The Physical Activity Counseling randomized controlled trial integrated a physical activity (PA) counselor into a primary care practice to provide intensive counseling to sedentary patients following brief counseling from their regular health care provider. This article presents the voices of 15 patients, who through a series of 3 interviews, described their experience with this 3-month combined provider PA counseling intervention. Patient satisfaction was a dominant emergent theme, and the patients were particularly positive about the quality of care and educational support for lifestyle change. They favored the tailored approach and felt the strategies for overcoming PA barriers were helpful.
IntroductionMore women experience cardiac pain related to coronary artery disease and cardiac procedures compared with men. The overall goal of this programme of research is to develop an integrated smartphone and web-based intervention (HEARTPA♀N) to help women recognise and self-manage cardiac pain.Methods and analysisThis protocol outlines the mixed methods strategy used for the development of the HEARTPA♀N content/core feature set (phase 2A), usability testing (phase 2B) and evaluation with a pilot randomised controlled trial (RCT) (phase 3). We are using the individual and family self-management theory, mobile device functionality and pervasive information architecture of mHealth interventions, and following a sequential phased approach recommended by the Medical Research Council to develop HEARTPA♀N. The phase 3 pilot RCT will enable us to refine the prototype, inform the methodology and calculate the sample size for a larger multisite RCT (phase 4, future work). Patient partners have been actively involved in setting the HEARTPA♀N research agenda, including defining patient-reported outcome measures for the pilot RCT: pain and health-related quality of life (HRQoL). As such, the guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols (SPIRIT-PRO) are used to report the protocol for the pilot RCT (phase 3). Quantitative data (eg, demographic and clinical information) will be summarised using descriptive statistics (phases 2AB and 3) and a content analysis will be used to identify themes (phase 2AB). A process evaluation will be used to assess the feasibility of the implementation of the intervention and a preliminary efficacy evaluation will be undertaken focusing on the outcomes of pain and HRQoL (phase 3).Ethics and disseminationEthics approval was obtained from the University of Toronto (36415; 26 November 2018). We will disseminate knowledge of HEARTPA♀N through publication, conference presentation and national public forums (Café Scientifique), and through fact sheets, tweets and webinars.Trial registration numberNCT03800082.
This article presents a case study of a community-university physical activity initiative in which the author operated as a change agent responsible for facilitating community intersectoral collaboration, capacity, and autonomy. Change agents in community-institution initiatives typically work with communities or organizations to initiate and maintain a change effort. Using a first-person, insider action research approach, the change agent examined a set of dilemmas and dynamics she faced throughout the course of the initiative, and framed these in terms of tensions occurring along three continuums: (1) process-product, defined by the challenge of finding a balance between building capacity and delivering concrete and timely results; (2) insider-outsider, linked to the duality of roles of the change agent and community partners, and ensuing conflicts of identity, territory, loyalty, and accountability; and (3) bottom-up/top-down, associated with the difficulty of respecting local circumstances and needs while simultaneously operating within set parameters. The author critically reflects on the role of institutions involved as partners in community-institution initiatives, and draws attention to the complexity of the change agent's role in such initiatives. Recommendations for practice are offered, including the need for communityinstitution initiatives to provide sufficient time and resources for community capacity-building processes to develop, properly support change agents in their multiple roles and core functions, and develop their own capacities to engage in community capacity-building and change.
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