Smock Carissa, Chatfield Sheryl L
Health Services North central University, 11335 Torrey Pines Road La Jolla, CA 92037, USA.
College of Public Health, Kent State University, Moulton Hall, 800 Hilltop Drive, Kent, OH 44242, USA.
Adv Prev Med. 2020 May 11;2020:5084053. doi: 10.1155/2020/5084053. eCollection 2020.
The purpose of this paper is to describe development and preliminary assessment of an instrument designed to assess facilitators and barriers of provider-provided, place-based exercise prescriptions, including provider attributes, perceptions, knowledge, and resource needs. Although the American Medical Association-Supported "Exercise is Medicine" initiative encourages the practice of exercise prescription among member providers, only a small proportion engages in this practice. Additionally, little is known about the role of place-based exercise prescriptions, although access to physical activity resources differs based on residence, access to transportation, income, and other factors. To utilize potential for prescriptions to encourage physical activity, better understanding of the role of place is essential.
Previously validated and newly developed items were combined to create an 88-item survey that was administered to 166 healthcare providers.
Results of principal components analysis suggested a five-factor structure; three factors-provider belief in exercise benefits, provider training needs, and place-based concerns-demonstrated high internal consistency. Factors demonstrating low internal consistency included provider attitudes about their role in exercise prescription and providers' perceptions of patient barriers.
Following this stage in survey validation, the 88-item developed survey could be shortened by eliminating items with low loadings. Providers may be more receptive to a shorter instrument, which could facilitate reliability and validity testing of a revised instrument. Further steps to validate the instrument include assessing consistent responses over time and considering predictive ability of the survey as an additional measure of validity. Results from the initial survey administration indicate that providers' lack of training regarding how to prescribe exercise and lack of knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise present barriers to wider use of exercise prescriptions. Community-clinical linkages which network providers with area physical activity and exercise resources may present a partial solution. Knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise presents a barrier to place-based exercise prescriptions.
本文旨在描述一种工具的开发与初步评估，该工具旨在评估由医疗服务提供者提供的、基于场所的运动处方的促进因素和障碍，包括提供者的属性、认知、知识和资源需求。尽管美国医学协会支持的“运动即良药”倡议鼓励会员医疗服务提供者开具运动处方，但只有一小部分人从事这项工作。此外，尽管获得体育活动资源的机会因居住地点、交通便利性、收入和其他因素而有所不同，但对于基于场所的运动处方的作用知之甚少。为了利用处方的潜力来鼓励体育活动，更好地理解场所的作用至关重要。
将先前验证过的项目和新开发的项目相结合，创建了一份包含88个条目的调查问卷，并对166名医疗服务提供者进行了调查。
主成分分析结果显示出一个五因素结构；三个因素——提供者对运动益处的信念、提供者的培训需求以及基于场所的担忧——表现出较高的内部一致性。内部一致性较低的因素包括提供者对其在运动处方中作用的态度以及提供者对患者障碍的认知。
在调查验证的这一阶段之后，可以通过剔除负荷较低的项目来缩短这份88个条目的调查问卷。医疗服务提供者可能更容易接受较短的问卷，这有助于对修订后的问卷进行信度和效度测试。验证该问卷的进一步步骤包括评估随时间的一致反应，并将问卷的预测能力作为效度的一项额外衡量指标。首次调查的结果表明，医疗服务提供者缺乏关于如何开具运动处方的培训，以及对患者进行规定运动时安全、经济实惠或距离较近的场所缺乏了解，这些都阻碍了运动处方的更广泛应用。将医疗服务提供者与当地体育活动和运动资源联系起来的社区临床联系可能是一个部分解决方案。对于患者进行规定运动时安全、经济实惠或距离较近的场所缺乏了解是基于场所的运动处方的一个障碍。
