Accuracy of recall of exercise counseling among primary care patients

doi:10.1016/j.ypmed.2004.02.005

Preventive Medicine

Volume 39, Issue 6, December 2004, Pages 1063-1067

https://doi.org/10.1016/j.ypmed.2004.02.005 Get rights and content

Abstract

Background. In evaluating the efficacy of health care provider counseling to encourage patients to modify health behaviors such as physical activity, it is important to be able to accurately measure the extent of health care provider counseling.

Methods. The Physical Activity Exit Interview (PAEI) is a brief measure of a patient's perception of the content of physical activity promotion counseling received during a visit with his or her physician. Forty-three primary care patients, and their physicians, completed a PAEI following a visit, which was compared to an audiotape of the visit that was coded to identify the physical activity counseling steps taken.

Results. Participants were 67% female, 81.7% white, and had a mean age of 47.1 years. Overall, there was good concordance in the overall number of counseling activities reported between patients and audiotapes (r = 0.47, P < 0.01), patients and physicians (r = 0.51, P < 0.01), and between physicians and audiotapes (r = 0.57, P < 0.01). Significant differences between the three measurement methods (patient exit interview, physician exit interview, audiotape) existed for only 4 of 12 items.

Conclusions. The PAPEI was overall accurate in measuring the content of physical activity counseling, though accuracy differed between items. When discrepancy occurred, it was typically due to patient overreporting of counseling steps.

Introduction

Healthy People 2010 supports increasing the percentage of patients that receive appropriate counseling to modify health behaviors, including smoking, physical activity, and diet. Physicians, however, have typically fallen short of preventive counseling goals [1], [2], [3], [4]. The Healthy People 2010 physical activity goal is to increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 min per day [1]. One way to achieve that goal is to increase the frequency of physician counseling for exercise [1], [5], [6].

Measuring counseling outcomes in primary care-based studies, however, is rarely performed. Two major reasons for this are that (1) counseling measures are not well-validated and (2) studies linking counseling “processes” to more well-validated and clinically meaningful outcomes, such as physical activity behavior, are rare. While some investigators have found that patients can accurately recall counseling activities, if asked soon after the clinical encounter, many studies have documented that patients' recall of events is poor [7], [8], [9], [10], [11], [12], [13].

We set out to develop and test, using audiotape as the measurement criterion, the performance of an instrument designed to measure the major components of exercise or physical activity counseling in a primary care setting. This measure was developed as an outcome measure for an intervention study to increase the quality of appropriate physical activity counseling in primary care settings. This study is novel as it is the first to our knowledge to assess the accuracy of patient and physician recall of physical activity counseling, against a gold standard such as audiotapes. Without a valid instrument, interventions seeking to increase physical activity counseling, in keeping with widely accepted public health goals, will lack a scientific basis for measuring outcomes.

Section snippets

Participants

A convenient sample of internal medicine residents (6) of the Rhode Island Hospital, a major teaching facility of Brown Medical School, and community primary care providers (2) were recruited to participate. Physicians agreed to discuss physical activity for 3–5 min with each patient recruited and were compensated $20 per patient. The physical activity counseling topics covered during the 3–5 min were entirely at the discretion of the physicians. Physicians were instructed to record the entire

Statistical analysis

All data analysis was carried out using SPSS for Windows, version 10.0 (November, 1999). Pearson's (r) correlation coefficients were used to compare the report by patients, physicians and the audiotape coders as to the overall number of counseling topics discussed. Chi-square and analysis of variance testing was used to examine associations between (1) the report by patients, physicians, and the audiotape coders as to whether or not the counseling topic was discussed and (2) patient variables

Overall

Of the 43 patients, the mean age was 47.1 years, 67% (24) were female, 16.3% (7) graduated from college, and 18.6% (8) were nonwhite. Twenty-nine (67%) had a body mass index (BMI) >25.0, 17 (40%) reported a history of high cholesterol, and 15 (35%) reported a history of high blood pressure. On average, the audiotape detected that 7.7 counseling topics were discussed, compared to 9.0 for the patient exit interview and 7.8 for the physician exit interview. On average, the number of discrepancies

Discussion

The present study was designed to examine the concurrent validity of patient report, physician report, and audiotape coding of physician counseling activities for physical activity promotion. The findings suggest that both the patient and physician reports of physical activity counseling have a moderate degree of correlation with an audiotape assessment as the gold standard. With regard to individual items, the present analysis shows that the PAEI was a valid measure for all but four of the

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2018, Social Science and Medicine
Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care.
We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care.
Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate.
We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high.
The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination.
The content of diet and physical activity consultations with older adults in primary care
2014, Patient Education and Counseling
Citation Excerpt :
Surprisingly little research has examined the actual content of lifestyle counseling. Sciamanna and colleagues (2004) conducted a study where all participating physicians were instructed to counsel their patients on physical activity, but the content of that counseling was left up to them [23]. The most common topics physicians counseled on were type of activity recommended, reasons to become active, and past experiences with activity.
Despite numerous benefits of consuming a healthy diet and receiving regular physical activity, engagement in these behaviors is suboptimal. Since primary care visits are influential in promoting healthy behaviors, we sought to describe whether and how diet and physical activity are discussed during older adults’ primary care visits.
115 adults aged 65 and older consented to have their routine primary care visits recorded. Audio-recorded visits were transcribed and diet and physical activity content was coded and analyzed.
Diet and physical activity were discussed in the majority of visits. When these discussions occurred, they lasted an average of a minute and a half. Encouragement and broad discussion of benefits of improved diet and physical activity levels were the common type of exchange. Discussions rarely involved patient behavioral self-assessments, patient questions, or providers’ recommendations.
The majority of patient visits include discussion of diet and physical activity, but these discussions are often brief and rarely include recommendations.
Providers may want to consider ways to expand their lifestyle behavior discussions to increase patient involvement and provide more detailed, actionable recommendations for behavior change. Additionally, given time constraints, a wider array of approaches to lifestyle counseling may be necessary.
Reach and equity of primary care-based counseling to promote walking among the adult population of Spain
2013, Journal of Science and Medicine in Sport
Some controlled trials have shown that brief counseling in primary care settings can increase walking. We examined the prevalence of primary care-based counseling to promote walking and assessed its reach and equity in Spain.
Data were taken from a cross-sectional study conducted in 2008–2010 among 11,951 individuals representative of the non-institutionalized population aged 18-years and older in Spain.
Information on whether advice was received, adherence to advice, and time spent walking was self-reported. Analyses were adjusted for proxies of the need for physical activity (age, subjective health, and classic cardiovascular risk factors, including physical activity other than walking and body mass index), equity (sex and educational level), and factors enabling counseling (use of primary care services).
Overall, 46.2% (95% confidence interval [CI] 45.0–47.4) of adults in Spain received counseling to promote walking. Older adults, those with worse subjective health, lower physical activity, with overweight or obesity, and higher use of primary care services were more likely to be counseled. For equal need, counseling was less frequent in men and those with lower socioeconomic position. A total of 69.2% (95% CI 67.8–70.6) of adults who received counseling reported following it. There was no difference in the time spent walking between those who received and did not receive counseling (+0.4 min/day; 95% CI −0.1 to 0.9).
A substantial proportion of Spanish adults has been encouraged to walk by primary care physician and nurses, but counseling did not translate into longer walking time.
Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling
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Citation Excerpt :
Wilson and McDonald28 found patient report to be an acceptable approach for measuring counseling on smoking and alcohol compared with audiotape assessment. Specific to counseling topics addressed in our study, Sciamanna et al29 demonstrated that adult patients’ report of physical activity counseling immediately after clinical encounters correlated well with audiotape evaluation. Similarly, Pill et al30 found that adult patients’ recall of lifestyle counseling delivered during primary care was reasonably high.
To determine whether parental reports and electronic health record documentation of physician counseling on nutrition and physical activity reflect actual counseling provided.
Participants were parents of 198 children 2 to 12 years of age seen in a primary care pediatric clinic at an academic medical center for well child care and their 38 physicians. Parents completed a post-visit questionnaire to report discussions on weight, nutrition, and physical activity that occurred during the visit. Electronic health records were reviewed to measure documentation of these topics during the visit. Parental reports and records were compared with actual discussions on the basis of coded audiotapes. Counseling was coded as having occurred if specific topics were mentioned during the encounter, however brief this mention was.
A total of 48% of the children were female, they were a mean age of 5.4 years, and 28% were overweight or obese. Sensitivity of parental report was high (63%–96%), but specificity was low (43%–77%) because of parents’ tendency to overreport counseling. Sensitivity of electronic health record documentation was generally low (40%–53%) except for discussion of screen time (92%) and physical activity (88%); the specificity of these data was also poor (42% and 21%, respectively, for screen time and physical activity).
Electronic health record documentation may not be the most valid method of measuring physician counseling on weight, nutrition, and physical activity in pediatric primary care. Parental report via the use of a questionnaire administered immediately after the visit is a better alternative in quality improvement or research studies when resources do not allow for direct observation, with the caveat that parents may overreport whether counseling was provided.
Physical activity supports provided by healthcare providers to patients with type 2 diabetes
2012, Canadian Journal of Diabetes
Citation Excerpt :
These inclusion criteria describe the ideal candidate to receive physical activity support from their HCP and match the case study patient in the HCP interview. The HCP PASQ and the Patient PASQ were developed by the investigators, and are based on the 7A's model (23) and the Physical Activity Exit Interview (24). The questionnaire was devised to answer the research questions specific to this study as there is currently no validated tool to do so.
There is limited evidence around the physical activity support delivered by different types of healthcare providers (HCPs) to patients with type 2 diabetes mellitus. The primary purpose of this study was to determine the type of physical activity support delivered by 3 HCP types, and to compare this support to that perceived by patients with type 2 diabetes. A secondary aim was to describe awareness, knowledge and use of the Canadian Diabetes Association (CDA) physical activity guidelines and Canada's Physical Activity Guide (CPAG).
The HCP and the Patient Physical Activity Support Questionnaire were answered by 48 HCPs and 26 patients from 8 interprofessional primary care clinics specializing in diabetes education.
There was no difference in the type of physical activity support between HCP types, however, there was a difference between overall HCP and patient report of physical activity support (5.29 vs. 2.04 unprompted; 9.90 vs. 6.07 prompted, p<0.001). Approximately half of HCPs used the CDA guidelines and the CPAG in practice.
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Les données sur le soutien à l’activité physique offert par les différents types de fournisseurs de soins de santé (FSS) aux patients ayant le diabète sucré de type 2 sont limitées. Le but premier de cette étude était de déterminer le type de soutien à l’activité physique offert par 3 types de FSS et de comparer ce soutien à la perception des patients ayant le diabète de type 2. Le deuxième but était de décrire la perception, la connaissance et l’utilisation des lignes directrices sur l’activité physique de l’Association canadienne du diabète (ACD) et du Guide d’activité physique canadien (GAPC).
Les questionnaires sur le soutien à l’activité physique du FSS et du patient ont été remplis par 48 FSS et 26 patients de 8 cliniques interprofessionnelles en soins primaires se spécialisant dans l’enseignement sur le diabète.
Il n’y a eu aucune différence dans le type de soutien à l’activité physique entre les différents types de FSS. Cependant, il y a eu une différence entre l’ensemble des FSS et ce que les patients rapportaient sur le soutien à l’activité physique (5,29 vs 2,04 non ponctuel; 9,90 vs 6,07 ponctuel, p < 0,001). Près de la moitié des FSS ont utilisé les lignes directrices de l’ACD et le GAPC dans leur pratique.
Le soutien à l’activité physique est similaire entre tous les types de FSS du milieu interprofessionnel en soins primaires, mais ce soutien est perçu différemment par les patients. Les stratégies pour augmenter certains types de soutien à l’activité physique permettraient un counseling optimal en soins primaires.
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Citation Excerpt :
By using parental report, it is also possible that we could have introduced a desirability bias from parents. However, if that were the case, we would have expected counseling rates to be higher and to have occurred in both phases of the implementation and in both practices.48 Despite our reasonable sample size, the low prevalence of some risk factors may have led to insufficient power to detect true difference between the 2 phases of the study.
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We recruited 264 parents in the pre phase and 242 in the post phase. Among 215 parents whose child had one or more risk factors, parents in the post phase were as likely to report receiving counseling than parents in the pre phase for each of the risk factors: smoking odds ratio 6.75 (95% confidence interval, 0.51, 88.88), dental health odds ratio 1.44 (95% confidence interval, 0.47, 4.41), and sugar-sweetened beverage consumption odds ratio 0.34 (95% confidence interval, 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases.
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Accuracy of recall of exercise counseling among primary care patients

Abstract

Introduction

Section snippets

Participants

Statistical analysis

Overall

Discussion

Am. J. Prev. Med

Prev. Med

Am. J. Prev. Med

Healthy People 2010

Missed opportunities in preventive counseling for cardiovascular disease—United States, 1995

Morb. Mortal Wkly. Rep

Behavioral risk factor surveillance system

Physician recommendations for dietary change: their prevalence and impact in a population-based sample

Am. J. Public Health

Guide to clinical preventive services

Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research

J. Fam. Pract

Accuracy of patient recall of opportunistic smoking cessation advice in general practice