Exploration of sedentary behaviour among general practitioners: protocol for a mixed methods study
DOI:
https://doi.org/10.18203/2349-3259.ijct20210145Keywords:
General practitioner, Primary care, Sedentary behaviour, Physical activityAbstract
Background: Many general practitioners (GPs) are sedentary for most of their working day. Levels of sedentary behaviour may have been exacerbated by increased use of telemedicine in light of the COVID-19 pandemic, as this is traditionally performed while sitting down. Excessive sedentary behaviour is associated with many adverse health outcomes and increased all-cause mortality. This study will gain quantitative data on levels of sedentary behaviour among GPs and general practice specialty trainees (GPSTs), to identify to what extent general practice is a sedentary occupation, as well as qualitative data regarding the barriers and facilitators to reducing sedentary behaviour in the general practice setting.
Methods: The study follows a sequential, mixed-methods model. The first stage will involve the dissemination of a questionnaire survey, where participants self-estimate their sedentary behaviour on a working day and on a non-working day. The second stage will use thigh-worn accelerometers and a sleep/work log to obtain objective data regarding sedentary behaviour among a purposive subset of participants who responded to the questionnaire. The third stage will involve semi-structured interviews with a purposive subset of accelerometer study participants, analysed with the application of a theoretical framework regarding the acceptability of healthcare interventions.
Conclusions: This paper outlines a protocol for a sequential, mixed-methods study exploring sedentary behaviour among GPs and GPSTs. Findings of this study will shed light on the new ways of working as a result of the COVID-19 pandemic, which will be relevant to clinicians working in similar primary care settings throughout the world.
Trial Registration: ClinicalTrials.gov Identifier: NCT04556695. Date of registration: 21st September 2020.
References
Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Physical Activity. 2017;14(1).
Hamer M, Stamatakis E, Steptoe A. Dose-response relationship between physical activity and mental health: the Scottish Health Survey. Br J Sports Med. 2009;43(14):1111-4.
Rovio S, Kåreholt I, Helkala E-L, Viitanen M, Winblad B, Tuomilehto J, et al. Leisure-time physical activity at midlife and the risk of dementia and Alzheimer's disease. Lancet Neurol. 2005;4(11):705-11.
Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015;162(2):123-32.
Koster A, Caserotti P, Patel KV, Matthews CE, Berrigan D, Van Domelen DR, et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity. PLoS One. 2012;7(6):e37696.
Levine JA. Interindividual Variation in Posture Allocation: Possible Role in Human Obesity. Science. 2005;307(5709):584-6.
Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388(10051):1302-10.
Ekelund U, Tarp J, Steene-Johannessen J, Hansen BH, Jefferis B, Fagerland MW, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570.
Scarborough P, Bhatnagar P, Wickramasinghe KK, Allender S, Foster C, Rayner M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. J Public Health. 2011;33(4):527-35.
Ding D, Lawson KD, Kolbe-Alexander TL, Finkelstein EA, Katzmarzyk PT, Van Mechelen W, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388(10051):1311-24.
Heron L, O'Neill C, McAneney H, Kee F, Tully MA. Direct healthcare costs of sedentary behaviour in the UK. J Epidemiol Comm Health. 2019;73(7):625-9.
Davies SC, Atherton F, McBride M, Calderwood C. UK Chief Medical Officers' Physical Activity Guidelines 2019.
OECD. Physicians by category. 2020. Available at: http://www.oecd.org/health/health-data.htm. Accessed on: 20 October 2020.
NHS-England. NHS 5 Year Forward View - Primary Care. 2017. Available at: https://www .england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/primary-care/. Accessed on: 20 October 2020.
Croteau K, Schofield G, McLean G. Physical activity advice in the primary care setting: Results of a population study in New Zealand. Aus N Zeal J Public Health. 2006;30(3):262-7.
Short CE, Hayman M, Rebar AL, Gunn KM, De Cocker K, Duncan MJ, et al. Physical activity recommendations from general practitioners in Australia. Results from a national survey. Aus N Zeal J Public Health. 2016;40(1):83-90.
17. Frank E, Segura C, Shen H, Oberg E. Predictors of Canadian Physicians’ Prevention Counseling Practices. Canad J Public Health. 2010;101(5):390-5.
Klein D, Guenther C, Ross S. Do as I say, not as I do. Lifestyles and counseling practices of physician faculty at the University of Alberta. 2016;62(7):393-9.
Lobelo F, de Quevedo IG. The evidence in support of physicians and health care providers as physical activity role models. Am J Lifestyle Med. 2016;10(1):36-52.
Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2008;43(2):89-92.
Stanford FC, Durkin MW, Stallworth JR, Powell CK, Poston MB, Blair SN. Factors that Influence Physicians’ and Medical Students’ Confidence in Counseling Patients About Physical Activity. 2014;35(3):193-201.
Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Family Med. 2000;9(3):287-9.
Fraser S, Leveritt M, Ball L. Patients' perceptions of their general practitioner's health and weight influences their perceptions of nutrition and exercise advice received. J Prim Health Care. 2013;5(4):301-7.
Lemaire JB, Ewashina D, Polachek AJ, Dixit J, Yiu V. Understanding how patients perceive physician wellness and its links to patient care: A qualitative study. PlOs one. 2018;13(5):e0196888.
Joy M, McGagh D, Jones N, Liyanage H, Sherlock J, Parimalanathan V, et al. Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK. Br J Gen Pract. 2020;70(697):540-7.
Keohane DM, McGillivary NA, Daly B. Physical activity levels and perceived barriers to exercise participation in Irish General Practitioners and General Practice trainees. Ir Med J. 2018;111(2):690.
Suija K, Pechter U, Maaroos J, Kalda R, Ratsep A, Oona M, et al. Physical activity of Estonian family doctors and their counselling for a healthy lifestyle: a cross-sectional study. BMC Fam Pract. 2010;11:48.
Brotons C, Björkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, et al. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. 2005;40(5):595-601.
Pardo A, McKenna J, Mitjans A, Camps B, Aranda-García S, Garcia-Gil J, et al. Physical Activity Level and Lifestyle-Related Risk Factors From Catalan Physicians. 2014;11(5):922-9.
Ivankova NV, Creswell JW, Stick SL. Using Mixed-Methods Sequential Explanatory Design: From Theory to Practice. Field Methods. 2006;18(1):3-20.
Prince SA, LeBlanc AG, Colley RC, Saunders TJ. Measurement of sedentary behaviour in population health surveys: a review and recommendations. Peer J. 2017;5:4130.
Prince SA, Cardilli L, Reed JL, Saunders TJ, Kite C, Douillette K, et al. A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis. Int J Behav Nutr Physical Activity. 2020;17(1):31.
Skotte J, Korshøj M, Kristiansen J, Hanisch C, Holtermann A. Detection of Physical Activity Types Using Triaxial Accelerometers. J Physical Activity Health. 2014;11(1):76-84.
Crowley P, Skotte J, Stamatakis E, Hamer M, Aadahl M, Stevens ML, et al. Comparison of physical behavior estimates from three different thigh-worn accelerometers brands: a proof-of-concept for the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS). Int J Behav Nutr Physical Activity. 2019;16(1):65.
Doherty A, Jackson D, Hammerla N, Plötz T, Olivier P, Granat MH, et al. Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study. PlOs one. 2017;12(2):e0169649.
Migueles JH, Cadenas-Sanchez C, Ekelund U, Delisle Nyström C, Mora-Gonzalez J, Löf M, et al. Accelerometer Data Collection and Processing Criteria to Assess Physical Activity and Other Outcomes: A Systematic Review and Practical Considerations. Sports Med. 2017;47(9):1821-45.
Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Services Res. 2017;17(1).
World Health Organization. BMI Classification. Global Database on Body Mass Index. 2014.
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) Requiring Invasive Mechanical Ventilation. Obesity. 2020.
Bolderston A. Conducting a Research Interview. J Med Imaging Rad Sc. 2012;43(1):66-76.