“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
- 680 Downloads
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.
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.
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.
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.
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.
KeywordsGuidelines Healthcare provider Implementation science Knowledge translation Osteoporosis Physical activity
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
L. Giangregorio has consulted for ICON on behalf of Eli Lilly. No other conflicts of interest relevant to this work.
- 2.Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS (2011) Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports 22(1):7–14 http://www.ncbi.nlm.nih.gov/pubmed/21510585. Accessed November 24, 2016
- 3.Morgan F, Battersby A, Weightman AL et al (2016) Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators. BMC Public Health 16:227. doi: 10.1186/s12889-016-2882-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Giangregorio LM, Papaioannou A, MacIntyre NJ, et al. (2014) Too Fit to Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int 25(3):821-835. doi: 10.1007/s00198–013–2523-2.
- 7.Giangregorio LM, McGill S, Wark JD, et al. (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): 891-910. doi: 10.1007/s00198–014–2881-4.
- 11.Cornuz J, Ghali WA, Di Carlantonio D, Pecoud A, Paccaud F (2000) Physicians’ attitudes towards prevention: importance of intervention-specific barriers and physicians’ health habits. Fam Pract 17(6):535–540 http://www.ncbi.nlm.nih.gov/pubmed/11120727. Accessed November 22, 2016CrossRefPubMedGoogle Scholar
- 14.Canadian Institutes of Health Research. Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches. http://www.cihr-irsc.gc.ca/e/45321.html. Accessed November 22, 2016.
- 15.Michie S, Atkins L, West R (2014) The behaviour change wheel: a guide to designing interventions, 2nd edn. Silverback Publishing, SuttonGoogle Scholar
- 16.Statistics Canada. From urban areas to population centres. http://www.statcan.gc.ca/eng/subjects/standard/sgc/notice/sgc-06. Accessed November 22, 2016
- 19.Osteoporosis Canada. Too Fit To Fracture. http://www.osteoporosis.ca/osteoporosis-and-you/too-fit-to-fracture/. Accessed January 18, 2017
- 21.Webb AJS, Butterworth RJ (2015) Clinical neurology and neurosurgery determinants of clinical effectiveness and significant neurological diagnoses in an urgent brain cancer referral pathway in the United Kingdom. Clin Neurol Neurosurg 132:37–40. doi: 10.1016/j.clineuro.2015.02.014 CrossRefPubMedGoogle Scholar
- 24.Tzortziou Brown V, Underwood M, Mohamed N, Westwood O, Morrissey D (2016) Professional interventions for general practitioners on the management of musculoskeletal conditions. Tzortziou Brown V, ed. Cochrane Database Syst Rev 5:CD007495. doi: 10.1002/14651858.CD007495.pub2
- 29.Oldridge NB, Jones NL (1983) Improving patient compliance in cardiac exercise rehabilitation: effects of written agreement and self-monitoring. J Card Rehabil 3(4):257–262Google Scholar
- 35.Grant RW, Schmittdiel JA, Neugebauer RS, Uratsu CS, Sternfeld B (2014) Exercise as a vital sign: A quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels. J Gen Intern Med. 29(2): 341-348. doi: 10.1007/s11606–013–2693-9.