JMIR Publications

ABSTRACT

Background:

Background:

Physical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counselling on PA is not common.

Objective:

Objective:

To assess the feasibility of implementing an eHealth tool to support PA counselling by PCPs, and estimate intervention effectiveness on patient PA levels.

Methods:

Methods:

A pragmatic pilot study was conducted using a stepped wedge cluster randomized trial design. The study was conducted at a single primary care clinic, with four pre-existing PCP teams. Adult patients who had a periodic health review (PHR) scheduled during the study period were invited to participate. The eHealth tool involved an electronic survey sent to participants prior to their PHR via email or tablet; data was used to automatically produce tailored resources and a PA prescription in the electronic medical record of intervention arm participants. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at four months post-PHR, measured as Metabolic Equivalent of Task minutes (MET-minutes). Secondary outcomes assessed determinants of PA, including self-efficacy and intention to change based on Health Action Process Approach (HAPA) behaviour change theory.

Results:

Results:

1028 patients belonging to 34 physicians were invited to participate and 530 (51.6%) consented (intervention n=296, control n=234). Of the participants who completed a process evaluation, almost half (88/178 or 49.4%) stated they received a physical activity prescription, with only 42 receiving the full intervention including tailored resources. A cluster-level linear regression analysis yielded a non-statistically significant positive difference in MET minutes reported per week at follow-up between intervention and control conditions (mean difference 1027, 95% CI -155 to 2209; p=.09). No statistically significant differences were observed for secondary outcomes.

Conclusions:

Conclusions:

Our results suggest that it is feasible to build an eHealth tool that screens and provides tailored resources for PA in a primary care setting but sub-optimal intervention fidelity suggests greater work must be done to address physician barriers to resource distribution. Participant responses to the primary effectiveness outcome (MET-minutes) were highly variable, reflecting a need for more robust measures of PA in future trials to address limitations in patient-reported data. Clinical Trial: Trial Registration: Registered on ClinicalTrials.gov as NCT03181295.