Promoting physical activity in primary care settings: health visitors' and practice nurses' views and experiences

AIM: This paper reports a study investigating health visitors' and practice nurses' attitudes, beliefs and practice associated with routinely advising patients about physical activity. BACKGROUND: There is worldwide concern about increasing rates of obesity and decreasing population levels of physical activity, and it has been argued that primary healthcare professionals are ideally placed to promote physical activity within local communities. In recent years, the public health role of primary care-based nurses in the United Kingdom has been considerably expanded to include playing a key role in improving the health of their local practice populations. A systematic literature search revealed that very few studies investigating nurses' views and experiences of this type work have been published. The limited amount of research that has been conducted is generally small-scale and primarily concerned with general medical practitioners' practice and attitudes, and not those of nurses. METHODS: A questionnaire survey (n = 630) and 20 in-depth interviews were conducted with health visitors and practice nurses in four health regions in Scotland between March and April 2004. The response rate was 63% overall. RESULTS: Ninety per cent (n = 149) of health visitors and 88% (n = 186) of practice nurses said that they were very likely or likely to recommend all apparently healthy adult patients to take moderate exercise. Health visitors were more likely to discuss psychological benefits than practice nurses. However, only 9% (n = 15) of practice nurses and 11% (n = 15) of health visitors correctly described the current recommendations - an accumulation of 30 minutes of moderate physical activity five times a week. Interview data suggested that most nurses gave physical activity advice based on their beliefs about the patient's willingness to change and their impressions of the patient's presenting condition, underlying physical condition and life circumstances. No measure of underlying physical fitness was used. There was a lack of agreement between the questionnaire and interview data associated with levels of physical activity advising. CONCLUSION: There were high levels of enthusiasm for physical activity promotion amongst health visitors and practice nurses. However, nursing leaders and opinion-makers should challenge practitioners' current beliefs and assumptions about physical activity promotion in the general population.