Matthews Anne, Jones Natasha, Thomas Alastair, van den Berg Perdy, Foster Charlie
Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
Department of Sports and Exercise Medicine, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7HE, UK.
BMC Health Serv Res. 2017 Feb 11;17(1):130. doi: 10.1186/s12913-017-2040-7.
Increasing levels of physical activity decreases the risk of premature mortality associated with chronic diseases e.g., coronary heart disease, type 2 diabetes, stroke. Despite this, most adults in England do not meet physical activity guidelines. Physical activity advice and signposting offered to at-risk patients by primary care providers is recommended. However, exercise medicine education is sparse, leading to poor practitioner knowledge of the risk reduction evidence and strategies to implement effective patient behaviour change. The 'Generation Games' intervention seeks physical activity increase in the 50+ population of Oxfordshire. It offers a Health Professional Education Programme (HPEP) providing exercise medicine education, and promotion of Generation Games to which health professionals can signpost patients. There is a poor evidence base concerning how such education translates into patient exercise behaviour change.
The research aimed to create more understanding of how an education programme can influence health professionals to recommend Generation Games to and increase exercise behaviour in type 2 diabetes patients. A case study method facilitated examination of the routines and cultures studied - the experience of Diabetes nurses was used as an example of best practice engagement with the HPEP. Observation, interviews and documentation were employed to triangulate data. Data analysis refined and developed themes within key theoretical frameworks.
Firstly, there is a lack of knowledge about physical activity risk reduction benefits and a belief that efforts to motivate patients to increase their physical activity are ineffective, thus creating barriers to engagement with the HPEP. Secondly, practice nurses tasked with delivering lifestyle advice to diabetes patients - themselves suffering a motivational interviewing skill deficit - find ingrained physical activity behaviours extremely challenging, and therefore highly value the HPEP for providing helpful tools. Thirdly, patients who hear of Generation Games from a health professional may have mismatched expectations of how their exercise behaviour can change.
Exercise medicine education has the potential to improve patient care and services. Before initiatives like the HPEP can succeed, primary care practice requires a more supportive exercise medicine culture. Also necessary is adequate resourcing of patient-centred behaviour change advice, training, encouragement and monitoring services.
增加身体活动水平可降低与慢性疾病（如冠心病、2型糖尿病、中风）相关的过早死亡风险。尽管如此，英国大多数成年人并未达到身体活动指南的要求。建议初级保健提供者向高危患者提供身体活动建议和指引。然而，运动医学教育匮乏，导致从业者对降低风险的证据以及实施有效的患者行为改变策略的了解不足。“世代游戏”干预旨在增加牛津郡50岁及以上人群的身体活动。它提供了一个健康专业人员教育计划（HPEP），提供运动医学教育，并推广“世代游戏”，健康专业人员可将患者指引至该项目。关于此类教育如何转化为患者运动行为改变，目前证据不足。
该研究旨在更深入了解一个教育项目如何影响健康专业人员向2型糖尿病患者推荐“世代游戏”并增加其运动行为。采用案例研究方法，便于对所研究的日常工作和文化进行考察——以糖尿病护士的经验为例，说明与HPEP进行最佳实践互动的情况。通过观察、访谈和文件记录对数据进行三角验证。数据分析在关键理论框架内提炼并发展主题。
首先，对身体活动降低风险的益处缺乏了解，并且认为激励患者增加身体活动的努力是无效的，从而为参与HPEP设置了障碍。其次，负责向糖尿病患者提供生活方式建议的执业护士——他们自身存在动机性访谈技能缺陷——发现根深蒂固的身体活动行为极具挑战性，因此高度重视HPEP提供的有用工具。第三，从健康专业人员那里听说“世代游戏”的患者，对于自己的运动行为如何改变可能抱有不匹配的期望。
运动医学教育有改善患者护理和服务的潜力。在HPEP等举措取得成功之前，初级保健实践需要一种更支持运动医学的文化。以患者为中心的行为改变建议、培训、鼓励和监测服务也需要充足的资源。
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