"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.

Autor: Clark RE; University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada., McArthur C; University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada., Papaioannou A; McMaster University, Hamilton, ON, L8S 4L8, Canada.; Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada., Cheung AM; University of Toronto, Toronto, ON, M5S 1A1, Canada., Laprade J; University of Toronto, Toronto, ON, M5S 1A1, Canada.; Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, M3C 1H9, Canada., Lee L; McMaster University, Hamilton, ON, L8S 4L8, Canada.; Centre for Family Medicine, Kitchener, Canada.; Schlegel-UW Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada., Jain R; Ontario Osteoporosis Strategy & Osteoporosis Canada, Toronto, ON, M3C 1H9, Canada., Giangregorio LM; University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca.; Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada. lmgiangr@uwaterloo.ca.; Schlegel-UW Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada. lmgiangr@uwaterloo.ca.; Toronto Rehabilitation Institute, University Health Network, Toronto, Canada. lmgiangr@uwaterloo.ca.
Jazyk: angličtina
Zdroj: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2017 Jun; Vol. 28 (6), pp. 1953-1963. Date of Electronic Publication: 2017 Apr 17.
DOI: 10.1007/s00198-017-3975-6
Abstrakt: 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.
Databáze: MEDLINE
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