Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors

Abstract

BackgroundThe aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil.MethodsA phone survey was carried out in 2011 with professionals working in primary health care in Brazil. The target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. The overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses.ResultsThe prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. In the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient’s physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). In the stratified analysis, only assessing patient’s physical activity was a significant correlate among physicians whereas assessing patient’s physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses.ConclusionsPhysicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units.

Promoção da atividade física e da alimentação saudável e a saúde da família em municípios com academia da saúde

“…ese professionals have been pointed out as being extremely relevant for health promotion in the SUS. A survey done with a sample of professionals working in primary health units in Brazil in 2011 showed that doctors and nurses considered physical education professionals as the main professionals responsible for promoting physical activity within the teams 24 . A recent systematic review study emphasized the increase in the participation of physical education professionals in the actions carried out in the scope of primary health care in Brazil 25 .…”

“…Most of the interventions to promote physical activity performed in primary health units in Brazil are already coordinated by physical education professionals 32 . Health managers and professionals working in primary health care also recognize physical education professionals as very important in actions to promote physical activity in SUS 24,34 . Regarding healthy eating, it was observed that food and nutritional surveillance was advanced in the SUS 35 .…”

Description of health promotion actions in Brazilian cities that received funds to develop “Academia da Saúde” program

“…Only 25% of the cities had plan for training health professionals for develop the actions in "Academia da Saúde". Studies conducted with health professionals in Brazil showed that knowledge is important for physical activity and healthy food promotion in primary health care units 26,27 . The food guide for Brazilian population and book about physical activity promotion in primary health care settings can be good instruments for training these professionals 28,29 .…”

“…For example, Florindo et al 10 showed that nutritionists and physical education professionals are very important for promotion healthy food and physical activity in these cities with "Academia da Saúde" 10 . And survey conducted in primary health care settings in Brazil showed that physicians and nurses are important for physical activity promotion 26 . However, is necessary improve actions for training these professionals.…”

Avaliação da efetividade da promoção da atividade física por agentes comunitários de saúde em visitas domiciliares

“…O Ministério da Saúde, por meio do Sistema Único de Saúde (SUS), tem investido em ações de promoção da atividade física 19 e o cenário atual é promissor na opinião de médicos e enfermeiros que atuam na Atenção Básica que consideram importante promover atividade física nas UBS 20 . No entanto, os ACS ainda são pouco envolvidos como atores importantes na promoção da atividade física no Brasil, apesar de seu potencial por possuírem características de atuação singulares e manterem contato frequente com as pessoas da comunidade, dada que a maior parte das suas ações é realizada extraunidade.…”