Creating a Physical Activity Screening Tool for Primary Care

Abstract

Background: Only 20% of the population meets the aerobic Canadian Physical Activity Guidelines despite the many benefits of regular activity. Healthcare providers (HCP) in primary care are well positioned to discuss physical activity, since a majority of the population visits a physician at least once a year. Unfortunately, many HCPs face barriers that prevent them from routinely screening for physical activity. Objectives: The Knowledge-to-Action cycle guides the study objectives, which aim to determine the needs, preferences and barriers healthcare providers, patients and other stakeholders have to the implementation and adoption of a physical activity screening and counselling tool in primary care. This study also aims to validate a brief physical activity questionnaire against a criterion measure, an accelerometer. Methods: A qualitative study design using semi-structured interviews with healthcare providers, patients and other stakeholders was used for the tool development and revision process. Thematic and content analysis on all the transcripts identified emerging themes and design elements for the screening tool, and informed the creation of the Physical Activity Screening (PAS) tool. To validate the PAS tool participants wore an accelerometer for seven days. Bland Altman plots were used to determine the agreement between the two measures. Results: 38 physicians, nurses, patients and other stakeholders (mean age 40.8 years, 71% from primary care) participated in the tool development study, and 60 participants completed the validation study (mean age 75.3, 75% female and 61.7% community dwelling). Two themes were evident; there is a willingness and interest for physical activity screening in primary care, but healthcare providers have limited opportunities and capabilities to complete the process. Many physicians already screen for and counsel on physical activity, but their efforts are not consistent or standardized. HCPs face many barriers in primary care such as limited time per patient, and a lack of knowledge regarding physical activity guidelines or about tailoring information to patients with chronic diseases. The PAS was designed to be time efficient, uses simple language and contains non-confrontational questions to allow HCPs to have a conversation with patients about physical activity. From the Bland-Altman plots, the mean difference between the PAS and accelerometer moderate vigorous physical activity (MVPA) was -12 minutes (unbouted), and -58.5 minutes (bouted). The intra-rater reliability for aerobic and strength training is 0.584 and 0.589 respectively. The sensitivity of the PAS to determine patients not meeting guidelines is 71.4%. Conclusion: There is a tension between the capacity of primary care and the ideal process for physical activity screening and counselling. The PAS was developed with input from multiple user groups to create a desirable screening tool for primary care in Ontario. The PAS is a valid physical activity screening tool that is able to identify patients that are not meeting the aerobic physical activity guidelines. The PAS can facilitate physical activity screening, and provide opportunities to discuss physical activity, hopefully leading to behaviour change in patients.