Physical activity counselling among GPs: a qualitative study from Thailand

Abstract

Background Physical activity (PA) counselling is an intervention to promote PA among patients in primary care, yet it remains limited in this clinical setting. This study aimed to explore PA counselling practices among general practitioners (GPs), as well as barriers to and recommendations for improving PA counselling. Methods This qualitative study employed a descriptive approach. Data were collected by in-depth interviews and analysed by thematic analysis. The study was conducted in district hospitals in Nakhon Si Thammarat, Thailand, from February 2017 to February 2018. The study participants were GPs who worked at district hospitals. Results Seventeen GPs (6 males and 11 females, mean age 29.8 ± 3.4 years) from 6 district hospitals were interviewed. Their clinical experience ranged from 2 to 12 years (mean 4.7 ± 2.9). The GPs saw 30–80 outpatients/day (mean 56.2 ± 14.1) and spent 1–8 min (mean 3.8 ± 1.8) with each patient. They emphasised PA in patients with poorly controlled non-communicable diseases (NCDs) using the word ‘exercise’ in the Thai language as well as discussing time and frequency of exercise. PA was considered a non-pharmacological treatment in the management of NCDs, which improved patient health and quality of life. Barriers to PA counselling among GPs included time constraints, insufficient knowledge, and lack of opportunities to follow-up previously counselled patients. GPs suggested that training in PA counselling was required. Conclusions GPs concurred that PA counselling is essential in the treatment of NCDs. Physicians’ recommendations to improve the quality of PA counselling in primary care include 3 Ts: training in PA counselling, tools for prescribing PA, and teams of healthcare professionals. Implementing use of written PA prescriptions may encourage patients to increase PA. Multidisciplinary teams should be developed to support PA counselling in the clinical setting. Further studies should focus on appropriate techniques to implement PA counselling and overcome existing barriers.

Overview of Physical Activity Counseling in Primary Care

“…Nevertheless, this component is, sometimes, neglected by counselors. 23) There are several ways to identify the intensity of physical activity (Table 1). 31,41,57,84,85) Time refers to the duration of an activity session.…”

“…Time constraints are a major barrier to PAC, as documented by studies in various settings. 20,23) Specifically, the duration of consultation in primary care varies from 48 seconds in Bangladesh to 22.5 minutes in Sweden. 93) Hence, the implementation of an appropriate proportion of PAC in the primary care consultation is difficult.…”

“…18,19) However, physician-, patient-, and system-based barriers to PAC in primary care have been documented. [20][21][22][23] Moreover, various primary care services contribute to different PAC practices. For example, PAC can be conducted solely by physicians or allied health professionals, or in combination.…”

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review

“…However, challenges of PA counselling and the use of eHealth in PHC are addressed. Time constraint is a key barrier to PA counselling in PHC [ 14 , 15 ]. This factor varies in healthcare settings.…”

“…Implementing PA counselling in PHC is challenging. Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills, and systemic barriers [ 14 – 17 ].…”