Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults

Jennifer K. Carroll, Sue Flocke, Mechelle R. Sanders, Lisa Lowenstein, Kevin Fiscella, Ronald M. Epstein

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background.: Physical activity (PA) counselling is challenging in primary care. It is unknown whether clinician training on the 5As (Ask, Advise, Agree, Assist, Arrange) improves PA counselling skills. Objective.: To evaluate the effect of a clinician training intervention on PA counselling for underserved adults using the 5As framework. Methods.: Pragmatic pilot clinical trial was used in the study. Clinicians (n = 13) were randomly assigned to two groups. Each group received the intervention consisting of four 1-hour training sessions to teach the 5As for PA counselling. Patient-clinician visits (n = 325) were audio recorded at baseline, immediately post-intervention, and at 6 months. Outcomes were the frequency and quality of PA discussions using the 5As, assessed by blinded coders. Results.: Patients' mean age was 44 years; 75% were African American. PA was discussed in 37% (n = 119) of visits overall and did not change from baseline to follow-up. When PA discussions occurred, the frequency of 5As increased from baseline to follow-up for Advise (51-54%), Agree (11-26%), and Assist (11-17%); however, none of the 5As had a statistically significant increase. For Agree, exploration of patient willingness to engage in PA increased from 23% at baseline to 50% at follow-up. Conclusion.: A clinician-directed intervention to improve PA counselling increased the frequency of Advise, Agree and Assist, and the quality of Ask and Agree statements, though the absolute numbers were small and only Agree reached statistical significance. Future research is needed to understand the factors that affect the optimal uptake and approach to 5As counselling.

Original languageEnglish (US)
Pages (from-to)488-491
Number of pages4
JournalFamily Practice
Volume33
Issue number5
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

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Exercise
Counseling
Pragmatic Clinical Trials
African Americans
Primary Health Care

Keywords

  • Intervention
  • Physical activity counselling
  • Underserved populations

ASJC Scopus subject areas

  • Family Practice

Cite this

Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults. / Carroll, Jennifer K.; Flocke, Sue; Sanders, Mechelle R.; Lowenstein, Lisa; Fiscella, Kevin; Epstein, Ronald M.

In: Family Practice, Vol. 33, No. 5, 01.10.2016, p. 488-491.

Research output: Contribution to journalArticle

Carroll, Jennifer K. ; Flocke, Sue ; Sanders, Mechelle R. ; Lowenstein, Lisa ; Fiscella, Kevin ; Epstein, Ronald M. / Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults. In: Family Practice. 2016 ; Vol. 33, No. 5. pp. 488-491.
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abstract = "Background.: Physical activity (PA) counselling is challenging in primary care. It is unknown whether clinician training on the 5As (Ask, Advise, Agree, Assist, Arrange) improves PA counselling skills. Objective.: To evaluate the effect of a clinician training intervention on PA counselling for underserved adults using the 5As framework. Methods.: Pragmatic pilot clinical trial was used in the study. Clinicians (n = 13) were randomly assigned to two groups. Each group received the intervention consisting of four 1-hour training sessions to teach the 5As for PA counselling. Patient-clinician visits (n = 325) were audio recorded at baseline, immediately post-intervention, and at 6 months. Outcomes were the frequency and quality of PA discussions using the 5As, assessed by blinded coders. Results.: Patients' mean age was 44 years; 75{\%} were African American. PA was discussed in 37{\%} (n = 119) of visits overall and did not change from baseline to follow-up. When PA discussions occurred, the frequency of 5As increased from baseline to follow-up for Advise (51-54{\%}), Agree (11-26{\%}), and Assist (11-17{\%}); however, none of the 5As had a statistically significant increase. For Agree, exploration of patient willingness to engage in PA increased from 23{\%} at baseline to 50{\%} at follow-up. Conclusion.: A clinician-directed intervention to improve PA counselling increased the frequency of Advise, Agree and Assist, and the quality of Ask and Agree statements, though the absolute numbers were small and only Agree reached statistical significance. Future research is needed to understand the factors that affect the optimal uptake and approach to 5As counselling.",
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