title: Clinician-targeted intervention and patient-reported counseling on physical activity.
abstract: BACKGROUND
  Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population.
  
  
  METHODS
  Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre-post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians' counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews.
  
  
  RESULTS
  Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0-15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program.
  
  
  CONCLUSIONS
  A clinician training intervention showed mixed results for 5As physical activity counseling.
authors.affiliation: University of Rochester Medical Center, Department of Family Medicine, Family Medicine Research Programs, 1381 South Ave, Rochester, NY 14620. E-mail: Jennifer_carroll@urmc.rochester.edu.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Carroll
authors.affiliation: University of Rochester, Rochester, New York.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Winters
authors.affiliation: University of Rochester, Rochester, New York.
authors.forename: Mechelle R
authors.initials: MR
authors.lastname: Sanders
authors.affiliation: University of Rochester, Rochester, New York.
authors.forename: Francesca
authors.initials: F
authors.lastname: Decker
authors.affiliation: University of Rochester, Rochester, New York.
authors.forename: Thanh
authors.initials: T
authors.lastname: Ngo
authors.affiliation: Penn State College of Medicine, Hershey, Pennsylvania.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Sciamanna
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease / Q000517:prevention & control / Q000523:psychology*; D003151:Community Health Centers; D037001:Directive Counseling / Q000379:methods*; D015444:Exercise / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009518:New York; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation; D057566:Self Report; D012959:Socioeconomic Factors