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Evaluating the effectiveness of physician counseling to promote physical activity in Mexico: an effectiveness-implementation hybrid study

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

Integrating physical activity (PA) counseling in routine clinical practice remains a challenge. The purpose of this study was to evaluate the implementation and effectiveness of a pragmatic strategy aimed to improve physician PA counseling and patient PA. An effectiveness-implementation type-2 hybrid design was used to evaluate a 3-h training (i.e., implementation strategy-IS) to increase physician use of the 5-As (assess, advise, agree, assist, arrange) for PA counseling (i.e., clinical intervention-CI) and to determine if the CI improved patient PA. Patients of trained and untrained physicians reported on PA and quality of life pre-post intervention. Medical charts (N = 1700) were examined to assess the proportion of trained physicians that used the 5-As. The RE-AIM framework informed our evaluation. 305/322 of eligible physicians participated in the IS (M age = 40 years, 52% women) and 683/730 of eligible patients in the CI (M age = 49 years, 77% women). The IS was adopted by all state regions and cost ~ $20 Mexican pesos (US$1) per provider trained. Physician adoption of any of the 5-As improved from pre- to post-training (43 vs. 52%, p < .01), with significant increases in the use of assessment (43 vs. 52%), advising (25 vs. 39%), and assisting with barrier resolution (7 vs. 15%), but not in collaborative goal setting (13 vs. 17%) or arranging for follow-up (1 vs. 1%). Patient PA and quality of life did not improve. The IS intervention was delivered with high fidelity at a low cost, but appears to be insufficient to lead to broad adoption of the CI.

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Acknowledgments

This study was part of the Pausa Laboral Project, a collaboration among researchers from Queen’s University, the University of Guadalajara, Arizona State University, Emory University, the University of Nebraska Medical Center, the Metropolitan Autonomous University, and the Jalisco Secretary of Health. We thank the Jalisco Secretary of Health for providing support and access to conduct this study. We also thank the physicians and patients from the Jalisco Secretary of Health who participated in this study. Finally, we thank the dietitians and physical activity experts who helped with data collection (in alphabetical order): María Bueno Rea, Claudia Brizuela Rosas, Karla Castellanos Díaz, Karen Cortez García, José de Jesús Contreras, Guillermo Cuevas Aguilar, Ricardo Echauri Baltazar, Sandra Espinolla Magallón, Silvia García González, Raúl García Robles, José Gómez Gamboa, Mara Guzmán Gómez, Dorian Lizandro Velazco, Mauricio Madrid Hernández, Carolina Márquez Muñoz, Gloria Montes López, Liliana Muñoz Moreno, Yareli Orozco Loyola, Denise Ivette Páez, Viviana Pérez Bernal, Mercedes Robles Ramos, José Luis Saavedra Gómez, Fabiola Sánchez Rodríguez, Isabel Tovar, Gibran Urbano, and Carmen Villalvazo Reina.

Funding

This work was conducted with the financial support of a grant (CIHR GIR 127075) from the Canadian Institutes of Health Research (CIHR), Institute of Population and Public Health, the CIHR Institute of Cancer Research and the Public Health Agency of Canada–—Chronic Disease Prevention Branch.

Author information

Authors and Affiliations

  1. Hubert Department of Global Health, Emory University, #1518 Clifton Rd NE, Atlanta, GA, 30322, USA

    Karla I. Galaviz

  2. College of Public Health, Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA

    Paul A. Estabrooks

  3. Department of Preventive Medicine, Jalisco Secretary of Health, Calle Baeza Alzaga #107, Zona Centro, Guadalajara, Jalisco, Mexico

    Edtna Jauregui Ulloa

  4. Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd Street, Phoenix, AZ, 85004, USA

    Rebecca E. Lee

  5. School of Kinesiology and Health Studies, and Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada

    Ian Janssen

  6. Institute of Physical Activity and Sports Applied Sciences, University of Guadalajara, #950 Sierra Mojada, Guadalajara, 44340, Mexico

    Juan López y Taylor

  7. Universidad Autónoma Metropolitana, #1100 Calzada del Hueso, Coyoacan, CDMX, 04960, Mexico

    Luis Ortiz-Hernández

  8. School of Kinesiology and Health Studies, Queen’s University, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada

    Lucie Lévesque

Authors
  1. Karla I. Galaviz
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  2. Paul A. Estabrooks
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  3. Edtna Jauregui Ulloa
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  4. Rebecca E. Lee
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  5. Ian Janssen
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  6. Juan López y Taylor
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  7. Luis Ortiz-Hernández
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  8. Lucie Lévesque
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Corresponding author

Correspondence to Lucie Lévesque.

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Conflict of interest

The other authors declare that they have no financial or other conflict of interests. Edtna Jauregui works for the Jalisco Secretary of Health and receives salary from that institution.

Additional information

Implications

Practice: These findings can have an impact on researchers by providing evidence of how an effectiveness-implementation hybrid study design can be used to blend clinical effectiveness trial and implementation research elements to speed the translation of research findings into routine practice.

Policy: These findings can have an impact on practitioners by informing their physical activity promotion practices and describing an evidence-based tool they can use in their practice.

Research: These findings can have an impact on policy makers by informing current physician training strategies the Secretary of Health in Jalisco is implementing.

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Galaviz, K.I., Estabrooks, P.A., Ulloa, E.J. et al. Evaluating the effectiveness of physician counseling to promote physical activity in Mexico: an effectiveness-implementation hybrid study. Behav. Med. Pract. Policy Res. 7, 731–740 (2017). https://doi.org/10.1007/s13142-017-0524-y

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