Research article
Screening for Physical Activity in Family Practice: Evaluation of Two Brief Assessment Tools

https://doi.org/10.1016/j.amepre.2005.07.005Get rights and content

Background

Physical activity (PA) is relevant to the prevention and management of many health conditions in family practice. There is a need for an efficient, reliable, and valid assessment tool to identify patients in need of PA interventions.

Methods

Twenty-eight family physicians in three Australian cities assessed the PA of their adult patients during 2004 using either a two- (2Q) or three-question (3Q) assessment. This was administered again approximately 3 days later to evaluate test–retest reliability. Concurrent validity was evaluated by measuring agreement with the Active Australia Questionnaire, and criterion validity by comparison with 7-day Computer Science Applications, Inc. (CSA) accelerometer counts.

Results

A total of 509 patients participated, with 428 (84%) completing a repeat assessment, and 415 (82%) accelerometer monitoring. The brief assessments had moderate test–retest reliability (2Q k=58.0%, 95% confidence interval [CI]=47.2–68.8%; 3Q k=55.6%, 95% CI=43.8–67.4%); fair to moderate concurrent validity (2Q k=46.7%, 95% CI=35.6–57.9%; 3Q k=38.7%, 95% CI=26.4–51.1%); and poor to fair criterion validity (2Q k=18.2%, 95% CI=3.9–32.6%; 3Q k=24.3%, 95% CI=11.6–36.9%) for identifying patients as sufficiently active. A four-level scale of PA derived from the PA assessments was significantly correlated with accelerometer minutes (2Q rho=0.39, 95% CI=0.28–0.49; 3Q rho=0.31, 95% CI=0.18–0.43). Physicians reported that the assessments took 1 to 2 minutes to complete.

Conclusions

Both PA assessments were feasible to use in family practice, and were suitable for identifying the least active patients. The 2Q assessment was preferred by clinicians and may be most appropriate for dissemination.

Introduction

The promotion of physical activity (PA) is essential for curbing the escalating levels of obesity evident worldwide and for addressing the growing burden of preventable chronic conditions.1 In Australia, the United States, and other nations, the prevalence of physical inactivity exceeds 50%,2, 3, 4 highlighting the importance of finding effective strategies for promoting PA in populations.

Among the range of agents who can contribute to increasing PA, physicians have an important role to play because most people visit a family practitioner at least once a year,5 and many regard their physician as their preferred source of health advice.6 While reviews of PA intervention studies in healthcare settings have reached diverse conclusions,7, 8 the U.S. Department of Health and Human Services (Healthy People 2010)9 and the American Heart Association10 recommend that physicians advise their patients about PA because of its clinical relevance to many conditions and its broader public health significance.

The 5As approach (assess, advise, agree, assist, arrange)11 is a guide for offering behavior change interventions in family practice that may be applied to PA. The elements of this approach follow: assessing behavioral risk factors and patient propensity for change, advising about behavior changes and the benefits of these, agreeing to goals and strategies for change, assisting with behavior modification and social support strategies, and arranging follow-up contacts and referral to specialized assistance.

Assessment is the first of the 5As, highlighting the need for a reliable and accurate assessment of PA for physicians wanting to address this behavior among patients. Instruments with acceptable reliability and validity are available to assess smoking,12 alcohol use,13 and dietary habits14 in primary health care, but PA assessments have not yet been thoroughly developed and tested. A PA assessment used in the Physical Activity Counseling for Exercise (PACE) program15 had acceptable test–retest reliability, but its validity has not been reported. Physical activity assessments have also been developed for use by U.S. healthcare providers,16 and general practitioners in the United Kingdom17; however, the reliability and validity of these assessments has not been reported. A number of single-question measures of PA have been developed for use in epidemiologic studies,18, 19, 20 but none are reported to have been evaluated in primary health care.

A PA assessment tool meant for use in primary care should be acceptable to time-pressured physicians and be able to clearly identify patients who could benefit from interventions to address this behavior. A two-question PA assessment was recently pilot tested in family practices in Australia and found to be feasible for physician use, and to have moderate reliability and validity.21 The aim of this study is to evaluate the feasibility, acceptability, test–retest reliability, concurrent and criterion validity of this two-question assessment, and of a longer three-question version, in a larger sample of Australian primary care physicians and patients.

Section snippets

Physician and Patient Recruitment

Family physicians in Sydney, Melbourne, and Brisbane were recruited by advertisements in Division of General Practice newsletters, faxed invitation letters, and direct telephone contact. Eight physicians were recruited in both Sydney and Brisbane and 12 in Melbourne, from a total of 21 practices. Each physician was offered a $100 book voucher for participating.

Eligible patients were aged >18 years, able to communicate in English, and not affected by mobility or cognitive impairments. The study

Study Participants

The characteristics of the 467 participants who were administered a brief assessment by their family physician, and then completed a repeat assessment by the exercise physiologist and/or 5 to 7 days of accelerometer monitoring are shown in Table 2. Participants receiving the 2Q and 3Q did not differ in any of these characteristics.

Test–Retest Reliability

The Spearman’s rank-order coefficients showed a significant positive correlation between the amount of moderate, vigorous, and total PA reported by participants on

Discussion

This study comprehensively evaluated two brief PA assessment tools that were developed for use in routine family practice. Brief assessments of this type are an important element of the systems required to improve the integration of preventive counseling into medical practice.28

The test–retest reliability results for both brief assessments were encouraging, particularly as these were administered by different professionals, in different contexts, on two occasions. It is well documented that

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    This study was funded by the Australian Department of Health and Ageing. Members of the research team who carried out the field work included Peter Ryan, Thea Kremser, and Monique Desmarchelier (Sydney); Belinda Houtgraaf (Brisbane); and Kate Singleton (Melbourne). Stewart Trost, MD (Kansas State University) wrote the software for analysis of the raw accelerometer data.

    No financial conflict of interest was reported by the authors of this paper.

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