Health Care Providers' Perspectives on Promoting Physical Activity and Exercise in Health Care.

Health care providers (HCPs) are entrusted with providing credible health-related information to their patients/clients. Patients/clients who receive physical activity and exercise (PAE) advice from an HCP typically increase their PAE level. However, most HCPs infrequently discuss PAE or prescribe PAE, due to the many challenges (e.g., time, low confidence) they face during regular patient care. The purpose of this study was to ascertain HCPs' perspectives of what could be done to promote PAE in health care. HCPs (n = 341) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices and ideas to promote PAE. The sample consisted of 114 physicians, 114 exercise professionals, 65 dietitians, and 48 nurses. Quantitative textual analysis (frequency of theme ÷ number of respondents) was performed to identify common themes to promote PAE in health care. In the pooled sample, the primary theme cited was to increase the availability of community programs (24.1% of respondents), followed by more educational opportunities for providers (22.5%), greater promotion of PAE from HCPs (17.1%), reducing financial barriers experienced by patients/clients (16.3%), and increasing availability of qualified exercise professionals (15.0%). Altogether, increased PAE education and greater availability of affordable community PAE programs incorporating qualified exercise professionals, would reduce barriers preventing routine PAE promotion and support the promotion of PAE in Nova Scotia.

Physical Activity Counselling and Exercise Prescription Practices among Dietitians Across Nova Scotia.

The purpose of this study was to assess the perceptions and practices around physical activity counselling and exercise prescription of dietitians in Nova Scotia. Dietitians (n = 95) across Nova Scotia completed an online self-reflection survey regarding their current physical activity and exercise (PAE) practices. Most (51%; n = 48) reported no previous PAE educational training. Dietitians infrequently prescribed exercise to their patients (16% ± 26% of appointments) or provided PAE referrals (17% ± 24%). Dietitians reported moderate confidence (57% ± 21%) performing PAE counselling and included PAE-related content in half of patient appointments (52% ± 31%). Almost all respondents (95%) identified interest in further PAE education or training. Open-ended responses also demonstrated the need for community-based exercise programs (28% of providers) and qualified exercise professionals to refer to (25%). Overall, dietitians report rarely providing patients with written exercise prescriptions or referrals to other professionals for PAE content but do frequently include PAE in patient appointments. Dietitians in Nova Scotia are well positioned to promote PAE, but more educational training and improved referral systems to qualified exercise professionals or community exercise programs is strongly desired. Exercise professionals and dietitians should concurrently advocate for these changes and collaborate to help more patients lead physically active lifestyles.

Perceptions and Practices of Providing Physical Activity Counselling and Exercise Prescriptions among Physiotherapists in Nova Scotia.

Purpose: We assessed the perceptions and practices of physical activity counselling and exercise prescription of physiotherapists in Nova Scotia. Method: A total of 146 physiotherapists in Nova Scotia completed an online self-reflection survey regarding their current practice of, confidence in, barriers to, and facilitators of providing physical activity and exercise (PAE) counselling to their patients. Results: Physiotherapists included physical activity counselling and exercise content in 85% of patient counselling appointments. They reported a high level of confidence (> 90%) in providing PAE information and answering patients' PAE questions and moderate confidence in their patients' abilities to maintain PAE over the long term (73%) and to follow through on their PAE recommendations (66%). Patients' interest in PAE was the greatest barrier to providing PAE counselling. The physiotherapists reported being most comfortable when prescribing exercise for patients with musculoskeletal conditions and least comfortable with patients with cancer, insulin-dependent diabetes, and respiratory conditions. Most physiotherapists (71%) reported being interested in pursuing further education or training in PAE counselling and prescription. Conclusions: The physiotherapists frequently recommended PAE to their patients, had moderate confidence in their patients' ability to follow through on their advice, and experienced patients' disinterest in PAE as the greatest barrier to providing PAE counselling. The results of this study suggest a desire by physiotherapists for educational training opportunities, which we recommend be focused on providing behavioural strategies and further information to help overcome patient-focused barriers; this will help patients adopt and maintain physically active lifestyles.

Objectif : évaluer les perceptions et les pratiques des physiothérapeutes de la Nouvelle-Écosse en matière de conseils sur l'activité physique et de prescription d'exercice. Méthodologie : au total, 146 physiothérapeutes de la Nouvelle-Écosse ont rempli un sondage d'autoréflexion en ligne sur les conseils qu'ils donnent à leurs patients en matière d'activité physique et d'exercice (APE) à leurs patients, leur confiance, les obstacles et les incitations à cet égard. Résultats : les physiothérapeutes incluaient des conseils en matière d'activité physique et un contenu d'exercice lors de 85 % des rendez-vous de conseils aux patients. Ils déclaraient un taux de confiance élevé (> 90 %) quant à l'information en matière d'APE et aux réponses aux questions des patients à ce sujet, et un taux de confiance modéré envers les capacités de leurs patients à maintenir leur APE à long terme (73 %) et à donner suite à leurs recommandations en matière d'APE (66 %). L'intérêt des patients envers l'APE était le principal obstacles aux conseils sur l'APE. Les physiothérapeutes ont déclaré être plus à l'aise de prescrire des exercices aux patients ayant des affections musculosquelettiques, mais moins à l'aise auprès des patients atteints de cancer, de diabète insulinodépendant et de troubles respiratoires. La plupart des physiothérapeutes (71 %) déclaraient souhaiter poursuivre leur formation sur les conseils et la prescription d'APE. Conclusions : les physiothérapeutes recommandaient fréquemment l'APE à leurs patients, avaient une confiance modérée dans les capacités de leurs patients à donner suite à leurs conseils et trouvaient que le désintérêt de leurs patients envers l'APE était le principal obstacle aux conseils en matière d'APE. Selon les résultats de cette étude, les physiothérapeutes souhaitent pouvoir suivre des formations. Les auteurs recommandent qu'elles portent sur des stratégies comportementales et sur l'information plus approfondie pour vaincre les obstacles liés aux patients, car ces stratégies aideront les patients à adopter et à maintenir un mode de vie actif.

The effects of previous educational training on physical activity counselling and exercise prescription practices among physicians across Nova Scotia: a cross-sectional study.

BACKGROUND: Physicians (MDs) report difficulty including physical activity (PA) and exercise (PAE) as part of routine care. MDs who report previous educational training in PAE may prescribe exercise more frequently. We evaluated the effects of previous training on perceptions and practices of PA counselling and exercise prescriptions among MDs in Nova Scotia. METHODS: MDs (n=174) across Nova Scotia completed an online self-reflection survey regarding their current PAE practices. MDs who reported previous training (n=41) were compared to those who reported no training (n=133). RESULTS: Trained-MDs were 22% more confident performing PA counselling than untrained-MDs (p<0.005). In patient appointments, trained-MDs included PAE more often (51% vs 39%; p=0.03) but trained-MDs and untrained-MDs had similar rates of exercise prescriptions (12%; p>0.05). The most impactful barriers (on a scale of 1 to 4) were lack of time (2.5) and perceived patient interest (2.4), which were unaffected by previous training (p>0.05). CONCLUSION: Previous training was associated with a higher confidence to include PAE discussions with patients by MDs in Nova Scotia, but had minimal influence on their many barriers that prevent exercise prescription. Although some training supports MDs inclusion of PAE into their practice, there is a need for greater, more intensive educational training to assist MDs in prescribing exercise.

Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project.

BACKGROUND: Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. OBJECTIVE: The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. DESIGN: A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. SETTING AND PARTICIPANTS: The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. INTERVENTION: A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. MEASUREMENTS: Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. RESULTS: The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a "champion" was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. CONCLUSIONS: Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy.

Action planning for daily mouth care in long-term care: the brushing up on mouth care project.

Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.

Six essential roles of health promotion research centres: the Atlantic Canada experience.

Over the past 20 years, the federal government and universities across Canada have directed resources towards the development of university-based health promotion research centres. Researchers at health promotion research centres in Canada have produced peer-reviewed papers and policy documents based on their work, but no publications have emerged that focus on the specific roles of the health promotion research centres themselves. The purpose of this paper is to propose a framework, based on an in-depth examination of one centre, to help identify the unique roles of health promotion research centres and to clarify the value they add to promoting health and advancing university goals. Considering the shifting federal discourse on health promotion over time and the vulnerability of social and health sciences to changes in research funding priorities, health promotion research centres in Canada and elsewhere may need to articulate their unique roles and contributions in order to maintain a critical focus on health promotion research. The authors briefly describe the Atlantic Health Promotion Research Centre (AHPRC), propose a framework that illustrates six essential roles of health promotion research centres and describe the policy contexts and challenges of health promotion research centres. The analysis of research and knowledge translation activities over 15 years at AHPRC sheds light on the roles that health promotion research centres play in applied research. The conclusion raises questions regarding the value of university-based research centres and challenges to their sustainability.