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

Karla I. Galaviz, Paul A. Estabrooks, Edtna Jauregui Ulloa, Rebecca E. Lee, Ian Janssen, Juan López y Taylor, Luis Ortiz-Hernández, Lucie Lévesque

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)731-740
Number of pages10
JournalTranslational behavioral medicine
Volume7
Issue number4
DOIs
StatePublished - Dec 1 2017

Keywords

  • Behavior change
  • Lifestyle medicine
  • RE-AIM
  • Translation research

ASJC Scopus subject areas

  • Applied Psychology
  • Behavioral Neuroscience

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