Physicians' Perceptions on Physical Activity and Exercise in Non Communicable Diseases.
Condition: Physicians' Perceptions on Physical Activity and Exercise for Health
MeSH terms: Noncommunicable Diseases
Study type: Observational

Summary: 
      This descriptive, cross sectional study aims to investigate the knowledge, attitudes,
      intentions, abilities, and behavior of physicians who manage patients with chronic,
      non-communicable, diseases about physical activity and exercise. The sample will be
      nationwide and consisted of about 20.350 physicians of all the 13 Greek Regions. An
      anonymous, coded and self- administered questionnaire will be used as the main research tool
      for measuring the knowledge, attitudes, intentions, abilities and behavior of physicians. The
      questionnaire will be developed via the Delphi method after a systematic literature review
      and a focus group. The construction of the main questionnaire via the Delphi method, will
      include 2-3 quantitative rounds of data collection by 16 experts. The experts, who will be
      physicians and have knowledge and experience in matters related to physical activity,
      exercise and chronic diseases, will be selected based on specific criteria. Once the
      questionnaire has been developed, it will be piloted on a sample of approximately 40-50
      physicians - different from that of the study. Then it will be sent to the physicians of the
      main study. Beside the main questionnaire, the Greek Edition of International Physical
      Activity Assessment Questionnaire (International Physical Activity Questionnaire-Short,
      IPAQ), will be also provided to the physicians to evaluate their levels of physical activity.
      Both the questionnaires will be completed online, via electronic form (google), because of
      the Covid-19 pandemic. The questionnaires and the information letter will be sent
      electronically to the participants through the Panhellenic Medical Association. This study
      has been approved by the Bioethics and Ethics Committee of the School of Medicine of National
      and Kapodistrian University of Athens.
    

Detailed description: 
      This nationwide, cross-sectional study aims at investigating the knowledge, attitudes,
      intentions, abilities and behavior of physicians who manage patients with chronic,
      non-communicable diseases on physical activity and exercise. Secondly, it aims at developing
      a new questionnaire via the Delphi method that evaluates the knowledge, attitudes,
      intentions, abilities, and behavior on physical activity and exercise of physicians who
      manage patients with non-communicable diseases, and be weighted in terms of its validity and
      reliability.

      The study will be conducted in Greece, in three main phases: 1) development of a new research
      tool (questionnaire) based on the questions of a draft questionnaire generated from the
      results of a systematic literature review and a focus group between researchers. The new
      questionnaire will explore the knowledge, attitudes, intentions, abilities, and behavior of
      physicians who manage patients with non-communicable diseases on physical activity and
      exercise, 2) pilot testing of the new questionnaire, and 2) main study implementation.

      Phase 1: Construction of the questionnaire via the Delphi method.

      The purpose of the Delphi method is to reach a consensus / agreement on questions about
      physicians' knowledge, attitudes, intentions, abilities, and behavior regarding physical
      activity and exercise and the research question of the method is: "What are the questions
      with consensus≥75% that will be included in the final main study questionnaire, which will
      explore physicians' knowledge, attitudes, intentions, abilities, and behavior in physical
      activity and exercise? ".

      Delphi method research design: A two or three-round Delphi survey, with a list of questions
      on physicians' knowledge, attitudes, intentions, abilities, and behavior (draft
      questionnaire) generated from the results of a systematic literature review and a focus group
      between researchers, will be conduct. The draft questionnaire will be provided by principal
      researcher to the Delphi experts in the 1st round of the method, as described below.
      Specifically, at the first round of the procedure the experts will be invited to participate
      to Delphi method via e-mail. The method will start after obtaining their informed consent.
      Then the principal researcher will send to experts, via a google form, an anonymous, self-
      administered, coded and semi-structured questionnaire (draft), with closed and open
      questions, on which experts must give their consensus. The definition for consensus is
      percent agreement, with 75% being the threshold to define consensus. There will be two
      defined criteria to terminate the Delphi method; the one is the achievement of consensus≥75%
      and the second is the specific number of rounds (maximum 3). The experts will score on a
      7/Likert scale (from 1, completely insignificant question to 7, completely important
      question). Under each closed question there will be the same open optional question
      (comment/justify) for adding comments. As well, at the end of each section there will be an
      additional open-ended question, to suggest, if desired, their own questions for the next
      round questionnaire. The questions of the semi-structured questionnaire will be divided into
      6 main sections: Demographic and educational characteristics, knowledge, attitudes,
      intentions, abilities and behavior in physical activity and exercise.

      After the collection of the 1st round data, a statistical analysis of the answers will be
      conducted and the experts will be informed about the first results, in the context of their
      feedback. This will give them the opportunity to change their point of view if they wish.
      Based on the results of the 1st round, the research team will construct the semi-structured
      questionnaire of the 2nd round, which will be checked of its face validity. The 2nd round
      will be conducted 2-3 weeks after and in accordance with the 1st round. The data collection
      of the 2nd round will be followed by their statistical analysis, feedback and the creation of
      the final questionnaire, if the desired consensus will be reached. If it will not, then the
      questionnaire will be sent back to the experts in a 3rd and final round 2-3 weeks after the
      2nd round. The implementation of the Delphi method is scheduled for 01/2022 to 03/2022.

      Phase 2: Pilot implementation and weighting of the main new research tool (questionnaire).

      After the Delphi method, the final questionnaire will be pilot tested on a sample of 40-50
      physicians from the 12 specialties of the main study. The pilot test will be conducted to
      evaluate feasibility, duration, adverse events, and improve upon the study design prior to
      performance of the full-scale research. The implementation of the pilot study is scheduled
      for 04/2022 to 06/2022.

      Phase 3: Implementation of the main study.

      The main study aims to investigate the knowledge, attitudes, intentions, abilities and
      behavior regarding physical activity and exercise of physicians who manage patients with
      chronic, non-communicable, diseases. The sample will be nationwide and consisted of about
      20.350 physicians of all the 13 Greek Regions. An anonymous, coded and self- administered
      questionnaire will be used as the main research tool for investigating the knowledge,
      attitudes, intentions, abilities and behavior of physicians. The questionnaire will be
      developed via the Delphi method after a systematic literature review and a focus group and
      will be pilot tested, according to the above mentioned. After its pilot testing, the
      questionnaire will be provided to the physicians of the main study for completion. Beside the
      main questionnaire, the Greek Edition of International Physical Activity Assessment
      Questionnaire (International Physical Activity Questionnaire-Short, IPAQ, 8 items), will be
      also provided to the physicians to evaluate their levels of physical activity. Both
      questionnaires will be completed online, via electronic form (google), because of the
      Covid-19 pandemic. The questionnaires and the information letter will be sent electronically
      (via email) to the participants through the Panhellenic Medical Association or the local
      Medical Associations. This study has been approved by the Bioethics and Ethics Committee of
      the School of Medicine of National and Kapodistrian University of Athens. The implementation
      of the main study is scheduled for 06/2022 to 02/2023.
    

Intervention name(s): Questionnaire
Intervention type(s): Behavioral
Intervention description(s): A questionnaire will be developed via the Delphi method, will be pilot tested and implemented to assess physicians' perceptions and behaviors on physical activity and exercise in chronic, non-communicable diseases.
Observational model: Other
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Greek physicians who are members of the Panhellenic Medical Association, have one of the
        following specialties: General Medicine, Endocrinologists, Neurologists, Cardiologists,
        Orthopedists, Pathologists, Rheumatologists, Phytochemists-Pneumonologists, Vascular
        Surgeons, Oncologists-Pathologists, Psychiatrists, Neurologists-Psychiatrists, and manage
        patients with chronic non-communicable diseases.