Evaluation of Physical Activity Counseling in Primary Care Using Direct Observation of the 5As

Jennifer K. Carroll; Elizabeth Antognoli; Susan A. Flocke

doi:10.1370/afm.1299

Article Figures & Data

Tables

Additional Files

View popup

Table 1

Operationalized Definitions of 5As for Assessment From Audio-Recorded Discussions of Physical Activity

Task	Definition
Ask	Identification of current behaviors related to physical fitness by the physician or by the patient
Advise	Recommendation, by the physician or the patient, that the patient would benefit from increased physical activity
Assess	Determination of the patient’s readiness and/or willing- ness to change his/her physical activity status—made by either physician or patient
Assist	Construction of a specific goals and/or plan of action for the purposes of improving physical activity status—by the physician or patient
Arrange	Establishment, by either the physician or patient, of a method of follow-up to track the patient’s progress

View popup

Table 2

Patient and Visit Characteristics (N = 135)

Characteristics	No. (%)
Patients
Age^a	54.1 (10.1)
Race
White	89 (66.9)
Black	34 (25.6)
Other	10 (7.5)
Hispanic	2 (1.5)
Female	99 (73.3)
Education
High school diploma or less	29 (21.5)
Some college	47 (34.8)
College degree	38 (28.1)
Graduate degree	21 (15.6)
Chronic conditions
Diabetes	28 (20.7)
High cholesterol level	63 (46.7)
High blood pressure	70 (51.9)
Heart disease	7 (5.2)
None of the above conditions	33 (24.4)
Self-reported health status
Excellent	16 (11.9)
Very good	47 (34.8)
Good	46 (34.1)
Fair	20 (14.8)
Poor	6 (4.4)
Visits
Visit duration, min^a	23.0 (11.1)
Visit type
Acute care	30 (22.2)
Chronic care	63 (46.7)
Well-care	42 (31.1)

↵a Mean (SD) reported for continuous variables.

View popup
Table 3
Frequency of 5As Tasks Among 135 Discussions of Physical Activity
Task Accomplished n (%) Accomplished by Patient n (%)^a
Ask 123 (91) 44 (36)
Advise 71 (53) 9 (13)
Assess 76 (56) 48 (63)
Assist 52 (39) 9 (17)
Arrange 8 (6) 0 (0)

↵a The number of instances accomplished by the patient divided by the total number of instances accomplished (eg, 44/123 = 35.7%).

View popup

Table 4

Selected Quotations From Patient-Physician 5As Discussions

Example 1	Patient: I have to try to figure out a way to make myself do the exercise I need to do.
Example 2	Physician: You like to exercise, or…? Patient: Exercise, yes. I know I need to, and I just can’t [laughter] make myself do it.
Example 3	Patient: See the big problem is I work the 3 to 11 pm shift. And I’ll typically wake up later and then I usually don’t eat before I go to work. I’ll have something at work, and then I’ll go home and eat, and I know that’s terrible, cause then I go to bed You know I, I do understand that (I need to improve exercise), but it’s hard, just hard to break out of routine.
Example 4	Patient: I walk the dogs regularly...it’s not enough to get my heart rate up, because you know, they stop and sniff…. But what I’m trying to do is use an exercise bike. But I’m minimally successful with that...it’s not a knowledge deficit. I mean, I know what I need to do. It’s [laughter], it’s a performance deficit. It’s clear to me that I need more of that moderate exercise.
Example 5	Physician: Okay, now are you exercising regularly? Patient: Okay, no. Physician: Oh, I guess it’s kind of hard with 4 kids. Patient: If chasing 4 kids count, then yes. But I know that probably is not on the list. Physician: You know, 30 minutes of dedicated exercise—it would be great if you could put them in a stroller and just go for a walk.
Example 6	Physician: Are you exercising regularly? Patient: Not like I should. No. Physician: No? All right, I suppose <laughter> that’s true for most of us. Patient: [Laughter] Physician: Is that <laughter> is that something that you can start to get into? Patient: [Sigh] I’m going to try to do better. Physician: Okay. All I ask is that you try, you know, so and then, um, a quick question for you. It looks like you’re coming up due for a mammogram?

Additional Files

Tables

Supplemental Appendix

Supplemental Appendix. 5As Direct Observation Code for Physical Activity

Files in this Data Supplement:

Supplemental data: Appendix - PDF file, 9 pages, 303 KB
The Article in Brief

Evaluation of Physical Activity Counseling in Primary Care Using Direct Observation of the 5As

Jennifer K. Carroll , and colleagues

Background The 5As (ask, advise, assess, assist, arrange) are recommended as a strategy for brief physical activity counseling in primary care. There is no reference standard measurement, however, and patient participation is not well understood. This study reports on a new method to measure the 5As and describes the degree to which patients and physicians accomplish the 5As in discussions of physical activity.

What This Study Found During 361 audio-recorded office visits, the overall frequency of any 5As talk about physical activity was 38 percent. Physicians infrequently assess patients� readiness to change, though it is commonly revealed by patients in response to the physicians� assessment of their current level of activity. Patients often express ambivalence about changing their behavior, and physicians make limited or no attempts to offer assistance.

Implications

The authors suggest that, in discussions of physical activity, clinicians improve their skills in exploring patient ambivalence and readiness to change and increase explicit mention of recommended guidelines.