How and why do podiatrists promote physical activity?

Field: Health Professions (Health Sciences)

\(Background:\) Physical inactivity is a serious health issue. Not only is it the fourth leading risk factor contributing to death and the burden of disease globally (Lee et al. 2012), but regular physical activity has numerous benefits for health and well‐being. Health professionals are ideally placed to provide primary, secondary and tertiary prevention of many chronic diseases through the promotion of physical activity. While the factors that influence some health professionals have been studied, little is known about podiatrists’ physical activity promotion behaviours. Therefore, it is important to understand how and why health professionals, particularly podiatrists, engage in physical activity promotion. The overall objective of this thesis was to explore and understand the factors that influence podiatrists’ physical activity promotion behaviours. The specific aims were: 1. To identify the current status of physical activity promotion in podiatry in Australia; 2. To identify Australian podiatrists’ attitudes and beliefs regarding physical activity promotion; 3. To identify patients’ experiences and perceptions of podiatrists’ physical activity promotion; 4. To identify the factors that influence podiatrists to engage in the promotion of physical activity. \(Method:\) A pragmatic paradigm that employs both qualitative and quantitative methods was used to study physical activity promotion by podiatrists. The focus was on factors related to the podiatrist and their patients, and elements of the theory of planned behaviour were used to help explain behaviour. A systematic review of the literature was conducted to determine the factors associated with non-medical health professionals’ engagement in physical activity promotion (Chapter 3). Qualitative data were collected in a study that involved semi‐structured interviews with 20 purposefully selected podiatrists that aimed to identify podiatrists’ physical activity assessment and promotion practices, the barriers and enablers facing them and their salient beliefs about and attitudes towards physical activity promotion and their role (Chapter 4). These two inductive studies helped to inform a quantitative survey study that aimed to describe the current status of 316 podiatrists’ physical activity promotion practices, identify their attitudes, social norms, confidence, control over, perceived knowledge and skills, role beliefs, perceived barriers, and past training regarding physical activity promotion (Chapter 5). Furthermore, it aimed to identify the factors associated with podiatrists’ engagement in physical activity promotion. Finally, a quantitative survey study of 170 podiatry patients aimed to provide an understanding of the physical activity promotion interaction from patients’ point of view (Chapter 6). This study included collecting data on perceptions of the physical activity promotion role of podiatrists, experiences of the physical activity promotion behaviours of podiatrists, and perceptions of the effectiveness of and satisfaction with physical activity promotion provided by podiatrists. A range of methods were used in the analysis and interpretation of the data including thematic analysis, descriptive statistics, factor analysis and structural equation modelling. \(Key\) \(findings\) \(were:\) • Amongst non‐medical health professionals, self‐efficacy in physical activity promotion, positive beliefs in the benefits of physical activity, assessing patients’ physical activity level, and physical activity promotion training were the main factors associated with engaging in physical activity promotion, while a lack of remuneration was not (Chapter 3). • Podiatrists generally engage and are confident in carrying out rudimentary physical activity promotion activities, such as asking a patient about physical activity and giving general physical activity advice, but are less confident or less likely to assess physical activity levels, provide specific advice, follow up patient physical activity levels, carry out physical activity counselling or refer to other health or exercise professionals (Chapters 4, 5 and 6). • Podiatrists’ attitudes to physical activity promotion were mostly positive and most agree it is part of their role (Chapters 4 and 5). • Many podiatrists report a lack of guidelines, patient interest and resources as major barriers to physical activity promotion (Chapters 4 and 5). • Behavioural beliefs, outcome evaluations and behavioural control were significantly associated with the level of physical activity promotion provided by podiatrists (Chapter 5). • Patients are broadly supportive of the physical activity promotion actions of podiatrists and see that podiatrists have a role to play in physical activity promotion (Chapter 6). • Many patients report discussing physical activity with their podiatrist, however, many patients report not receiving any advice about physical activity, and if they do, the level of delivery they receive appears rudimentary (Chapter 6). • Patients are mostly satisfied with the advice they receive, finding it useful and believing that they would act upon it (Chapter 6). \(Conclusion:\) This study is the first internationally to describe the current status of podiatrists’ engagement in physical activity promotion, and identify factors associated with physical activity promotion in this setting. Physical activity promotion appears feasible in podiatry practice in terms of opportunity and acceptability to both practitioners and patients. Many Australian podiatrists are engaged in physical activity promotion, however, the levels of promotion are underdeveloped. Positive attitudes to and greater confidence in delivering physical activity promotion were key factors associated with podiatrists’ physical activity promotion behaviours. This study demonstrated that podiatrists are in a unique position to promote physical activity, and that physical activity promotion in this setting is supported by both podiatrists and patients. Identifying effective strategies for increasing physical activity promotion among podiatrists is the next critical step towards improving the health and wellbeing of podiatry patients through increased physical activity.