Physical activity as a treatment in primary health care. The role of the GP and Somali women’s views and levels of physical activity.

Physical inactivity has been identified as the fourth leading risk factor for global mortality and healthcare systems play a major role in increasing physical activity among the population. Physical activity on prescription (PAP) is a non-pharmacological method used in Swedish healthcare to prevent and treat disease. Primary health care is the first level of care, in a strong position to work for increasing physical activity on a primary and secondary level among the population, patients and vulnerable groups. Somali women living in Sweden are vulnerable and susceptible to bad health, due to physical inactivity. The general aim was to increase the numbers of prescribed PAP, investigate GP´s view and use of PAP and to elucidate facilitators and barriers to a physical active lifestyle among Somali women and their actual level of physical activity and inactivity. The thesis comprised four studies with three different designs conducted within primary health care in southern Sweden. The intervention in paper I was to alter routines prescribing PAP. Paper II and III were qualitative focus group studies where GPs views of PAP and Somali women’s views of physical activity were elucidated. In Paper IV Somali women’s physical activity levels were monitored. We found that an increase of PAP prescribed by GPs was possible when involving a physiotherapist to individualize the prescription. GPs see it as their responsibility to optimize the total use of healthcare resources to ensure the best possible access for those in need of care, and thus prescribing PAP is regarded by GPs as a task with low priority that should involve physiotherapists and nurses in the team. Somali women living in Sweden are a vulnerable group susceptible to non-communicable diseases indicating low levels of physical activity and sedentary behaviours. Life post migration gives little incentive to adopt a physically active lifestyle even though physical activity is considered to be a part of health. This thesis indicates that in order for PAP to become everyday practice among GPs there is a need to create routines involving personnel with knowledge of how to individualize the prescription, preferably a physiotherapist. Somali women living in Sweden need individualized, tailored interventions with respect for Somali traditions to meet global guidelines of physical activity

Simplified routines in prescribing physical activity can increase the amount of prescriptions by doctors, more than economic incentives only: an observational intervention study

<p>Abstract</p> <p>Background</p> <p>Physical inactivity is one well-known risk factor related to disease. Physical activity on prescription (PAP) has been shown in some studies to be a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method involves motivational counselling that can be time-consuming for the prescribing doctor and might be a reason why physical activity on prescription is not used more frequently. This study might show a way to make the method of prescribing physical activity more user-friendly. The purpose is to determine whether a change in procedures increases the use of physical activity on prescription, and thus the aim of this study is to describe the methodology used.</p> <p>Results</p> <p>The observational intervention study included an intervention group consisting of one Primary Health Care (PHC) clinic and a control group consisting of six PHC clinics serving 149,400 inhabitants in the County of Blekinge, Sweden.</p> <p>An economic incentive was introduced in both groups when prescribing physical activity on prescription. In the intervention group, a change was made to the process of prescribing physical activity, together with information and guidance to the personnel working at the clinics. Physical therapists were used in the process of carrying out the prescription, conducting the motivational interview and counselling the patient. This methodology was used to minimise the workload of the physician. The chi-2 test was used for studying differences between the two groups. PAP prescribed by doctors increased eightfold in the intervention group compared to the control group. The greatest increase of PAP was seen among physicians in the intervention group as compared to all other professionals in the control group. The economic incentive gave a significant but smaller increase of PAP by doctors.</p> <p>Conclusion</p> <p>By simplifying and developing PAP, this study has shown a concrete way to increase the implementation of physical activity on prescription in general practice, as opposed to what can be gained by an economic bonus system alone. This study indicates that a bonus system may not be enough to implement an evidence-based method.</p

Does physical activity affect risk of revision of total hip arthroplasty? A matched pairs study

Purpose: The purpose of this study was to investigate differences in level of physical activity between patients who underwent revision after surgery with total hip arthroplasty and those who did not. Secondary purposes were to study if level of physical activity, frequency of physical activity, body mass index, sex or age could predict the risk of revision an to find out if patients were sufficiently active. Methods: The patients who had surgery with total hip arthroplasty at any time and required a revision were identified (n = 27) and matched with controls. The primary outcome measure was the University of California Los Angeles activity scale. Secondary outcome measures were risk prediction including body mass index, age, year between total hip arthroplasty and revision, frequency of physical activity, and level of physical activity. Results and conclusions: There were no statistical significant differences for University of California Los Angeles activity scale score between samples (p = .914). 44% Of the participants in the revision group and 33% in the control group were insufficiently active. Level or frequency of physical activity did not increase the risk of revision (OR 0.96 and 0.46), nor did body mass index, age or sex (OR 1.00, 0.98 and 1.00)

Somali women's view of physical activity - a focus group study

Background: Physical inactivity presents a major public health challenge and is estimated to cause six to ten percent of the major non-communicable diseases. Studies show that immigrants, especially women, have an increased risk of non-communicable diseases compared to ethnic Swedes. Somali immigrant women have increased rates of overweight and obesity, low fitness levels and low levels of cardiorespiratory fitness compared to non-immigrant women. These findings suggest that Somali women are at increased risk of developing lifestyle-related diseases. Few studies explore determinants of physical activity among Somali women. The aim of this study was to explore Somali women's views and experiences of physical activity after migration to Sweden. Methods: A qualitative focused ethnographic approach was used in this study. Four focus groups were conducted with twenty-six Somali women ranging from 17 to 67 years of age. Focus group discussions were recorded, transcribed verbatim and analysed using qualitative content analysis. Results: The analysis resulted in four main themes and ten categories: Life in Somalia and Life in Sweden, Understanding and enhancing health and Facilitators and barriers to physical activity. Great differences were seen between living in Somalia and in Sweden but also similarities such as finding time to manage housework, the family and the health of the woman. The extended family is non-existent in Sweden, making life more difficult. Health was considered a gift from God but living a healthy life was perceived as the responsibility of the individual. Misconceptions about enhancing health occurred depending on the woman's previous life experience and traditions. There was an awareness of the importance of physical activity among the participants but lack of knowledge of how to enhance activity on an individual basis. Enhancing factors to an active lifestyle were identified as being a safe and comfortable environment. Conclusions: Some barriers, such as climate, lack of motivation and time are universal barriers to an active lifestyle, but some factors, such as tradition and religion, are distinctive for Somali women. Since traditional Somali life never involves leisure-time physical activity, one cannot expect to compensate for the low daily activity level with leisure-time activity the Swedish way. Immigrant Somali women are a heterogeneous group with individual needs depending on age, education and background. Tailored interventions with respect to Somali traditions are necessary to achieve an actual increase in physical activity among migrant women of Somalian origin

Physical activity on prescription (PAP) from the general practitioner's perspective - a qualitative study

Background: Physical activity on prescription (PAP) is a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method seems to be sparsely used by general practitioners (GPs) and there is limited information about GPs' attitudes to counselling using PAP as a tool. The aim of the study was to explore and understand the meaning of prescribing physical activity from the general practitioner's perspective. Methods: Three focus group interviews were conducted with a purposive sample of 15 Swedish GPs in the south of Sweden. Participants were invited to talk about their experience of using PAP. The interviews were transcribed verbatim, analysed using qualitative content analysis. Results: The analysis resulted in four categories: The tradition makes it hard to change attitude, Shared responsibility is necessary, PAP has low status and is regarded with distrust and Lack of procedures and clear guidelines. Traditionally GPs talk with patients about the importance of an increased level of physical activity but they do not prescribe physical activity as a treatment. Physician's education focuses on the use of pharmaceuticals. The responsibility for patients' physical activity level is shared with other health professionals, the patient and society. The GPs express reservations about prescribing physical activity. A heavy workload is a source of frustration. PAP is regarded with distrust and considered to be a task of less value and status. Using a prescription to emphasize an increased level is considered to be redundant and the GPs think it should be administered by someone else in the health care system. Scepticism about the result of the method was also expressed. Conclusions: There is uncertainty about using PAP as a treatment since physicians lack education in non-pharmaceutical methods. The GPs do not regard the written referral as a prioritized task and rather refer to other professionals in the health care system to prescribe PAP. GPs pointed out a need to create routines and arrangements for the method to gain credibility and become everyday practice among GPs