Abstract
BackgroundConducting 5 A’s counseling in clinic and utilizing technology-based resources are recommended to promote physical activity but little is known about how to implement such an intervention. This investigation aimed to determine the feasibility and acceptability, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, of a pragmatic, primary care-based intervention that incorporated 5 A’s counseling and self-control through an activity monitor.MethodsPrimary care patients (n = 40) 55–74 years of age were recruited and randomized to receive a pedometer or an electronic activity monitor (EAM), Jawbone UP24, to monitor activity for 12 weeks. Participants were also invited to a focus group after completing the intervention. Stakeholders (n = 36) were recruited to provide feedback.ResultsThe intervention recruitment rate was 24.7%. The attrition rate was 20% with a significantly higher rate for the pedometer group (p = 0.02). The EAM group increased their minutes of physical activity by 11.1 min/day while the pedometer maintained their activity (0.2 min/day), with no significant group difference. EAM participants liked using their monitor and would continue wearing it while the pedometer group was neutral to these statements (p < 0.05). Over the 12 weeks there were 490 comments and 1094 “likes” given to study peers in the corresponding application for the UP24 monitor. Some EAM participants enjoyed the social interaction feature while others were uncomfortable talking to strangers. Participants stated they would want counseling from a counselor and not their physician or a nurse. Other notable comments included incorporating multiple health behaviors, more in-person counseling with a counselor, and having a funding source for sustainability.ConclusionsOverall, the study was well-received but the results raise a number of considerations. Practitioners, counselors, and researchers should consider the following before implementing a similar intervention: 1) utilize PA counselors, 2) target multiple health behaviors, 3) form a social support group, 4) identify a funding source for sustainability, and 5) be mindful of concerns with technology.Trial registrationclinicaltrials.gov- NCT02554435. Registered 24 August 2015.
Highlights
Conducting 5 A’s counseling in clinic and utilizing technology-based resources are recommended to promote physical activity but little is known about how to implement such an intervention
Twenty-seven (67.5%) participants were recruited in-person at the clinic, 8 (20%) were recruited through flier postings, and 5 (12.5%) were referred by a friend or employee that heard of the study from the clinic
Notable comments include incorporating multiple health behaviors, more in-person counseling with a counselor, and having a funding source to supply activity monitors to patients
Summary
Conducting 5 A’s counseling in clinic and utilizing technology-based resources are recommended to promote physical activity but little is known about how to implement such an intervention. The American Heart Association encourages the implementation of individual clinical and population-level strategies to target these barriers and reduce physical inactivity [11] One such strategy is to implement 5 A’s counseling within the primary care clinic [11]. Five A’s counseling was developed by the Counseling and Behavioral Interventions Work Group of the United States Preventive Services Task Force to provide brief counseling within the primary care setting [12]. This form of counseling is recommended over comprehensive counseling because it is short in duration and more feasible for a busy clinic [11, 13,14,15,16,17]. Shaping knowledge and providing feedback through counseling are effective behavioral strategies [19] but the addition of technology is recommended to enhance counseling for individuals at moderate risk for CVD [11]
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