title: Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults.
abstract: Physical activity (PA) counselling is challenging in primary care. It is unknown whether clinician training on the 5As (Ask, Advise, Agree, Assist, Arrange) improves PA counselling skills.
  
  
  
  To evaluate the effect of a clinician training intervention on PA counselling for underserved adults using the 5As framework.
  
  
  
  Pragmatic pilot clinical trial was used in the study. Clinicians (n = 13) were randomly assigned to two groups. Each group received the intervention consisting of four 1-hour training sessions to teach the 5As for PA counselling. Patient-clinician visits (n = 325) were audio recorded at baseline, immediately post-intervention, and at 6 months. Outcomes were the frequency and quality of PA discussions using the 5As, assessed by blinded coders.
  
  
  
  Patients' mean age was 44 years; 75% were African American. PA was discussed in 37% (n = 119) of visits overall and did not change from baseline to follow-up. When PA discussions occurred, the frequency of 5As increased from baseline to follow-up for Advise (51-54%), Agree (11-26%), and Assist (11-17%); however, none of the 5As had a statistically significant increase. For Agree, exploration of patient willingness to engage in PA increased from 23% at baseline to 50% at follow-up.
  
  
  
  A clinician-directed intervention to improve PA counselling increased the frequency of Advise, Agree and Assist, and the quality of Ask and Agree statements, though the absolute numbers were small and only Agree reached statistical significance. Future research is needed to understand the factors that affect the optimal uptake and approach to 5As counselling.
authors.affiliation: Department of Family Medicine, University of Colorado, Aurora, CO, USA, jennifer.2.carroll@ucdenver.edu.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Carroll
authors.affiliation: Department of Family Medicine, Case Western Reserve University, Cleveland, OH, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
authors.affiliation: Department of Family Medicine, Family Medicine Research Programs, University of Rochester Medical Center, Rochester, NY, USA and.
authors.forename: Mechelle R
authors.initials: MR
authors.lastname: Sanders
authors.affiliation: Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lowenstein
authors.affiliation: Department of Family Medicine, Family Medicine Research Programs, University of Rochester Medical Center, Rochester, NY, USA and.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: Department of Family Medicine, Family Medicine Research Programs, University of Rochester Medical Center, Rochester, NY, USA and.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
mesh_terms: D000328:Adult; D003142:Communication; D037001:Directive Counseling / Q000379:methods*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods; D035862:Vulnerable Populations
keywords: Physical activity counselling; intervention; underserved populations.