Original ResearchPhysical Activity Supports Provided by Healthcare Providers to Patients with Type 2 Diabetes
Introduction
The prevalence of type 2 diabetes mellitus is increasing around the world (1) resulting in higher healthcare system costs (2) and substantial premature mortality (3). Physical activity has an important role in preventing 4, 5, 6 and managing (7) type 2 diabetes, as physical activity reduces glycated hemoglobin levels, increases insulin sensitivity, improves body composition and improves lipid profiles (8).
Although the health benefits are well-established, 69% of people with type 2 diabetes do not engage in sufficient physical activity (9). As such, finding strategies to increase physical activity in these individuals is highly desirable. The primary care system offers an attractive opportunity to support patients to become more physically active, as healthcare providers (HCPs) working in these clinics are seen as credible sources of health information and regularly see their patients throughout the year (10) and use physical activity as a way to manage chronic conditions (11). Studies examining HCP physical activity counselling have investigated physical activity support practices, knowledge, attitudes and/or barriers toward providing physical activity support to general clinic patients 10, 12, 13, 14, 15, 16, 17, 18, 19. However, none have determined specific physical activity support practices delivered by several different types of HCPs working in interprofessional primary care clinics to patients with type 2 diabetes, nor have they examined the awareness, knowledge and use of key physical activity recommendations (i.e., the Canadian Diabetes Association [CDA] physical activity guidelines [20] or Canada's Physical Activity Guide [CPAG] [21]) by HCPs, despite their applicability and importance. Previous studies that have examined HCP physical activity support practices have only assessed a select amount of support practices, rather than all physical activity support practices that could be important for health behaviour change. Furthermore, no studies have measured the HCP physical activity support and use of guidelines reported by patients and compared it to that reported by HCPs. Given this lack of evidence and the more recent reliance on the use of allied HCPs for physical activity counselling (22), a comprehensive examination of the relevant physical activity support delivered by all HCP types working in interprofessional primary care clinics, as well as the perceptions of HCP physical activity support from the patients receiving support, is warranted.
Thus, the primary purpose of this pilot investigation was to determine the type of physical activity support delivered by three HCPs types (physician, nurse, other HCP) to patients with type 2 diabetes, and to compare the supports reported by HCPs to the supports perceived by adult patients with type 2 diabetes. A secondary aim was to determine HCP awareness, knowledge and use of the CDA physical activity guidelines and CPAG.
Section snippets
Research design
This study was reviewed by the research ethics board of the investigator's university and was given access approval by the local regional health authority. In Part A of the project, HCPs from interprofessional primary care clinics answered the HCP Physical Activity Support Questionnaire (PASQ) in person to determine the type of physical activity supports (Behaviour Change, Assessment/Prescription, Information/Referrals/Community Resources) normally provided to a patient with type 2 diabetes. A
Clinic characteristics
Eight of a possible 14 clinics located in the regional health authority agreed to take part in the study. Four clinics declined to participate due to other clinical pressures (the H1N1 pandemic) and 2 did not respond to repeated telephone messages. The number of HCPs and patients interviewed from each clinic are outlined in Table 1.
Demographic characteristics
The demographic characteristics of the HCPs and patients are outlined in Table 2 and Table 3. The types of HCPs included in the study were: dietitians, social
Discussion
In this study, we found that both unprompted and prompted, there was no significant difference in the type of physical activity support (subcategories and overall) delivered by physicians, nurses and other HCPs. There was, however, a significant difference in 2 individual support items reported by HCPs, and between patient perceived physical activity support and HCP reported physical activity support. Additionally, awareness of the CDA and CPAG guidelines was relatively high, but overall,
Acknowledgments
The authors would like to thank all of the clinic staff and patients for taking the time to participate in this study. As well, to the Canadian Institutes of Health Research, the University of Manitoba, and the Asper family for providing financial support for Ms. Hnatiuk during her master's work.
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