Physical Activity (PA) Promotion in General Practices of Barcelona

Abstract

Sixty-five percent of adult Catalans are inactive. While official Catalan policy encourages primary care health professionals to promote physical activity (PA), physicians and nurses rarely integrate this into consultations. PA promotion in Catalan general practices is opportunistic, focused on selected patients, uses generalised messages, is highly dependent on physicians/nurses' personal interests and happens in isolation from community services. This is the result of unfavourable work conditions to promoting PA, with the main barriers being lack of time, training and protocols. PURPOSE: This case study aimed to generate a deeper understanding of why PA promotion is so rarely integrated into general practices of Barcelona, the capital of Catalonia. METHODS: This explanatory study adopted a qualitative approach, based on three techniques; focus groups (n=3), semi-structured (n=25) and short individual interviews (n=5). Participants comprised patients (n=20), policy makers (n=6), academics (n=5), PA professionals (n=3), medical doctors (n=3), researchers (n=2), media employees (n=2) and one social worker and they discussed the wider environment surrounding primary care from their distinctive professional and personal perspectives. Phenomenological techniques were used for data coding and interpretation. Contributors confirmed the final interpretation. RESULTS: Three main factors underpinned the lack of integration of PA promotion approaches. (1) PA promotion was rarely seen as contributing to either the patients' individual needs or to helping patients to become more active. (2) There was limited official support for GP-based PA promotion. (3) Primary care staff intentionally isolated their practice from other professionals and/or services in the community. Respondents reported that PA promotion would be better integrated by (a) introducing strategies to match patient interests in exercise and exercising, (b) creating top-down approaches, and (c) connecting primary care with other professionals and institutions in the community. CONCLUSIONS: Barcelona showed the same barriers – and solutions – to promoting PA in general practices than other countries. However, using qualitative techniques and collecting the point of view of both patients and the principal stakeholders provides a novel approach to addressing these complex issues. This is a key issue given that the current evidence regarding intervention efficiency in promoting PA through primary care is not strong yet.