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Activating People: Physical activity in the general population and referral schemes among primary health care patients in a Swedish county
Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this thesis the need for physical activity interventions is investigated in a general adult population, the characteristics of physical activity referral (PAR) scheme recipients and referral practitioners, and the effectiveness of PAR in a routine primary health-care (PHC) setting in the county of Östergötland, Sweden. The thesis consists of four papers: three papers are based on a quantitative, uncontrolled prospective PAR study and one paper is based on a population survey in the county of Östergötland, Sweden.

In 2006, only one in four of the adult population, aged 18–84 years, in Östergötland was considered sufficiently active to meet the Swedish national public health recommendations, stated as “30 minutes of moderate physical activity a day”. More than one-third (37%) reported that they hade no intentions to change their physical activity levels, while 36% had thought about change, and 27% were determined to change. Although the individuals felt a large responsibility for their own physical activity, they also believed that this responsibility is partly shared by health-care providers. Among those who wanted to increase their physical activity level, almost one in seven of the total population and one in four among those reporting poor general health, with a BMI over 30 and those who were inactive reported that they wanted support to bring about this change. More than half of them wanted this support from their health-care provider.

During 2004 and 2005, a total of 6300 patients received PARs as part of the Östergötland PAR scheme. Two-thirds of the patients were female and half of the patients were 45–64 years old. The PAR scheme reached a relatively high proportion of physically inactive people. PARrelated statistics, including the numbers of referrals made at individual PHC centres and by different professional categories, showed large differences in prescribing activities, both by patient categories, and by prescribing professionals, indicating great potential for further improvements of this scheme in the future.

Half of the patients (51%) who received PARs were recommended home-based activities, such as walking. Patient follow-up showed that an increase in self-reported physical activity level was achieved by 52% of the patients at the 12-month follow-up. The proportion of inactive patients decreased from 33% at baseline to 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 32% at 12 months. Neither patient age, diagnosis/PAR reason nor the profession of the prescriber were associated with differences in effectiveness. Low activity levels at baseline and homebased activities were significantly associated with increased physical activity at 12 months. Half of the patients (50%) achieved adherence to PARs at the 12-month follow-up, with adherence assessed by simply asking the patients about their adherence to prescribed activity. Patients’ activity levels at baseline (being at least somewhat physically active) and being issued home-based activities were significantly associated with higher adherence at 12 months.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 100 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1096
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16825ISBN: 978-91-7393-710-8 (print)OAI: oai:DiVA.org:liu-16825DiVA: diva2:174277
Public defence
2009-03-11, Aulan i Hälsans hus, ingång 16, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-20 Created: 2009-02-20 Last updated: 2017-06-30Bibliographically approved
List of papers
1. Is there a demand for physical activity interventions from health care providers?: Findings from a population survey
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2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 34Article in journal (Refereed) Published
Abstract [en]

Background: Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity.

Methods: A regional public health survey was mailed to 13 440 adults (aged 18-84 years) living in Östergötland County (Sweden) in 2006. The survey was part of the regular effort by the regional Health Authorities.

Results: About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37%) had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity) more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support.

Conclusion: These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for their own physical activity levels, but also attribute responsibility for promoting increased physical activity to health care practitioners.

Keyword
Exercise, public health, health survey, health behaviour, lifestyle
National Category
Public Health, Global Health, Social Medicine and Epidemiology Environmental Health and Occupational Health
Identifiers
urn:nbn:se:liu:diva-16816 (URN)10.1186/1471-2458-10-34 (DOI)000275405700002 ()
Note

Original Publication:Matti Leijon, Diana Stark-Ekman, Per Nilsen, Kerstin Ekberg, Lars Walter, Agneta Stahle and Preben Bendtsen, Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey, 2010, BMC PUBLIC HEALTH, (10), 34.http://dx.doi.org/10.1186/1471-2458-10-34Licensee: BioMed Centralhttp://www.biomedcentral.com/

Available from: 2009-02-19 Created: 2009-02-19 Last updated: 2017-12-13Bibliographically approved
2. Physical activity referrals in Swedish primary health care: prescriber and patient characteristics, reasons for prescriptions, and prescribed activities
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2008 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, no 201Article in journal (Refereed) Published
Abstract [en]

Background: Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.

Methods: Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.

Results: During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week.

The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).

Conclusion: Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16823 (URN)10.1186/1472-6963-8-201 (DOI)
Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2017-12-13Bibliographically approved
3. Does a physical activity referral scheme improve the physical activity among routine primary health care patients?
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2009 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 5, 627-636 p.Article in journal (Refereed) Published
Abstract [en]

Physical activity referral (PAR) schemes or concepts occur in varying forms. Because few physical activity intervention studies have been carried out in routine health care settings, it is difficult to translate research findings into daily practice. The aim of this study was to analyze the effectiveness of a PAR scheme implemented in routine primary health care. The study did not include a control group and was based on the ordinary staff's work efforts and follow-up measures. During a 2-year period, 6300 PARs were issued. Effectiveness was measured by an increase in self-reported physical activity. Half of the patients reached reported increased physical activity both at 3 months (49%) and at 12 months (52%). The proportion of inactive patients decreased from 33% at baseline to 17% at 3 months and 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 33% at 3 months and 32% at 12 months. Neither the patient's age nor the profession of the prescriber was associated with differences in effectiveness. The patient's activity level at baseline, the type of physical activity as well as the reason for the prescription were associated with increased physical activity.

Keyword
Exercise, prescription, lifestyle, primary prevention, health promotion, health education, interpersonal relations, health service research
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15609 (URN)10.1111/j.1600-0838.2008.00820.x (DOI)
Note
The definitive version is available at www.blackwell-synergy.com: M. E. Leijon, P. Bendtsen, P. Nilsen, K. Festin, A. Ståhle, Does a physical activity referral scheme improve the physical activity among routine primary health care patients?, 2008, Scandinavian Journal of Medicine and Science in Sports.http://dx.doi.org/10.1111/j.1600-0838.2008.00820.x. Copyright: Blackwell Publishing www.blackwell-synergy.comAvailable from: 2008-11-21 Created: 2008-11-21 Last updated: 2017-12-14Bibliographically approved
4. Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care
Open this publication in new window or tab >>Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care
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2010 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, no 38Article in journal (Refereed) Published
Abstract [en]

Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.

Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.

Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.

Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.

Place, publisher, year, edition, pages
London, UK: BioMed Central, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16824 (URN)10.1186/1471-2296-11-38 (DOI)000279851800001 ()
Note

Original Publication:Matti E. Leijon, Preben Bendtsen, Agneta Stahle, Kerstin Ekberg, Karin Festin and Per Nilsen, Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care, 2010, BMC Family Practice, (11), 38.http://dx.doi.org/10.1186/1471-2296-11-38Licensee: BioMed Centralhttp://www.biomedcentral.com/

Available from: 2009-02-20 Created: 2009-02-20 Last updated: 2017-12-13Bibliographically approved

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