Physical Activity Promotion in Mexican Healthcare Settings: From Knowledge to Action

Abstract

The rising burden of physical inactivity among Mexican adults warrants population wide intervention strategies. The healthcare setting has been recognized as an appropriate place to implement such strategies. Although physician-delivered strategies have been shown to improve patient physical activity (PA), physician counselling, prescription and referral rates remain low. Guided by the Knowledge-to-Action framework, the purpose of this dissertation was to identify gaps in Mexican physician PA prescription practices, to identify a counselling tool for addressing this gap and to implement an intervention for improving physician counselling practices. In study 1, the PA prescription behaviour of Mexican primary care physicians (N=633) and the psychosocial factors influencing this behaviour were explored. Findings showed that only 6% of physicians regularly prescribe PA and that their perceived ability to prescribe, as well as their own PA behaviour, explain this practice. In study 2, the informational (e.g. signage), educational (e.g. posters) and instrumental (e.g. stairs) environments of 40 primary care clinics/hospitals in Guadalajara were assessed for their potential to promote PA. The Healthcare Environment Assessment Tool was developed to assess these environments (kappa=.81). Findings showed that the instrumental environment is encouraging, but the informational and educational environments could be improved. In study 3, a theory-based training intervention to improve PA counselling practices among primary care physicians was developed and evaluated using the RE-AIM framework. The training strategy reached 305 primary care physicians (52% female, mean age 40 years), was effective for improving physicians’ psychosocial constructs in iii the short term and PA counselling practices in the long term, was successfully adopted and consistently implemented across the state of Jalisco and was institutionalized by the Jalisco Secretary of Health. This dissertation demonstrates that knowledge translation efforts in Mexican healthcare settings are feasible and promising for promoting evidence-based PA promotion practices. This dissertation represents the first step in that direction and sheds light on potential approaches for facilitating such efforts.