Physical activity counseling intervention at a federally qualified health center: improves autonomy-supportiveness, but not patients' perceived competence

Abstract

Objective: To assess the effect of a pilot intervention to promote clinician-patient communication about physical activity on patient ratings of their perceived competence for physical activity and their clinicians' autonomy-supportiveness.

Methods: Family medicine clinicians (n=13) at two urban community health centers were randomized to early or delayed (8 months later) communication training groups. The goal of the training was to teach the 5As (Ask, Advise, Agree, Assist, Arrange) for physical activity counseling. Outcome measures were changes in patient perceptions of autonomy support (modified Health Care Climate Questionnaire, mHCCQ) and perceived competence (Perceived Competence Scale for physical activity, PCS) completed via surveys at baseline, post-intervention and six-month follow-up.

Results: Patients (n=326) were mostly female (70%) and low income. Using a generalized estimating equations model (GEE) with patients nested within clinician, patient perceived autonomy support increased at post-intervention compared to baseline (mean HCCQ scores 3.68-4.06, p=0.03). There was no significant change in patient perceived competence for physical activity.

Conclusions: A clinician-directed intervention increased patient perceptions of clinician autonomy support but not patient perceived competence for physical activity.

Practice implications: Clinicians working with underserved populations can be taught to improve their autonomy supportiveness, according to patient assessments of their clinicians.

Trial registration: ClinicalTrials.gov NCT01419093.

Keywords: Autonomy-supportiveness; Counseling intervention; Physical activity.

Conflict of interest statement

Conflict of Interest: The authors report no conflicts of interest and have no financial interests in the content of this manuscript.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1. Participant flow through study (CONSORT Diagram)

*note the patients are not mutually inclusive across groups nor intervention points. The n for each time point are independent from each other.

Figure 2. Participants’ sources of support and resources for physical activity* (n=326)

*Responses are to a single open-ended question, “What sources of support, resources, or inner qualities do you have that can help you improve your physical activity?”

Figure 3. Participants’ barriers and challenges to physical activity* (n=326)

*Responses are to a single open-ended question, “What do you find most difficult or challenging to improving your physical activity/exercise habits?”