Leveraging the built environment to promote physical activity in primary care settings: implementation of a precision health strategy

Background

Physical activity (PA) counselling by primary care providers (PCPs) is a promising, cost-effective and feasible intervention. Yet, fewer than 10% of patients report being offered PA counselling or support by PCPs. Several reasons account for this poor uptake by PCPs. These include:

1. inadequate involvement of interested parties in the implementation process;

2. insufficient tailoring to patients’ environmental profile [e.g., neighbourhood characteristics, social ties];

3. insufficient grounding in behavioural science; 4) poor adaptation to clinical settings and workflows.

To address these challenges, we propose a multi-phase mixed methods study, followed by a knowledge translation activity with interested parties, culminating in a co-created scale up strategy. The study phases have been designed to ensure we identify and understand context-specific needs, explore the dynamic relationship between context, complexity, and the implementation process in the Canadian and Ghanaian clinical sites, and generate context-sensitive scale up strategies in line with established scale-up guidance.

Aims

The long-term objective of this proposal is to implement a contextually tailored, effective behaviour change intervention in Ghana and Canada designed to increase PA in individuals in the early stages of, or at high risk of developing, NCDs.

We will adapt, implement and evaluate a primary care-based PA intervention called PEP (i.e., Prescribing Exercise in Primary care). PEP includes brief exercise counselling, and a PA prescription specifying goals patients set with their PCP. Importantly, we will adapt PEP to the social and physical resources available to each patient. Throughout all phases of the project, we will work with Canadian and Ghanaian experts, collaborators and healthcare and social services partners to implement PEP in several clinical settings located in underserved areas in Tamale (Ghana) and Montreal (Canada). Our project meets two aims of the call: Theme 1, as we propose an innovative approach to promote PA in urban settings; and Theme 3, as we focus largely on improving the delivery of primary NCD prevention services in urban health systems.

Project plan

Our proposal is designed to better integrate upstream prevention of NCDs within primary healthcare settings, by adapting and tailoring primary care-based PA prescribing to local built environments. While the contexts will be highly heterogenous across and within partnering countries, the process of adapting, tailoring, implementing and scaling up will be achieved collectively. We expect that working in our varied settings will enrich our learnings and improve global capacity for PA promotion in primary care settings, including resource-limited contexts. Finally, our team was assembled to “break the silos”- teams across both countries share similar aspirations and goals. By combining our strengths, experience, and expertise, we will be better equipped to meet the challenges of rising NCDs globally.

Specifically, we will:

1. Co-adapt the effective PEP, to patients’ environmental profiles and to PCPs clinical workflows, both in the Ghanaian and Canadian settings.

2. Demonstrate effectiveness of the PEP and implementation strategies via a randomized proof of concept study within two participating city regions.

3. Produce an implementation theory explaining how, why and in what circumstances the
   effectiveness of the PEP implementation varied using a realist evaluation and integrate it within the broader political context influencing PEP and its eventual scale-up.

4. Co-create a scale up strategy, based on results from the multiphase mixed methods study, to implement PEP across Canada and Ghana.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage.

Funding organisations

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