Department of Family Medicine, 1Family Medicine Research Programs, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, USA.
BMC Health Serv Res. 2012 Oct 30;12:374. doi: 10.1186/1472-6963-12-374.
The present study protocol describes the trial design of a clinician training intervention to improve physical activity counseling in underserved primary care settings using the 5As. The 5As (Ask, Advise, Agree, Assist, Arrange) are a clinical tool recommended for health behavior counseling in primary care.
METHODS/DESIGN: The study is a two-arm randomized pilot pragmatic trial to examine a primary care clinician communication intervention on use of the 5As in discussion of physical activity in audio-recorded office visits in an ethnically diverse, low-income patient population. The study setting consists of two federally qualified community health centers in Rochester, NY. Eligible clinicians (n=15) are recruited and randomized into two groups. Group 1 clinicians participate in the training intervention first; Group 2 clinicians receive the intervention six months later. The intervention and its outcomes are informed by self-determination theory and principles of patient-centered communication. Assessment of outcomes is blinded. The primary outcome will be the frequency and quality of 5As discussions as judged by evaluating 375 audio-recorded patient visits distributed over baseline and in the post-intervention period (immediately post and at six months). Secondary outcomes will be changes in patients' perceived competence to increase physical activity (Aim 2) and patients and clinicians beliefs regarding whether pertinent barriers to promoting exercise have been reduced. (Aim 3). Exploratory outcomes (Aim 4) are potential mediators of the intervention's effect and whether the intervention affects actual enrollment in the community program recommended for exercise. The analysis will use repeated measures (in the form of recorded office visits) from each clinician at each time point and aggregate measures of Groups 1 and 2 over time.
Results will help elucidate the role of 5As communication training for clinicians on counseling for physical activity counseling in primary care. Results will explore the effectiveness of the 5As model linked to community resources for physical activity promotion for underserved groups.
本研究方案描述了一项临床医生培训干预措施的试验设计，该干预措施旨在通过使用 5A 来改善服务不足的初级保健环境中的体力活动咨询。5A（询问、建议、同意、协助、安排）是推荐用于初级保健中健康行为咨询的临床工具。
方法/设计：这项研究是一项两臂随机试验性实用研究，旨在检查初级保健临床医生沟通干预措施对在种族多样化、低收入患者群体的录音门诊就诊中讨论体力活动时使用 5A 的影响。研究地点包括纽约罗切斯特的两家联邦合格社区卫生中心。合格的临床医生（n=15）被招募并随机分为两组。第一组临床医生先参加培训干预；第二组临床医生在六个月后接受干预。干预及其结果以自主决定理论和以患者为中心的沟通原则为依据。结果评估是盲法的。主要结果将是通过评估 375 份录音患者就诊记录（分布在基线和干预后期间，包括干预后即刻和六个月）来判断的 5A 讨论的频率和质量。次要结果将是患者感知增加体力活动能力的变化（目标 2）以及患者和临床医生对促进锻炼相关障碍是否减少的信念的变化（目标 3）。探索性结果（目标 4）是干预效果的潜在中介因素，以及干预是否会影响实际参与推荐的社区锻炼计划。分析将使用每位临床医生在每个时间点的重复测量（以记录的门诊就诊形式），并在一段时间内汇总第一组和第二组的汇总测量。
结果将有助于阐明 5A 沟通培训对临床医生进行体力活动咨询的作用。结果将探索将 5A 模型与社区资源联系起来，为服务不足群体促进体力活动的有效性。
