A qualitative exploration of the experiences of primary care patients engaged in email counseling meant to increase physical activity

Abstract

several recent larger trials in primary care confirm the positive effects of pedometer-based PA counseling, these studies also show that the effectiveness of these interventions is far from optimal (Harris et al., 2015), especially in the long term (Harris et al., 2017; Yates et al., 2017). Therefore, the factors that influence patients' effort to increase and maintain their PA need to be explored and elucidated. Recently, several groups have studied the beliefs, attitudes, behaviors, and experiences of patients participating in PA interventions delivered in a primary care setting (Casey et al., 2014; Wahlich et al., 2017) as well as barriers and facilitators that play a role in changing PA levels (Normansell et al., 2014; Patel, Schofield, Kolt, & Keogh, 2013). Most of these studies used qualitative analysis of interviews with the participants performed after the interventions were completed (Casey et al., 2014; Normansell et al., 2014; Wahlich et al., 2017). While this is a valid and useful approach, it also has its disadvantages as the interviewees might be influenced

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

“…Semi-structured interviews ( n = 22) [ 27 – 29 , 32 , 33 , 35 , 37 , 39 – 42 , 46 , 51 – 54 , 56 – 61 ], structured interviews ( n = 1) [ 31 ], unspecified interviews ( n = 2) [ 36 , 48 ], focus groups ( n = 8) [ 30 , 34 , 38 , 43 , 44 , 47 , 50 , 55 ] and open written responses ( n = 2) [ 45 , 49 ] were used.…”

“…Five studies did not present data to calculate a mean age [ 33 , 39 , 47 , 52 , 57 ]. Forty-six percent of studies were conducted in North America, four diet [ 29 , 30 , 34 , 36 ], eight activity [ 37 – 41 , 43 , 47 , 48 ] and four mixed [ 53 – 55 , 57 ]; 31% in Europe, three diet [ 28 , 31 , 35 ], four activity [ 42 , 44 , 45 , 49 ] and four mixed [ 51 , 58 – 60 ]; 9% Australia, two diet focused [ 27 , 32 ] and one mixed [ 61 ]; 9% East Asia, one activity [ 46 ] and two mixed focused [ 52 , 56 ]; 3% Africa, one activity focused study [ 50 ] and 3% South America, one diet focused [ 33 ]. Seventy-four percent of studies ( n = 26) included both males and females [ 27 – 30 , 32 , 33 , 35 , 38 – 42 , 44 , 45 , 48 , 49 , 51 – 53 , 55 – 61 ].…”

“…Forty-six percent of studies were conducted in North America, four diet [ 29 , 30 , 34 , 36 ], eight activity [ 37 – 41 , 43 , 47 , 48 ] and four mixed [ 53 – 55 , 57 ]; 31% in Europe, three diet [ 28 , 31 , 35 ], four activity [ 42 , 44 , 45 , 49 ] and four mixed [ 51 , 58 – 60 ]; 9% Australia, two diet focused [ 27 , 32 ] and one mixed [ 61 ]; 9% East Asia, one activity [ 46 ] and two mixed focused [ 52 , 56 ]; 3% Africa, one activity focused study [ 50 ] and 3% South America, one diet focused [ 33 ]. Seventy-four percent of studies ( n = 26) included both males and females [ 27 – 30 , 32 , 33 , 35 , 38 – 42 , 44 , 45 , 48 , 49 , 51 – 53 , 55 – 61 ]. Of these, only 14% ( n = 5) had more male participants than female and none of these were diet focused interventions.…”

“…Having a negative attitude towards the intervention or its guidelines hindered adherence. Participants revealed that ‘negative self-perception’ [ 29 , 31 , 33 , 38 , 43 – 46 , 49 , 51 , 52 , 58 ] (lacking self-efficacy or motivation to change behaviors), too many ‘competing priorities’ [ 29 , 31 , 33 , 34 , 38 , 40 , 43 – 49 , 52 , 54 – 56 , 59 , 60 ] (e.g., lack of time), ‘feeling overwhelmed’ [ 29 , 31 , 43 , 47 , 49 , 51 , 52 , 56 – 58 , 61 ] (e.g., previous failure in changing behaviors or not knowing how to start) or being ‘unwilling to change’ [ 29 , 40 , 43 , 45 , 48 ] (e.g., not interested) negatively impacted their attitudes and likelihood of adherence. In interventions with a diet component, ‘inner food cues’ like hunger, food cravings or emotional eating arose as a unique competing priority [ 27 , 29 , 31 , 32 , 34 , 35 , 51 , 56 , 61 ].…”

“…No equivalent discussion of feeling uncontrollable urges to be active or inactive were discussed in activity interventions. Other competing priorities common across all intervention types included ‘work outside of the home’ [ 29 , 33 , 38 , 40 , 44 , 48 , 52 , 54 , 55 , 60 ], ‘work inside the home’ [ 27 , 29 , 33 , 34 , 38 , 43 , 46 – 49 , 55 ] (e.g., caring for others) or unforeseen life events [ 27 , 31 , 46 – 48 , 50 , 61 ] (e.g., moving or travel).…”