Top

Published in:

Open Access 01-12-2018 | Research article

Promoting physical activity through primary health care: the case of Catalonia

Authors: Angelina Gonzalez-Viana, Mariona Violan Fors, Conxa Castell Abat, Maica Rubinat Masot, Laura Oliveras, Juanjo Garcia-Gil, Antoni Plasencia, Carmen Cabezas Peña, PAFES working group

Published in: BMC Public Health | Issue 1/2018

Abstract

Background

In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors).

Methods

The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance).

Results

PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a “healthy route” (Reach). The proportion of patients with at least one cardiovascular risk factor who were “sufficiently active” increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance).

Conclusions

In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.

Morris JN. Exercise in the prevention of coronary heart disease: today’s best buy in public health. Med Sci Sports Exerc. 1994;26(7):807–14.CrossRefPubMed

Lee I-M, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; https://doi.org/10.1016/S0140-6736(12)61031-9.

Sallis JF, Bull F, Guthold R, Heath GW, Inoue S, Kelly P, et al. Progress in physical activity over the Olympic quadrennium. Lancet. 2016; https://doi.org/10.1016/S0140-6736(16)30581-5.

Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet. 2012; https://doi.org/10.1016/S0140-6736(12)60646-1.

Ding D, Lawson KD, Kolbe-Alexander TL, Finkelstein EA, Katzmarzyk PT, van Mechelen W, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016; https://doi.org/10.1016/S0140-6736(16)30383-X.

Ng SW, Time Use PBM. Physical Activity: A Shift Away from Movement across the Globe. Obes Rev. 2013; https://doi.org/10.1111/j.1467-789X.2011.00982.x.

World Health Organization. Global strategy on diet, physical activity and health. Geneve: World Health Organization; 2004. http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf. Accessed 9 Feb 2018

Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka S, et al. Evidence-based intervention in physical activity: lessons from around the world. Lancet. 2012; https://doi.org/10.1016/S0140-6736(12)60816-2.

Abioye AI, Hajifathalian K, Danaei G. Do mass media campaigns improve physical activity? a systematic review and meta-analysis. Arch Public Heal. 2013; https://doi.org/10.1186/0778-7367-71-20.

10.

Brown DR, Soares J, Epping JM, Lankford TJ, Wallace JS, Hopkins D, et al. Stand-alone mass media campaigns to increase physical activity: A community guide updated review. Am J Prev Med. 2012; https://doi.org/10.1016/j.amepre.2012.07.035.

11.

Hajna S, Ross NA, Brazeau A-S, Bélisle P, Joseph L, Dasgupta K. Associations between neighbourhood walkability and daily steps in adults: a systematic review and meta-analysis. BMC Public Health. 2015; https://doi.org/10.1186/s12889-015-2082-x.

12.

de Souto Barreto P. Prescription of physical activity. Lancet. 2013; https://doi.org/10.1016/S0140-6736(13)61019-3.

13.

Richards EA, Cai Y. Integrative Review of Nurse-Delivered Physical Activity Interventions in Primary Care. West J Nurs Res. 2015; https://doi.org/10.1177/0193945915581861.

14.

Reis RS, Salvo D, Ogilvie D, Lambert EV, Goenka S, Brownson RC. Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving. Lancet. 2018; https://doi.org/10.1016/S0140-6736(16)30728-0.

15.

Milat AJ, Bauman A, Redman S. Narrative review of models and success factors for scaling up public health interventions. Implement Sci. 2015; https://doi.org/10.1186/s13012-015-0301-6.

16.

Government of Catalonia. Enquesta de salut de Catalunya. Barcelona: Departament de Salut, Generalitat de Catalunya; 2006. http://salutweb.gencat.cat/ca/el_departament/estadistiques_sanitaries/enquestes/esca/resultats_enquesta_salut_catalunya/. Accessed 9 Feb 2018

17.

Official statistics website of Catalonia. population. Barcelona: Generalitat de Catalunya, Institut d’Estadística de Catalunya (IDESCAT). https://www.idescat.cat/?lang=en. Accessed 9 Feb 2018

18.

Green LW. Making research relevant: If it is an evidence-based practice, where’s the practice-based evidence? Fam Pract. 2009; https://doi.org/10.1093/fampra/cmn055.

19.

Glasgow R, Vogt T, Boles S. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–1327. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508772/pdf/amjph00009-0018.pdf. Accessed 9 Feb 2018.

20.

Catalan Health System Observatory. Report of the results center. Primary care: 2015 data. http://observatorisalut.gencat.cat/en/central_de_resultats/informes_cdr/dades_actuals/. Accessed 15 Jun 2016.

21.

Government of Catalonia. Guia de Prescripció de l’Exercici Físic per a la Salut (Guia PEFS). Barcelona: Generalitat de Catalunya; 2007. http://salutpublica.gencat.cat/web/.content/minisite/aspcat/sobre_lagencia/Plans_estrategics/PAFES/arxius/guia_de_prescripcio_d_exercici_fisic_per_a_la_salut__pefs_.pdf. Accessed 9 Feb 2018

22.

Rollnick S, Miller WR. What is Motivational Interviewing? Behav Cogn Psychother. 1995;23(04):325.CrossRef

23.

Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Heal Promot. 1997; https://doi.org/10.4278/0890-1171-12.1.38.

24.

Catherine Woods, Nanette Mutrie, Marian Scott; Physical activity intervention: a Transtheoretical Model-based intervention designed to help sedentary young adults become active, Health Educ Res, Volume 17, Issue 4, 1 2002, Pages 451–460, https://doi.org/https://doi.org/10.1093/her/17.4.451

25.

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Heal Ment Heal Serv Res. 2011; https://doi.org/10.1007/s10488-010-0319-7.

26.

Mompart-Penina A, Medina-Bustos A, Guillén-Estany M, Alcañiz-Zanón M, Brugulat-Guiteras P. CaracterÃ sticas metodolÃ³gicas de la Encuesta de Salud de CataluÃ±a 2006. Medicina ClÃ nica. 2011;137:3–8.CrossRef

27.

Alcañiz-Zanón M, Mompart-Penina A, Guillén-Estany M, Medina-Bustos A, Aragay-Barbany JM, Brugulat-Guiteras P, Tresserras-Gaju R. Nuevo diseÃ±o de la Encuesta de Salud de CataluÃ±a (2010-2014): un paso adelante en planificaciÃ³n y evaluaciÃ³n sanitaria. Gaceta Sanitaria. 2014;28(4):338–40.CrossRefPubMed

28.

Roman-Viñas B, Serra-Majem L, Hagströmer M, Ribas-Barba L, Sjöström M, Segura-Cardona R. International Physical Activity Questionnaire: Reliability and validity in a Spanish population. Eur J Sport Sci. 2010; https://doi.org/10.1080/17461390903426667.

29.

Pardo A, Violán M, Cabezas C, García J, Miñarro C, Rubinat M, et al. Effectiveness of a supervised physical activity programme on physical activity adherence in patients with cardiovascular risk factors. Apunts Med Esport. 2014; https://doi.org/10.1016/j.apunts.2014.02.001.

30.

Constante Beitia C. El Plan de Salud de Cataluña: instrumento transformador del sistema de salud. Med Clin. 2015; https://doi.org/10.1016/S0025-7753(15)30033-6.

31.

Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: A systematic review of use over time. Am J Public Health. 2013; https://doi.org/10.2105/AJPH.2013.301299.

32.

Milat AJ, King L, Newson R, Wolfenden L, Rissel C, Bauman A, Redman S. Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers. Health Res Policy Syst. 2014;12(1).

33.

Aittasalo M, Miilunpalo S, Ståhl T, Kukkonen-Harjula K. From innovation to practice: initiation, implementation and evaluation of a physician-based physical activity promotion programme in Finland. Health Promot Int. 2007;22(1):19–27.CrossRefPubMed

34.

Harrison RA, McNair F, Dugdill L. Access to exercise referral schemes - a population based analysis. J Pub Health. 2005;27(4):326–30.CrossRef

35.

Bull FC, Milton KE. A process evaluation of a "physical activity pathway" in the primary care setting. BMC Public Health. 2010;10(1).

36.

Leijon M, Bendtsen P, Nilsen P, Ekberg K, Ståhle A. Physical activity referrals in Swedish primary health care – prescriber and patient characteristics, reasons for prescriptions, and prescribed activities. BMC Health Serv. Res. [Internet]. 2008;8:201.CrossRef

37.

Kallings LV, Leijon M, Hellénius M-L, Ståhle A. Physical activity on prescription in primary health care: a follow-up of physical activity level and quality of life. Scand. J. Med. Sci. Sports [Internet]. 2007;18:154–61.CrossRef

38.

Leijon ME, Bendtsen P, Nilsen P, Festin K, Ståhle A. Does a physical activity referral scheme improve the physical activity among routine primary health care patients. Scand. J. Med. Sci. Sports [Internet]. 2009;19:627–36.CrossRefPubMed

39.

Leijon ME, Bendtsen P, Ståhle A, Ekberg K, Festin K, Nilsen P. Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care. BMC Fam Pract. [Internet]. 2010;11:38.CrossRef

40.

Kallings LV. The Swedish approach on physical activity on prescription. 2016;6:2008–10.

41.

Murphy SM, Edwards RT, Williams N, Raisanen L, Moore G, Linck P, et al. An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative. J. Epidemiol. Community Health [Internet]. 2012;66:745–53.CrossRefPubMedPubMedCentral

42.

Edwards RT, Linck P, Hounsome N, Raisanen L, Williams N, Moore L, et al. Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial. BMC Public Health [Internet]. 1021;2013 [cited 2014 Aug 27]:13.

43.

Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ. 2003;326:793.CrossRefPubMedPubMedCentral

44.

Hamlin MJ, Yule E, Elliot CA, Stoner L, Kathiravel Y. Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative. Public Health. 2016;140:102–8.CrossRefPubMed

45.

Hotham S. Evaluation of a physical inactivity pilot delivered In Primary Care. Kent; 2016.

46.

Government of Catalonia. Principals resultats de l’Enquesta de salut de Catalunya 2016: Resum executiu. Barcelona: Departament de Salut, Generalitat de Catalunya; 2016. salutweb.gencat.cat/web/.content/home/el_departament/estadistiques_sanitaries/enquestes/resum_executiu_esca_2016.pdf. Accessed 9 Feb 2018

47.

Hinrichs T, Moschny A, Klaassen-Mielke R, Trampisch U, Thiem U, Platen P. General practitioner advice on physical activity: analyses in a cohort of older primary health care patients (getABI). BMC Fam Pract. 2011; https://doi.org/10.1186/1471-2296-12-26.

48.

Eakin E, Brown W, Schofield G, Mummery K, Reeves M. General practitioner advice on physical activity--who gets it? Am J Health Promot. 2007; https://doi.org/10.4278/0890-1171-21.4.225.

49.

Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: Is there enough time for prevention? Am J Public Health 2003;93(4):635–641. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447803/pdf/0930635.pdf. Accessed 9 Feb 2018.

50.

Josyula LK, Lyle RM. Barriers in the implementation of a physical activity intervention in primary care settings: lessons learned. Health Promot Pract. 2013; https://doi.org/10.1177/1524839910392991.

51.

Hebert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med. 2012; https://doi.org/10.1136/bjsports-2011-090734.

52.

Majeed A, Car J, Sheikh A. Accuracy and completeness of electronic patient records in primary care. Fam Pract. 2008; https://doi.org/10.1093/fampra/cmn047.

53.

Grandes G, Sanchez A, Sanchez-Pinilla RO, Torcal J, Montoya I, Lizarraga K, et al. Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med. 2009; https://doi.org/10.1001/archinternmed.2009.23.

54.

Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012; https://doi.org/10.1136/bmj.e1389.

55.

JB S, Skovgaard T, Puggaard L. Exercise on prescription in general practice: a systematic review. Scand J Prim Health Care. 2006; https://doi.org/10.1080/02813430600700027.

56.

Müller-Riemenschneider F, Reinhold T, Nocon M, Willich SN. Long-term effectiveness of interventions promoting physical activity: A systematic review. Prev Med. 2008; https://doi.org/10.1016/j.ypmed.2008.07.006.

57.

Grandes G, Sanchez A, Montoya I, Ortega Sanchez-Pinilla R, Torcal J. Two-year longitudinal analysis of a cluster randomized trial of physical activity promotion by general practitioners. PLoS One. 2011; https://doi.org/10.1371/journal.pone.0018363.

58.

Government of Catalonia. Resultats de l’Enquesta de Salut de Catalunya 2015. Barcelona: Departament de Salut, Generalitat de Catalunya; 2015. http://salutweb.gencat.cat/web/.content/home/el_departament/estadistiques_sanitaries/enquestes/esca_2015.pdf. Accessed 9 Feb 2018

59.

Sallis J, Owen N. Ecological models. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behaviour and Health Education: Theory, Research and Practice. Boston: Jossey-Bass; 1997. p. 403–24.

60.

Palacios-Ceña R, Fernandez-de-las-Peñas C, Hernández-Barrera V, Jiménez-Garcia R, Alonso-Blanco C, Carrasco-Garrido P. Sports participation increased in Spain: a population-based time trend study of 21 381 adults in the years 2000, 2005 and 2010. Br J Sports Med. 2012; https://doi.org/10.1136/bjsports-2012-091076.

61.

Pearce J, Mann MK, Jones C, van Buschbach S, Olff M, Bisson JI. The most effective way of delivering a Train-the-Trainers program: a systematic review. J Contin Educ Health Prof. 2012;32(3):215–26.CrossRefPubMed

62.

Balasubramanian BA, Cohen DJ, Clark EC, Isaacson NF, Hung DY, Dickinson LM, et al. Practice-Level Approaches for Behavioral Counseling and Patient Health Behaviors. Am J Prev Med. 2008; https://doi.org/10.1016/j.amepre.2008.08.004.

63.

Huijg JM, van der Zouwe N, Crone MR, Verheijden MW, Middelkoop BJC, W A G. Factors Influencing the Introduction of Physical Activity Interventions in Primary Health Care: a Qualitative Study. Int J Behav Med. 2014; https://doi.org/10.1007/s12529-014-9411-9.

64.

Matsudo SM, Matsudo VKR, Andrade DR, Araújo TL, Pratt M. Evaluation of a physical activity promotion program: The example of Agita São Paulo. Eval Program Plann. 2006; https://doi.org/10.1016/j.evalprogplan.2005.12.006.

65.

Bauman A, Mclean G, Hurdle D, Walker S, Boyd J, Van I, et al. Evaluation of the national 'Push Play' campaign in New Zealand--creating population awareness of physical activity. N Z Med J. 2003;116(1179):U535.PubMed

66.

Brown C, Lilford R. Cross sectional study of performance indicators for English Primary Care Trusts: testing construct validity and identifying explanatory variables. BMC Health Serv Res. 2006; https://doi.org/10.1186/1472-6963-6-81.

67.

Pencheon D. The Good Indicators Guide: Understanding how to use and choose indicators. Coventry: NHS Institute for Innovation and Improvement and The Association of Public Health Observatories; 2017. https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/The-Good-Indicators-Guide.pdf. Accessed 9 Feb 2018

68.

Gagliardi AR, Faulkner G, Ciliska D, Hicks A. Factors contributing to the effectiveness of physical activity counselling in primary care: a realist systematic review. Patient Educ Couns. 2015; https://doi.org/10.1016/j.pec.2014.11.020.

69.

Centre for Economic and Business Research (Cebr). The economic cost of physical inactivity in Europe. Copenhagen: International Sport and Culture Association (ISCA); 2015. http://inactivity-time-bomb.nowwemove.com/download-report/The Economic Costs of Physical Inactivity in Europe (June 2015).pdf Accessed 9 Feb 2018

70.

Levi J, Segal L, Juliano C. Prevention for a Healthier America: Investments in disease prevention yield significant savings, stronger communities. Washington: Trust for America’s Health; 2009. http://healthyamericans.org/reports/prevention08/Prevention08.pdf. Accessed 9 Feb 2018

71.

Centers for Disease Control and Prevention (CDC). A sustainability planning guide for healthy communities. Atlanta: Divission of Community Health, National Center for Chonic Disease Prevention and Health Promotion. https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/pdf/sustainability_guide.pdf. Accessed 9 Feb 2018

72.

Scheirer MA, Dearing JW. An agenda for research on the sustainability of Public Health Programs. Am J Public Health. 2011; https://doi.org/10.2105/AJPH.2011.300193.

73.

Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374(9686):315–23.CrossRefPubMed

74.

Bezruchka S. The effect of economic recession on population health. Can Med Assoc J. 2009;181(5):281–5.CrossRef

75.

Dykema J, Jones NR, Stevenson J, Piche T. Surveying Clinicians by Web: Current Issues in Design and Administration. Eval Health Prof. 2013; https://doi.org/10.1177/0163278713496630.

76.

Cho YI, Johnson TP, Vangeest JB. Enhancing Surveys of Health Care Professionals : A Meta-Analysis of Techniques to Improve Response. 2013; https://doi.org/10.1177/0163278713496425.

77.

Harzing A-W. Response rates in international mail surveys: Results of a 22-country study. Int Bus Rev. 1997; https://doi.org/10.1016/S0969-5931(97)00040-1.

78.

Aerny Perreten N, Domínguez-Berjón MF, Astray Mochales J, Esteban-Vasallo MD, Blanco Ancos LM, Lópaz Pérez MA. Tasas de respuesta a tres estudios de opinión realizados mediante cuestionarios en línea en el ámbito sanitario. Gac Sanit. 2012; https://doi.org/10.1016/j.gaceta.2011.10.016.

79.

Van Hecke L, Loyen A, Verloigne M, van der Ploeg HP, Lakerveld J, Brug J, et al. Variation in population levels of physical activity in European children and adolescents according to cross-European studies: a systematic literature review within DEDIPAC. Int J Behav Nutr Phys Act. 2016; https://doi.org/10.1186/s12966-016-0396-4.

80.

Macfarlane DJ, Lee CCY, Ho EYK, Chan KL, Chan D. Convergent validity of six methods to assess physical activity in daily life. J Appl Physiol. 2006; https://doi.org/10.1152/japplphysiol.00336.2006.

81.

Marques A, Sarmento H, Martins J, Saboga Nunes L. Prevalence of physical activity in European adults - Compliance with the World Health Organization’s physical activity guidelines. Prev Med. 2015; https://doi.org/10.1016/j.ypmed.2015.09.018.

82.

Westerterp KR. Assessment of physical activity: A critical appraisal. Eur J Appl Physiol. 2009; https://doi.org/10.1007/s00421-009-1000-2.

Title: Promoting physical activity through primary health care: the case of Catalonia
Authors: Angelina Gonzalez-Viana
Mariona Violan Fors
Conxa Castell Abat
Maica Rubinat Masot
Laura Oliveras
Juanjo Garcia-Gil
Antoni Plasencia
Carmen Cabezas Peña
PAFES working group
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5773-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Promoting physical activity through primary health care: the case of Catalonia

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Erratum to: cluster randomized evaluation of adolescent girls empowerment Programme (AGEP): study protocol

Higher low back and neck pain in final year Swiss health professions’ students: worrying susceptibilities identified in a multi-centre comparison to the national population

Correction to: Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study

Who is in the near market for bicycle sharing? Identifying current, potential, and unlikely users of a public bicycle share program in Vancouver, Canada

Examining the spatiotemporal evolution of vaccine refusal: nonmedical exemptions from vaccination in California, 2000–2013

Healthy offshore workforce? A qualitative study on offshore wind employees’ occupational strain, health, and coping