Co-producing tools to support integrated primary care discussions and medical curriculum renewal: A mixed methods dissertation to guide implementation of the 24-Hour Movement Guidelines for Adults

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Authors
Morgan, Tami L.
Keyword
movement behaviours , co-production , integrated knowledge mobilization , primary care , medical education , curriculum change
Abstract
Calls for physical activity (PA) promotion in medical practice and education have long populated the literature. Some tools have been integrated into primary care and some content on PA prescription and counselling have graced the medical curriculum in aims of improving health professionals’ knowledge and frequency of, and confidence and skill in, PA promotion. Often, PA is the only movement behaviour emphasized in these initiatives; however, Canada’s 24-Hour Movement Guidelines for Adults (24HMG) now support the health benefits of achieving an optimal combination of three interrelated movement behaviours—PA, sedentary behaviour, and sleep. Further, many of these initiatives have not adequately considered the specific contexts of primary care providers (PCPs) and medical educators, resulting in the need for tools and strategies that better address these knowledge-practice gaps. Mobilizing 24HMG evidence in practice is dependent on individual and contextual factors. Thus, to enhance movement behaviour promotion in primary care and medical education, the barriers, enablers, and complexity inherent in these two contexts must be considered. The overarching objective of this mixed methods dissertation was to enhance the uptake and use of the 24HMG among health professionals in Canada. A co-production approach was taken in all five studies to collaborate with relevant primary care and medical education experts from project outset. The aim of Studies 1-3 was to co-develop a tool for PCPs to implement the 24HMG in their practice. A scoping review followed by a qualitative think-aloud and near-live study and a mixed methods modified Delphi study were conducted. Findings informed the co-development and dissemination of the Whole Day Matters Toolkit for Primary Care. The aim of Studies 4-5 was to co-develop a competency-based curriculum map and integrated mapping process to implement the 24HMG in the local medical curriculum. An environmental scan of the local medical curriculum was performed, followed by a mixed methods modified Delphi study. Findings led to a 24HMG curriculum map, 24HMG objectives, and considerations for engaging in integrated curriculum mapping processes in competency-based education. The results of this dissertation have far-reaching implications including guiding future movement behaviour promotion in medicine, discussion tool development, and competency-based curriculum renewal.
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