28, Issue 6, pp 1953–1963

“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

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

DOI: 10.1007/s00198-017-3975-6

Cite this article as:
Clark, R.E., McArthur, C., Papaioannou, A. et al. Osteoporos Int (2017) 28: 1953. doi:10.1007/s00198-017-3975-6

Abstract

Summary

Guidelines for physical activity exist and following them would improve health. Physicians can advise patients on physical activity. We found barriers related to physicians’ knowledge, a lack of tools and of physician incentives, and competing demands for limited time with a patient. We discuss interventions that could reduce these barriers.

Introduction

Uptake of physical activity (PA) guidelines would improve health and reduce mortality in older adults. However, physicians face barriers in guideline implementation, particularly when faced with needing to tailor recommendations in the presence of chronic disease. We performed a behavioral analysis of physician barriers to PA guideline implementation and to identify interventions. The Too Fit To Fracture physical activity recommendations were used as an example of disease-specific PA guidelines.

Methods

Focus groups and semi-structured interviews were conducted with physicians and nurse practitioners in Ontario, stratified by type of physician, geographic area, and urban/rural, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the behavior change wheel framework, themes were categorized into capability, opportunity and motivation, and interventions were identified.

Results

Fifty-nine family physicians, specialists, and nurse practitioners participated. Barriers were as follows: Capability–lack of exercise knowledge or where to refer; Opportunity–pragmatic tools, fit within existing workflow, available programs that meet patients’ needs, physical activity literacy and cultural practices; Motivation–lack of incentives, not in their scope of practice or professional identity, competing priorities, outcome expectancies. Interventions selected: education, environmental restructuring, enablement, persuasion. Policy categories: communications/marketing, service provision, guidelines.

Conclusions

Key barriers to PA guideline implementation among physicians include knowledge on where to refer or what to say, access to pragmatic programs or resources, and things that influence motivation, such as competing priorities or lack of incentives. Future work will report on the development and evaluation of knowledge translation interventions informed by the barriers.

Keywords

Guidelines Healthcare provider Implementation science Knowledge translation Osteoporosis Physical activity 

Funding information

Funder NameGrant NumberFunding Note
Ontario Ministry of Health and Long-Term Care
  • 06681

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • R. E. Clark
    • 1
  • C. McArthur
    • 1
  • A. Papaioannou
    • 2
    • 3
  • A. M. Cheung
    • 4
  • J. Laprade
    • 4
    • 5
  • L. Lee
    • 2
    • 6
    • 7
  • R. Jain
    • 5
  • L. M. Giangregorio
    • 1
    • 3
    • 7
    • 8
  1. 1.University of WaterlooWaterlooCanada
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.Geriatric Education and Research in Aging Sciences CentreHamiltonCanada
  4. 4.University of TorontoTorontoCanada
  5. 5.Ontario Osteoporosis Strategy & Osteoporosis CanadaTorontoCanada
  6. 6.Centre for Family MedicineKitchenerCanada
  7. 7.Schlegel-UW Research Institute for AgingWaterlooCanada
  8. 8.Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada

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