Physical activity counseling intervention at a federally qualified health center: improves autonomy-supportiveness, but not patients' perceived competence

Abstract

Objective: To assess the effect of a pilot intervention to promote clinician-patient communication about physical activity on patient ratings of their perceived competence for physical activity and their clinicians' autonomy-supportiveness.

Methods: Family medicine clinicians (n=13) at two urban community health centers were randomized to early or delayed (8 months later) communication training groups. The goal of the training was to teach the 5As (Ask, Advise, Agree, Assist, Arrange) for physical activity counseling. Outcome measures were changes in patient perceptions of autonomy support (modified Health Care Climate Questionnaire, mHCCQ) and perceived competence (Perceived Competence Scale for physical activity, PCS) completed via surveys at baseline, post-intervention and six-month follow-up.

Results: Patients (n=326) were mostly female (70%) and low income. Using a generalized estimating equations model (GEE) with patients nested within clinician, patient perceived autonomy support increased at post-intervention compared to baseline (mean HCCQ scores 3.68-4.06, p=0.03). There was no significant change in patient perceived competence for physical activity.

Conclusions: A clinician-directed intervention increased patient perceptions of clinician autonomy support but not patient perceived competence for physical activity.

Practice implications: Clinicians working with underserved populations can be taught to improve their autonomy supportiveness, according to patient assessments of their clinicians.

Trial registration: ClinicalTrials.gov NCT01419093.

Keywords: Autonomy-supportiveness; Counseling intervention; Physical activity.