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BMC Health Services Research
Published in: BMC Health Services Research 1/2020

Open Access 01-12-2020 | Research article

How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation

Authors: N. Kime, A. Pringle, S. Zwolinsky, D. Vishnubala

Published in: BMC Health Services Research | Issue 1/2020

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Abstract

Background

Physical activity is recognised as important for diabetes management and improved overall health of individuals with diabetes, yet many adults with diabetes are inactive. Healthcare professionals have been identified as key to promoting physical activity, including individuals with diabetes, but are ill-prepared to deliver this. Our paper evaluates the barriers/facilitators of healthcare professionals’ delivery of physical activity guidance to adults with diabetes and aims to inform efforts to investigate and enhance their preparedness to promote physical activity.

Methods

A sequential mixed method, two-phase design was adopted involving a purposeful sample of healthcare professionals. Phase one was an online pilot survey designed to test assumptions around healthcare professionals’ knowledge, training and preparedness to deliver physical activity guidance. Phase two comprised eighteen semi-structured interviews, thematically analysed to provide an in-depth exploration of healthcare professionals’ experiences of delivering physical activity guidance to adults with diabetes.

Results

Healthcare professionals are committed to promoting physical activity to adults with diabetes and are reasonably confident in giving basic, generic guidance. Yet, significant challenges prevent them from achieving this in their practice, including: lack of education and training around physical activity, diabetes and health; ignorance of recommended physical activity and diabetes guidelines; lack of awareness of referral options; limited time and accessibility to appropriate resources. Nevertheless, healthcare professionals believed discussions around physical activity needed to be an integral part of consultations, incorporating improved communication strategies for conveying key physical activity messages.

Conclusions

HCPs have a key role in the promotion of physical activity to people with long-term conditions such as diabetes and they are identified within both the strategic policy context and national interventions for physical activity. Yet, this study indicated that HCPs face multiple and at times complex barriers to physical activity promotion generally and with diabetes patients. Conversely HCPs also reported what works, why and how, when promoting physical activity. Rich information derived from the day-to-day, working healthcare professional is integral to shaping future practices going forward. The bottom up, iterative design adopted in this study provides an approach to tap into this information.
Literature
1.
Sathish T. Diabetes prevention and lifestyle intervention in resource-limited settings. Lancet Diabetes Endocrinol. 2019;7(3):165–7.PubMedCrossRef
2.
3.
Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Barnighausen T, Davies J, Vollmer S. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care. 2018;41:963–70.PubMedCrossRef
4.
Kime N, Pringle A. Exercise and physical activity in people with type 1 diabetes: the importance of behaviour change. Diabetes Res Clin Pract. 2018;138:282–3.PubMedCrossRef
5.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.PubMedPubMedCentralCrossRef
6.
Grenny J, Patterson K, Maxfield D. McMillan R. Switzler A: Influencer - The new science of leading change. New York: McGraw-HIll Education; 2013.
7.
Lewis MA, Fitzgerald TM, Zulkiewicz B, Peinado S, Williams PA. (2017). Identifying synergies in multilevel interventions. Health Educ Behav. 2017;44:236–44.PubMedCrossRef
8.
Blue S, Shove E, Carmona C, Kelly M. Theories of practice and public health: understanding (un)healthy practices. Crit Public Health. 2016;26:36–50.CrossRef
9.
Gill M, Chan-Golston AM, Rice LN, Roth SE, Crespi CM, Cole BL, Koniak-Griffin D, Prelip ML. Correlates of social support and its association with physical activity among young adolescents. Health Educ Behav. 2018;45:207–16.PubMedCrossRef
10.
11.
12.
Campbell M, Kime N, McKenna J. Exercise and physical activity in patients with type 1 diabetes. Lancet Diabetes Endocrinol. 2017;5(7):493.PubMedCrossRef
13.
Physical activity guidelines: UK Chief Medical Officers’ report. A report from the Chief Medical Officers in the UK on the amount and type of physical activity people should be doing to improve their health. September 2019. Department of Health and Social Care, Llwodraeth Cymru Welsh Government, Department of Health Northern Ireland and the Scottish Government.
14.
15.
Kime NH, Pringle AP, Rivett MJ, Robinson PM. Physical activity and exercise in adults with type 1 diabetes: understanding their needs using a person-centered approach. Health Educ Res. 2018;33(5):375–88.PubMedCrossRef
16.
Knight CJ, Lowe R, Edwards M, Yardley JE, Bain SC, Bracken RM. Type 1 diabetes and physical activity: an assessment of knowledge and needs in healthcare practitioners. J Diabetes Nurs. 2016;20(8):271–7.
17.
Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5:377–90.PubMedCrossRef
18.
19.
Bohn B, Herbst A, Pfeifer M, Krakow D, Zimny S, Kopp F, Melmer A, Steinacker JM, Holl RW. DPV initiative. Impact of physical activity on glycemic control and prevalence of cardiovascular risk factors in adults with type 1 diabetes: a cross-sectional multicenter study of 18,028 patients. Diabetes Care. 2015;38:1536–43.PubMedCrossRef
20.
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39:2065–79.PubMedPubMedCentralCrossRef
21.
Pierre-Louis B, Guddati AK, Khyzar Hayat Syed M, Gorospe VE, Manguerra M, Bagchi C, Aronow WS, Ahn C. Exercise capacity as an independent risk factor for adverse cardiovascular outcomes among nondiabetic and diabetic patients. Arch Med Sci AMS. 2014;10:25–32.PubMedCrossRef
22.
Kriska AM, LaPorte RE, Patrick SL, Kuller LH, Orchard TJ. The association of physical activity and diabetic complications in individuals with insulin-dependent diabetes mellitus: the epidemiology of diabetes complications study–VII. J Clin Epidemiol. 1991;44:1207–14.PubMedCrossRef
23.
Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55:542–51.PubMedCrossRef
24.
25.
26.
Eldredge LKB, Markham CM, Ruiter RA, Fernández ME, Kok G, Parcel GS. Planning health promotion programs: an intervention mapping approach. United States: Wiley; 2016.
27.
28.
Pringle A, McKenna J, Zwolinsky S. Linking physical activity and health evaluation to policy: Lessons from UK evaluations. In: Piggin J, Mansfield L, Weed M, editors. Routledge handbook of physical activity policy and practice. Oxen: Routledge, vol. 2018; 2018. p. 425–40.
29.
Creswell J. Qualitative inquiry and research design: choosing among five approaches. Thousand Oaks: Sage; 2012.
30.
31.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
32.
Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. London: Sage; 1994.
33.
Lobelo F, Quevedo IG. The evidence in support of physicians and health care providers as physical activity role models. Am J Lifestyle Med. 2016;10(1):36–52.PubMedCrossRef
34.
Westland H, Koop Y, Schröder CD, Schuurmans MJ, Slabbers P, Trappenburg JC, Vervoort SC. Nurses’ perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study. BMC Fam Pract. 2018;19(1):194.PubMedPubMedCentralCrossRef
35.
Taylor CA, Shaw RL, Dale J, French DP. Enhancing delivery of health behaviour change interventions in primary care: a meta-synthesis of views and experiences of primary care nurses. Patient Educ Couns. 2011;85(2):315–22.PubMedCrossRef
36.
Kennedy A, Rogers A, Bowen R, Lee V, Blakeman T, Gardner C, Morris R, Protheroe J, Chew-Graham C. Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: a qualitative study. Int J Nurs Stud. 2014;51(8):1103–13.PubMedCrossRef
37.
Leenaars KE, Smit E, Wagemakers A, Molleman GR, Koelen MA. Facilitators and barriers in the collaboration between the primary care and the sport sector in order to promote physical activity: a systematic literature review. Prev Med. 2015;81:460–78.PubMedCrossRef
38.
Cuthill JA, Shaw M. Questionnaire survey assessing the leisure-time physical activity of hospital doctors and awareness of UK physical activity recommendations. BMJ Open Sport Exerc Med. 2019;5(1):e000534.PubMedPubMedCentralCrossRef
39.
Lion A, Vuillemin A, Thornton JS, Theisen D, Stranges S, Ward M. Physical activity promotion in primary care: a utopian quest? Health Promot Int. 2018;1:10.
40.
Mutrie N, Standage M, Pringle AR, Smith L, Strain T, Kelly P, Dall P, Milton K, Chalkley A, Colledge N. UK physical activity guidelines: developing options for future communication and surveillance; 2019.
41.
Litchfield I, Narendran P, Andrews R, Greenfield S. Patient and healthcare professionals perspectives on the delivery of exercise education for patients with type 1 diabetes. Front Endocrinol. 2019;10:76.CrossRef
42.
Din NU, Moore GF, Murphy S, Wilkinson C, Williams NH. Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: findings from a process evaluation of the National Exercise Referral Scheme in Wales. Health Educ J. 2015;74:743–57.PubMedCrossRef
43.
Hopkinson Y, Hill DM, Fellows L, Fryer S. 2018. Midwives understanding of physical activity guidelines during pregnancy. Midwifery. 2018;59:23–6.PubMedCrossRef
44.
Shirazipour CH, Tomasone JR, Martin Ginis KA. Enhancing health care professionals’ and trainees’ knowledge of physical activity guidelines for adults with and without SCI. J Spinal Cord Med. 2018;11:1–12.
45.
Dacey ML, Kennedy MA, Polak R, Phillips EM. Physical activity counselling in medical school education: a systematic review. Med Edu Online. 2014;19:24325.CrossRef
46.
Ward M. A Survey of Physical Activity in Medical Curricula: A report of the HEPA in Health Care Settings HEPA Europe Working Group: Copenhagen: HEPA Europe; 2015.
47.
Radenkovic D, Aswani R, Ahmad I, Kreindler J, Robinson R. Lifestyle medicine and physical activity knowledge of final year UK medical students. BMJ Open Sport Exerc Med. 2019;5(1):e000518.PubMedPubMedCentralCrossRef
48.
49.
50.
51.
52.
Vishnubala D, Pringle A, Kime N, Zwolinsky S. The role of nurses in the promotion of physical activity. J Gen Prac Nursing. in press.
53.
54.
55.
56.
BMA, British Medical Association. Feeling the squeeze – the local impact of cuts to public health budgets in England. London: BMA; 2018.
57.
58.
59.
Pringle A, Kime N, Lozano L, Zwolinksy S . Evaluating interventions. In D. Hackfort and R. Schinke (Ed). International Society of Sport Psychology Encyclopaedia. (in press).
60.
Lindqvist M, Persson M, Mogren I. “Longing for individual recognition”– pregnant women’s experiences of midwives’ counseling on physical activity during pregnancy. Sex Reprod Healthc. 2018;15:46–53.PubMedCrossRef
61.
Pringle A, McKenna J, Zwolinsky S. Linking physical activity and health evaluation to policy. England: Routledge Handbook of Physical Activity Policy and Practice; 2017.CrossRef
Metadata
Title
How prepared are healthcare professionals for delivering physical activity guidance to those with diabetes? A formative evaluation
Authors
N. Kime
A. Pringle
S. Zwolinsky
D. Vishnubala
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4852-0

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