title: Physical activity assessment in practice: a mixed methods study of GPPAQ use in primary care.
abstract: BACKGROUND
  Insufficient physical activity (PA) levels which increase the risk of chronic disease are reported by almost two-thirds of the population. More evidence is needed about how PA promotion can be effectively implemented in general practice (GP), particularly in socio-economically disadvantaged communities. One tool recommended for the assessment of PA in GP and supported by NICE (National Institute for Health and Care Excellence) is The General Practice Physical Activity Questionnaire (GPPAQ) but details of how it may be used and of its acceptability to practitioners and patients are limited. This study aims to examine aspects of GPPAQ administration in non-urgent patient contacts using different primary care electronic recording systems and to explore the views of health professionals regarding its use.
  
  
  METHODS
  Four general practices, selected because of their location within socio-economically disadvantaged areas, were invited to administer GPPAQs to patients, aged 35-75 years, attending non-urgent consultations, over two-week periods. They used different methods of administration and different electronic medical record systems (EMIS, Premiere, Vision). Participants' (general practitioners (GPs), nurses and receptionists) views regarding GPPAQ use were explored via questionnaires and focus groups.
  
  
  RESULTS
  Of 2,154 eligible consultations, 192 (8.9%) completed GPPAQs; of these 83 (43%) were categorised as inactive. All practices were located within areas ranked as being in the tertile of greatest socio-economic deprivation in Northern Ireland. GPs/nurses in two practices invited completion of the GPPAQ, receptionists did so in two. One practice used an electronic template; three used paper copies of the questionnaires.End-of-study questionnaires, completed by 11 GPs, 3 nurses and 2 receptionists and two focus groups, with GPs (n = 8) and nurses (n = 4) indicated that practitioners considered the GPPAQ easy to use but not in every consultation. Its use extended consultation time, particularly for patients with complex problems who could potentially benefit from PA promotion.
  
  
  CONCLUSIONS
  GPs and nurses reported that the GPPAQ itself was an easy tool with which to assess PA levels in general practice and feasible to use in a range of electronic record systems but integration within routine practice is constrained by time and complex consultations. Further exploration of ways to facilitate PA promotion into practice is needed.
authors.affiliation: Department of General Practice and Primary Care, Queen's University, Belfast, Northern Ireland. n.heron02@qub.ac.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Heron
authors.forename: Mark A
authors.initials: MA
authors.lastname: Tully
authors.forename: Michelle C
authors.initials: MC
authors.lastname: McKinley
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cupples
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D058006:General Practice; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity; D011320:Primary Health Care; D011795:Surveys and Questionnaires