Skip to main content
Log in

Factors Influencing Primary Health Care Professionals’ Physical Activity Promotion Behaviors: A Systematic Review

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired.

Purpose

To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals’ PA promotion practices.

Method

Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals’ PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors.

Results

Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals’ PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants.

Conclusion

This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tulloch H, Fortier M, Hogg W. Physical activity counseling in primary care: who has and who should be counseling? Patient Educ Couns. 2006;64(1–3):6–20.

    Article  PubMed  Google Scholar 

  2. Eakin EG, Glasgow RE, Riley KM. Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research. J Fam Pract. 2000;49(2):158–68.

    CAS  PubMed  Google Scholar 

  3. Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Sørensen JB, Skovgaard T, Puggaard L. Exercise on prescription in general practice: a systematic review. Scand J Prim Health. 2006;24:69–74.

    Article  Google Scholar 

  5. Fallon EA, Wilcox S, Laken M. Health care provider advice for African American adults not meeting health behavior recommendations. Prev Chron Dis. 2006;3(2):1–12.

    Google Scholar 

  6. Glasgow RE, Eakin EG, Fisher EB, Bacak SJ, Brownson RC. Physician advice and support for physical activity: results from a national survey. Am J Prev Med. 2001;21(3):189–96.

    Article  CAS  PubMed  Google Scholar 

  7. VanWormer JJ, Pronk NP, Kroeninger GJ. Clinical counseling for physical activity: translation of a systematic review into care recommendations. Diabetes Spec. 2009;22(1):48–55.

    Article  Google Scholar 

  8. Verheijden MW, Bakx JC, Delemarre ICG, Wanders AJ, Woudenbergh NM, Bottema BJAM, et al. GPs’ assessment of patients’ readiness to change diet, activity and smoking. Brit J Gen Pract. 2005;55:452–7.

    Google Scholar 

  9. Helmink JHM, Meis JJM, de Weerdt I, Visser FN, de Vries NK, Kremers SPJ. Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme. Int J Behav Nutr Phy. 2010;7:49.

    Article  Google Scholar 

  10. Green LW, Kreuter MW. Health promotion planning: an educational and environmental approach. 3rd ed. Mountain View: Mayfield; 1999.

    Google Scholar 

  11. Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health. 2003;93:1261–7.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Glasgow RE, Bull SS, Gilette C, Klesges LM, Dzewaltowski DA. Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity. Am J Prev Med. 2002;23(1):62–9.

    Article  PubMed  Google Scholar 

  13. Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, Stillman L, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Commun Psychol. 2008;41:171–81.

    Article  Google Scholar 

  14. Dzewaltowski DA, Estabrooks PA, Glasgow RE. The future of physical activity behavior change research: what is needed to improve translation of research into health promotion practice? Exerc Sport Sci Rev. 2004;32(2):57–63.

    Article  PubMed  Google Scholar 

  15. Aarons GA, Wells RS, Zagursky K, Fettes DL, Palinkas LA. Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis. Am J Public Health. 2009;99(11):2087–95.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Fleuren M, Wiefferink K, Paulussen T. Determinants of innovation within health care organizations: literature review and Delphi study. Int J Qual Health Care. 2004;16(2):107–23.

    Article  PubMed  Google Scholar 

  17. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: a synthesis of the literature. Tampa: University of South Florida; 2005.

    Google Scholar 

  20. Grol R, Wensing M, Eccles M. Improving patient care: the implementation of change in clinical practice. Oxford: Elsevier; 2005.

    Google Scholar 

  21. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362:1225–30.

    Article  PubMed  Google Scholar 

  22. Rogers EM. Diffusion of innovations. 3rd ed. New York: The Free Press; 1983.

    Google Scholar 

  23. Chaudoir SR, Dugan AG, Barr CHI. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level. Implement Sci. 2013;8:22.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Commun Psychol. 2008;41:327–50.

    Article  Google Scholar 

  25. Foy R, Eccles M, Grimshaw J. Why does primary care need more implementation research? Fam Pract. 2001;18(4):353–5.

    Article  CAS  PubMed  Google Scholar 

  26. Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity interventions into practice. Am J Prev Med. 2006;31(4S):S45–56.

    Article  PubMed  Google Scholar 

  27. Eakin EG, Smith BJ, Bauman AE. Evaluating the population health impact of physical activity interventions in primary care: are we asking the right questions? Phys Health. 2005;2:197–215.

    Google Scholar 

  28. Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Brit J Sport Med. 2012;46(9):625–31.

    Article  Google Scholar 

  29. Grol RPTM, Bosch MC, Hulscher MEJL, Eccles MP, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007;85(1):93–138.

    Article  PubMed Central  PubMed  Google Scholar 

  30. de Veer AJE, Fleuren MAH, Bekkema N, Francke AL. Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users. BMC Med Inform Decis. 2011;11(1):67.

    Article  Google Scholar 

  31. Rosman AN, Vlemmix F, Fleuren MAH, Rijnders ME, Beuckens A, Opmeer BC, et al. Patients’ and professionals’ barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands. Midwifery. 2013;1–7.

  32. Fleuren M, Dusseldorp E, van den Bergh S, Vlek H, Wildschut J, van den Akker E, et al. Implementation of a shared care guideline for back pain: effect on unnecessary referrals. Int J Qual Health Care. 2010;22(5):415–20.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Orwin RG. Evaluation coding decisions. In: Cooper H, Hedges L, editors. The handbook of research synthesis. New York: Russel Sage Foundation; 1994. p. 139–62.

    Google Scholar 

  34. Arai L, Britten N, Popay J, Roberts H, Petticrew M, Rodgers M, et al. Testing methodological developments in the conduct of narrative synthesis: a demonstration review of research on the implementation of smoke alarm interventions. Evid Policy. 2007;3(3):361–83.

    Article  Google Scholar 

  35. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  36. Patel A, Schofield GM, Kolt GS, Keogh JWL. General practitioners’ views and experiences of counselling for physical activity through the New Zealand Green Prescription program. BMC Fam Pract. 2011;12:119.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Swinburn BA, Walter LG, Arroll B, Tilyard MW, Russell DG. Green prescriptions: attitudes and perceptions of general practitioners towards prescribing exercise. Brit J Gen Pract. 1997;47(422):567–9.

    CAS  Google Scholar 

  38. Tompkins TH, Belza B, Brown M-A. Nurse practitioner practice patterns for exercise counseling. J Am Acad Nurse Prac. 2009;21(2):79–86.

    Article  Google Scholar 

  39. Bull FCL, Schipper ECC, Jamrozik K, Blanksby BA. Beliefs and behaviour of general practitioners regarding promotion of physical activity. Am J Public Health. 1995;19(3):300–4.

    CAS  Google Scholar 

  40. Bull FC, Milton KE. A process evaluation of a “physical activity pathway” in the primary care setting. BMC Public Health. 2010;10:463.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Schmid M, Egli K, Brian MW, Bauer GF. Health promotion in primary care: evaluation of a systematic procedure and stage specific information for physical activity counselling. Swiss Med Wkly. 2009;139:665–71.

    CAS  PubMed  Google Scholar 

  42. Douglas F, Van Teijlingen E, Torrance N, Fearn P, Kerr A, Meloni S. Promoting physical activity in primary care settings: health visitors’ and practice nurses’ views and experiences. J Adv Nurs. 2006;55(2):159–68.

    Article  PubMed  Google Scholar 

  43. Allenspach EC, Handschin M, Kutlar Joss M, Hauser A, Nüscheler M, Grize L, et al. Patient and physician acceptance of a campaign approach to promoting physical activity: the “Move for Health” project. Swiss Med Wkly. 2007;137:292–9.

    CAS  PubMed  Google Scholar 

  44. Bize R, Cornuz J, Martin B. Opinions and attitudes of a sample of Swiss physicians about physical activity promotion in a primary care setting. Swiss Med Wkly. 2007;55:97–100.

    Google Scholar 

  45. Petrella RJ, Wight D. An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP). Arch Fam Med. 2000;9(4):339–44.

    Article  CAS  PubMed  Google Scholar 

  46. Dauenhauer JA, Podgorski CA, Karuza J. Prescribing exercise for older adults. Gerontol Geriatr Educ. 2008;26(3):81–99.

    Article  Google Scholar 

  47. Van Sluijs EMF, Van Poppel MNM, Stalman WAB, Van Mechelen W. Feasibility and acceptability of a physical activity promotion programme in general practice. Fam Pract. 2004;21(4):429–36.

    Article  PubMed  Google Scholar 

  48. Winzenberg T, Reid P, Shaw K. Assessing physical activity in general practice: a disconnect between clinical practice and public health? Brit J Gen Pract. 2009;59:e359–367.

    Article  Google Scholar 

  49. Graham RC, Dugdill L, Cable NT. Health professionals’ perspectives in exercise referral: implications for the referral process. Ergonomics. 2005;48:1411–22.

    Article  CAS  PubMed  Google Scholar 

  50. Puig Ribera A, McKenna J, Riddoch C. Physical activity promotion in general practices of Barcelona: a case study. Health Educ Res. 2005;21(4):538–48.

    Article  Google Scholar 

  51. McKenna J, Naylor P-J, McDowell N. Barriers to physical activity promotion by general practitioners and practice nurses. Brit J Sport Med. 1998;32(3):242–7.

    Article  CAS  Google Scholar 

  52. Kennedy MF, Meeuwisse WH. Exercise counselling by family physicians in Canada. Prev Med. 2003;37(3):226–32.

    Article  PubMed  Google Scholar 

  53. Gribben B, Goodyear-smith F, Grobbelaar M, O’Neill D, Walker S. The early experience of general practitioners using Green Prescription. New Zeal Med J. 2000;113:372–3.

    CAS  PubMed  Google Scholar 

  54. McDowell N, McKenna J, Naylor P-J. Factors that influence practice nurses to promote physical activity. Brit J Sport Med. 1997;31:308–13.

    Article  CAS  Google Scholar 

  55. Sherman SE, Hershman WY. Exercise counseling: how do general internists do? J Gen Intern Med. 1993;8:243–8.

    Article  CAS  PubMed  Google Scholar 

  56. Puig Ribera A, McKenna J, Riddoch C. Physical activity promotion in general practices of Barcelona: a case study. Health Educ Res. 2006;21(4):538–48.

    Article  Google Scholar 

  57. Williford HN, Barfield BR, Lazenby RB, Scharff Olson M. A survey of physicians’ attitudes and practices related to exercise promotion. Prev Med. 1992;21:630–6.

    Article  CAS  PubMed  Google Scholar 

  58. Douglas F, Torrance N, Van Teijlingen E, Meloni S, Kerr A. Primary care staff’s views and experiences related to routinely advising patients about physical activity. A questionnaire survey. BMC Public Health. 2006;6:138.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Goodman C, Davies S, Dinan S, See Tai S, Lliffe S. Activity promotion for community dwelling older people: a survey of the contribution of primary care nurses. Brit J Comm Nurs. 2011;16(1):12–7.

    Article  Google Scholar 

  60. Wilson DM, Ciliska D, Singer J, Williams K, Alleyne J, Lindsay E. Family physicians and exercise counseling: can they be influenced to provide more? Can Fam Physician. 1992;38:2003–10.

    CAS  PubMed Central  PubMed  Google Scholar 

  61. Sassen B, Kok G, Vanhees L. Predictors of healthcare professionals’ intention and behaviour to encourage physical activity in patients with cardiovascular risk factors. BMC Public Health. 2011;11:246.

    Article  Google Scholar 

  62. Leijon ME, Bendtsen P, Nilsen P, Ekberg K, Ståhle A. Physical activity referrals in Swedish primary health care: prescriber and patient characteristics, reasons for prescriptions, and prescribed activities. BMC Health Serv Res. 2008;8:201.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Al-Shahri MZ, Al-Almaei, Sameeh M. Promotion of physical exercise by primary health care physicians in Riyadh City. Saudi Med J. 1998;19(1):67–9.

    Google Scholar 

  64. Märki A, Bauer GB, Angst F, Nigg CR, Gillmann G, Gehring TM. Systematic counselling by general practitioners for promoting physical activity in elderly patients: a feasibility study. Swiss Med Wkly. 2006;136:482–8.

    PubMed  Google Scholar 

  65. Lawlor DA, Keen S, Neal RD. Increasing population levels of physical activity through primary care: GPs’ knowledge, attitudes and self-reported practice. Fam Pract. 1999;16(3):250–4.

    Article  CAS  PubMed  Google Scholar 

  66. Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices of primary care physicians: a national survey. Clin J Sport Med. 2000;10(1):40–8.

    Article  CAS  PubMed  Google Scholar 

  67. Burns KJ, Camaione DN, Chatterton CT. Prescription of physical activity by adult nurse practitioners: a national survey. Nurs Outlook. 2000;48(1):28–33.

    Article  CAS  PubMed  Google Scholar 

  68. Shirley D, Van der Ploeg HP, Bauman AE. Physical activity promotion in the physical therapy setting: perspectives from practitioners and students. Phys Ther. 2010;90(9):1311–22.

    Article  PubMed  Google Scholar 

  69. Walsh JM, Swangard DM, Davis T, McPhee SJ. Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med. 1999;16(4):307–13.

    Article  CAS  PubMed  Google Scholar 

  70. Pinto BM, Goldstein MG, DePue JD, Milan FB. Acceptability and feasibility of physician-based activity counseling. The PAL project. Am J Prev Med. 1998;15(2):95–102.

    Article  CAS  PubMed  Google Scholar 

  71. Podl TR, Goodwin MA, Kikano GE, Stange KC. Direct observation of exercise counseling in community family practice. Am J Prev Med. 1999;17(3):207–10.

    Article  CAS  PubMed  Google Scholar 

  72. Patel NK, Parchman ML. The chronic care model and exercise discussions during primary care diabetes encounters. J Am Board Fam Med. 2011;24(1):26–32.

    Article  PubMed  Google Scholar 

  73. Epel OB, Regev Z. Quality and correlates of physical activity counseling by health care providers in Israel. Prev Med. 2000;31(5):618–26.

    Article  CAS  PubMed  Google Scholar 

  74. Damush TM, Stewart AL, Mills KM, King AC, Ritter PL. Prevalence and correlates of physician recommendations to exercise among older adults. J Gerontol. 1999;54A(8):M423–7.

    Article  Google Scholar 

  75. Eakin E, Brown W, Schofield G, Mummery K, Reeves M. General practitioner advice on physical activity: who gets it? Am J Health Promot. 2007;21(4):225–8.

    Article  PubMed  Google Scholar 

  76. Hinrichs T, Moschny A, Klaassen-Mielke R, Trampisch U, Thiem U, Platen P. General practitioner advice on physical activity: analyses in a cohort of older primary health care patients (getABI). BMC Fam Pract. 2011;12:26.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Are health care professionals advising patients with diabetes or at risk for developing diabetes to exercise more? Diabetes Care. 2006;29(3):543–8.

    Article  PubMed  Google Scholar 

  78. Robertson R, Jepson R, Shepherd A, McInnes R. Recommendations by Queensland GPs to be more physically active: which patients were recommended which activities and what action they took. Aust NZ J Publ Heal. 2011;35(6):537–42.

    Article  Google Scholar 

  79. Wee CC, McCarthy EP, Davis RB, Phillips RS. Physician counseling about exercise. JAMA. 1999;282(16):1583–8.

    Article  CAS  PubMed  Google Scholar 

  80. Croteau K, Schofield G, McLean G. Physical activity advice in the primary care setting: results of a population study in New Zealand. Aust NZ J Publ Heal. 2006;30(3):262–7.

    Article  Google Scholar 

  81. Sowden SL, Breeze E, Barber J, Raine R. Do general practices provide equitable access to physical activity interventions? Brit J Gen Pract. 2008;58:e1–8.

    Article  Google Scholar 

  82. McKenna J, Henderson L, Baic S. A survey to assess physical activity promotion by registered dietitians. J Hum Nutr Diet. 2004;17(1):63–9.

    Article  CAS  PubMed  Google Scholar 

  83. Harrison RA, McNair F, Dugdill L. Access to exercise referral schemes: a population based analysis. J Public Health. 2005;27(4):326–30.

    Article  CAS  Google Scholar 

  84. James DVB, Johnston LH, Crone D, Sidford AH, Gidlow C, Morris C, et al. Factors associated with physical activity referral uptake and participation. J Sport Sci. 2008;26(2):217–24.

    Article  Google Scholar 

  85. Smith PA, Gould MM, See Tai S, Iliffe S. Exercise as therapy? Results from group interviews with general practice teams involved in an inner-London “prescription for exercise” scheme. Health Educ J. 1996;55(4):439–46.

    Article  Google Scholar 

  86. McKenna J, Vernon M. How general practitioners promote “lifestyle” physical activity. Patient Educ Couns. 2004;54(1):101–6.

    Article  CAS  PubMed  Google Scholar 

  87. Huang N, Sims J, Pietsch J, Naccarella L. The Victorian Active Script Programme: promising signs for general practitioners, population health, and the promotion of physical activity. Brit J Sport Med. 2004;38:19–25.

    Article  CAS  Google Scholar 

  88. Almeida FA, Smith-Ray RL, Van den Berg R, Schriener P, Gonzales M, Onda P, et al. Utilizing a simple stimulus control strategy to increase physician referrals for physical activity promotion. J Sport Exerc Psy. 2005;27:505–14.

    Google Scholar 

  89. Ackermann RT, Deyo RA, LoGerfo JP. Prompting primary providers to increase community exercise referral for older adults: a randomized controlled trial. J Am Geriatr Soc. 2005;53:283–9.

    Article  PubMed  Google Scholar 

  90. Eakin EG, Brown WJ, Marshall AL, Mummery K, Larsen E. Physical activity promotion in primary care: bridging the gap between research and practice. Am J Prev Med. 2004;27(4):297–303.

    PubMed  Google Scholar 

  91. Johnson ST, Bates H, Fitzpatrick J, Marshall JD, Bell RC, McCargar L. Promotion of physical activity by Canadian registered dietitians in daily practice. J Hum Nutr Diet. 2007;20(1):37–40.

    Article  CAS  PubMed  Google Scholar 

  92. Eckstrom E, Hickam DH, Lessler DS, Buchner DM. Changing physician practice of physical activity counseling. J Gen Intern Med. 1999;14(6):376–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  93. Van der Ploeg HP, Smith BJ, Stubbs T, Vita P, Holford R, Bauman AE. Physical activity promotion: are GPs getting the message? Aust Fam Physician. 2007;36(10):871–4.

    PubMed  Google Scholar 

  94. Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J. Mixed method designs in implementation research. Admin Pol Ment Health. 2011;38(1):44–53.

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge Theo Paulussen and Annette Martens for their involvement in the conception and design of the study. This research was funded by ZonMw, The Netherlands Organisation of Health Research and Development.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Johanna M. Huijg.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huijg, J.M., Gebhardt, W.A., Verheijden, M.W. et al. Factors Influencing Primary Health Care Professionals’ Physical Activity Promotion Behaviors: A Systematic Review. Int.J. Behav. Med. 22, 32–50 (2015). https://doi.org/10.1007/s12529-014-9398-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-014-9398-2

Keywords

Navigation