Adoption and implementation of physical activity and dietary counseling by community health center providers and nurses

Abstract

Background: Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers.

Methods: Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity.

Results: Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered.

Conclusions: A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.

Figures

Figure 1

Provider adoption and implementation of study protocol. The bottom 2 boxes report the number and percentage of encounters where provider counseling was reported (left side) and counseling was audio recorded (right side) relative to the total number of participants seen at that clinic type, by provider degree, and by provider gender.

Figure 2

Nurse adoption and implementation of study protocol. The bottom 2 boxes report the number and percentage of encounters where goal setting occurred (left side; as evidenced by completed goal setting sheets or an audio recording of encounter) and goal setting was audio recorded (right side) relative to the total number of participants seen by clinic type.