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The Journal of the American Board of Family Medicine 21 (2): 118-127 (2008)
DOI: 10.3122/jabfm.2008.02.070117
© 2008 American Board of Family Medicine
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Original Research

Clinician-Patient Communication About Physical Activity in an Underserved Population

Jennifer K. Carroll, MD, MPH, Kevin Fiscella, MD, MPH, Sean C. Meldrum, MS, Geoffrey C. Williams, MD, PhD, Christopher N. Sciamanna, MD, MPH, Pascal Jean-Pierre, PhD, Gary R. Morrow, PhD, MS and Ronald M. Epstein, MD

Department of Family Medicine (KF, SCM, PJ-P, RME), University of Rochester, New York
Cancer Center (JKC, KF, PJ-P, GRM, RME), University of Rochester, New York
Department of Internal Medicine (GCW), University of Rochester, New York
Division of General Internal Medicine, Penn State College of Medicine (CNS)

Correspondence: Corresponding author: Jennifer Carroll, MD, MPH, University of Rochester School of Medicine, Family Medicine Research Programs, 1381 South Avenue, Rochester, NY 14620 (E-mail: Jennifer_Carroll{at}URMC.Rochester.edu)

Background: The 5A (Ask, Advise, Agree, Assist, Arrange) model, used to promote patient behavior changes in primary care, can also be applied to physical activity. Our goal was to assess primary care physicians' use of the 5A model in discussions with underserved populations about physical activity.

Methods: We analyzed 51 audio-recorded, transcribed office visits on randomly selected patient care days and after-visit patient surveys with adults in 2 community health centers in Rochester, New York.

Results: The patient sample was 51% African-American and predominantly female (70%), with the majority having a high school-level education or less (66%) and an annual household income <$39,000 (57%). Physical activity was discussed during 19 of the 51 visits, which included 16 (84%) visits with "Ask"; 10 (53%) with "Advise"; 4 (21%) with "Agree"; 5 (26%) with "Assist"; and 0 with "Arrange" statements. Most discussions of physical activity contained several Ask or Advise statements but few Agree, Assist, or Arrange statements.

Conclusion: Communication about physical activity that included Agree, Arrange, and Assist statements of the 5A model was infrequent. Health promotion interventions in underserved populations should target these steps and prompt patients to initiate communication to improve physical activity.




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