Barriers that Nurses May Face when Providing Physical Activity Counselling to Patients
Providing effective physical activity counselling to patients is not easy. This module will focus on solutions to some common barriers you may face when providing physical activity counselling,1 along with some suggestions for overcoming them.
Common Barriers to Physical Activity Counselling
Barrier # 1: “Patients are not interested in physical activity.”
One common barrier to providing physical activity counselling is the perception that patients are not interested in becoming active. You may think why bother trying to counsel them. Research suggests, however, that while many people are not currently physically active, they are aware of some of the benefits and may be thinking about starting an exercise program in the future1. Therefore, many patients you encounter will be interested in receiving guidance about physical activity.
Moreover, remember that part of physical activity counselling is simply initiating the behaviour change process. This means that, even if your counselling session results in a previously resistant patient starting to even consider increasing physical activity, you have succeeded.
Barrier # 2: “I don’t have time to provide physical activity counselling.”
Lack of time may be a problem you face when working with patients. Remember though that time spent discussing health behaviour change, including promotion of physical activity, is important as a means of improving health in the long run.2
Physical activity counselling sessions can be as short as a few minutes in length and can take longer if time permits. Motivational Interviewing techniques can be used for short exchanges and more lengthy conversations. The main advantage of motivational strategies is that less time is spent in counterproductive “arguing” activity.
It is also important to remember that not all physical activity behaviour change strategies need to be utilized during any given session with a patient. Instead, choose those that seem most applicable. If you are very short on time, try and include physical activity counselling during other tasks or educational sessions.
Barrier # 3: “I’m not sure what kind of physical activity to recommend to patients.”
In the past, you may have found it difficult to discuss physical activity with patients since you were not sure what specifically to recommend. These modules provide general physical activity recommendations appropriate for most patients.
For those patients with chronic disease requiring more individualized physical activity guidance or programming, referral to a community fitness centre where staff members have experience with individuals with chronic disease may be recommended.
Barrier # 4: “Patients won’t change as a result of physical activity counselling, so why bother?”
You may wonder how effective physical activity counselling is in leading to positive changes for patients. Although finding the motivation to start and maintain a physical activity program is hard, there is evidence that physical activity counselling in health care settings may be effective. Overall, physical activity counselling that involves behaviour change strategies, written materials, and training for health professionals on how to counsel has been found to be more effective for increasing physical activity levels than other kinds of counselling.3
You may be a valuable champion of positive health behaviour change because your patients trust you as they make decisions concerning their health. Research shows that a patient’s decision making concerning treatment is often influenced by the opinion of a health care provider.4 Therefore, it is likely that patients will look to you for guidance about other factors that influence health such as lifestyle behaviours.
The interactions you have with patients may be influential in determining the kinds of choices they make about physical activity and other health behaviours.
Barrier # 5 “I don’t feel qualified to provide physical activity counselling. I’m not an exercise specialist.”
It is natural to feel a little nervous about providing physical activity counselling to patients. You may feel that you are not qualified to discuss physical activity with patients since you may not know that much about it yourself. If this is your situation, remember that most people are interested in fairly simple physical activity programs such as walking.5
The information and skills discussed in these modules should provide you with sufficient background for physical activity counselling with most patients. If you do come across patients who are interested in more specific exercise programs, such as training for an endurance event, and you feel you are not qualified to give guidance, referral to a community program or fitness centre is appropriate.
With practice, you will sharpen your counselling skills and learn to provide more specific information. Remember too that you may be one of the few sources of physical activity guidance that your patients have.
Additional Physical Activity Resources
A number of physical activity resources exist in Canada. The Canadian Society for Exercise Physiology (CSEP) and ParticipAction offer access to information about physical activity and sedentary guidelines, resources, programs, and strategies for becoming active on their websites. (http://www.csep.ca/english/view.asp?x=804 ; http://www.participaction.com).
Opportunities for physical activity programs and facilities can be found at community centres such as the YMCA (http://www.ymca.ca/en/programs-and-services/health,-fitness-and-recreation.aspx) and commercial gyms and fitness centres.
Key Points:
- While there are various barriers to providing physical activity counselling, in general, they can be minimized to facilitate physical activity counselling.
- Physical activity counselling resources are available on the internet as well as through community centres, local gyms, fitness centres, and public health centres.
Over the past several weeks you have been exposed through these learning modules to a variety of topics concerning physical activity and physical activity counselling that you can use with your interactions with patients.
References
- Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12, 38-48.
- Genius SJ. An ounce of prevention. Can Fam Physician. 2007;53, 597-599.
- Petrella RJ, Lattanzio CN. Does counseling help patients get active? Can Fam Physician. 2002;48, 72-80.
- Conter HJ. Trust for treatment. J Cancer Educ. 2010;25, 466-468.
- Booth ML, Bauman A, Owen N, Gore CJ. Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians. Prev Med. 1997;26, 131-137.