Development Of A Physical Activity Assessment Tool For Use In Primary Care

Abstract

Physician counseling has been shown to be modestly effective in increasing the number of patients who achieve and maintain recommended levels of PA and to act as a primer for PA, increasing the proportion of sedentary patients who initiate PA by 50%. Yet physicians report that they do not counsel patients because of a lack of practical tools, time, reimbursement, knowledge and confidence. PURPOSE The PAAT was developed to address the lack of practical tools, physician knowledge and confidence and to decrease time for assessment. The formative methods used to develop the PAAT and assure content and construct validity will be presented. METHODS Patients at two primary care clinics were asked to identify from lists, types of PA that they commonly did or would consider doing. We then grouped PAs by intensity based on the updated Compendium of PA to give patients additional cues about intensity and to address physicians' inability to correctly classify PA. The PAAT was field tested in a qualitative study of women's roles and responsibilities and PA. Content and construct validity of the PAAT were assessed by comparing PA reported on the PAAT with that reported in response to open-ended questions and probes earlier in the interview. Participants in both studies were asked how they would feel about having their physician use such a tool to talk with them about their PA. RESULTS The list of PA types was adjusted to include additional activities suggested by patients, some were deleted if patients felt they were unfamiliar or would not consider doing them, and light activities were excluded because participants in the women's study incorrectly interpreted these to count toward PH recommendations. Participants in the women's study mentioned 18 types of MVPA a total of 56 times in response to open-ended questions, 13 types of MVPA were elicited 70 times by prompts about household chores and occupational PA; while 27 types of MVPA were reported 138 times on the PAAT. Twenty of twenty women reported more types of PA on PAAT than spontaneously and 17 reported more PA time, while 3 reported less on PAAT than in response to general questions. Participants in both studies liked the PAAT and said that they would welcome having their physician use the tool. CONCLUSION Overall, the PAAT was acceptable to patients and more types, episodes, and MVPA time were reported on the PAAT than was elicited with general questions, analogous to those a physician might ask. The PAAT has content and construct validity based on the manner in which it was developed. Additional work to strengthen the content and construct validity in low literacy populations is underway.