Correspondence to Dr Ibak Baky; [email protected]
STRENGTHS AND LIMITATIONS OF THIS STUDY
Participants were members of a network, which is reflective of the national demographic of general practitioners (GPs) in terms of practitioners’ personal and practice factors.
Analysis was conducted using a recognised inductive thematic framework by experienced qualitative researchers from different healthcare disciplines.
The study was restricted to a single national context.
Healthcare professionals who were not GPs, such as practice nurses, were not included.
Introduction
Physical inactivity is associated with premature morbidity and mortality,1 incurring huge health costs internationally,2 while being physically active is protective against multiple chronic conditions including dementia, several types of cancers, heart disease and fractures.3 The WHO guidelines for Physical Activity and Sedentary Behaviour recommend minimum weekly levels for healthy living,4 but significant numbers of adults fail to meet them.5 Physical activity advice should be delivered in primary care,6 and systematic reviews have demonstrated modest effectiveness for some brief interventions in this setting.7–9 However, such interventions are not delivered frequently or consistently.10 More frequent and standardised roll-out of such physical activity initiatives in primary care can support more effective patient outcomes and reduce the occurrence of chronic diseases.
Studies report that general practitioners (GPs) are receptive to counselling their patients about the benefits of physical activity, but the lack of time, training and protocols are principal barriers to promoting it in consultations.11 12 A recent cross-sectional study of over 800 GPs in England reported that GPs value physical activity for health but reported similar barriers.13 Research suggests that healthcare professionals who are themselves physically active are more likely to promote physical activity.14 15 Moreover, the link between more physically active GPs and physical activity promotion is long established in the literature.16 This should be a cause for concern for doctors’ own health as GPs with heavy caseloads often do not have opportunities for physical activity.17 18 Resolving the discrepancy between GPs’ physical activity goals and their actual behaviours could help develop a healthier medical workforce as per Antonovsky’s salutogenic model of health, which proposes that individuals with a greater sense of coherence between stated life objectives and achieving these goals can cope better with stress and are healthier.19 Clearly, both system-level (insufficient time or training in physical activity social prescribing) and individual-level (personal interest and behaviour) factors are at play. Behavioural change research suggests moving towards system-level (policy and regulation) changes to support GP’s social prescription.20
General practice in Ireland is a mixed public–private system, whereby approximately half of the population pay for visits to their GP and half have a state-funded GP visit or General Medical Services card.21 The cards are allocated based on the level of income, disability or age.21 Traditionally, visits to general practice were for acute illness or deterioration of chronic illnesses. However, one of the most important health policies in Ireland has been the introduction of the Chronic Disease Management programme in January 2020.22 For the first time, patients with certain chronic health conditions (including type 2 diabetes mellitus) now receive twice yearly free structured visits to their GP. The purpose of the visits is to monitor medical outcomes and to promote healthy behaviours, including recording and promoting physical activity. In 2023, there were 300 000 patients registered on the CDM programme, with over 800 000 CDM consultations recorded; this will rise as more patients register and more conditions are included in the programme.22 This has enabled a cohort of patients, often lacking financial ability, to attend GPs and have chronic conditions attended to that are suitable for social prescription.
The authors are not aware of any qualitative research conducted among GPs exploring how their own personal physical activity experiences influence how they promote physical activity in the consultation. Bandura’s social cognitive theory will be used to examine patients’ personal physical activity behaviours and how GPs believe they are influenced in the general practice consultation.23 Social cognitive theory in physical activity research is established in the literature, and thereby, personal, environmental and factors relating to physical activity make it very relevant to the aim and objectives of this study.24 The paper will provide deeper insights into GP perspectives on physical activity in their personal lives and their professional practice.
Specific objectives:
To understand the physical activity behaviours of GPs in their personal lives.
To explore how their personal experiences may influence physical activity promotion in their professional practice.
To investigate the perceptions of GPs regarding their role in physical activity promotion to their patients.
Methodology
Study design
A qualitative study design was used, consisting of online semi-structured interviews. The suitability of this study design is supported by recent research, concluding that conversations can identify motivation states and provide relevant information when people are motivated and have ‘established goals and commitments to take and maintain action’.25 The consolidated criteria for reporting qualitative research were used as guidelines to ensure transparency in reporting26 on how participants were recruited for the interview process, timings, data analysis and theme extraction (online supplemental material 1).
Ethical approval for the study was granted by the Education and Health Sciences Research Ethics Committee, University of Limerick: (reference number 2022_06_38_EHS (ER), approved on 13 July 2022).
Participants: eligibility and recruitment
Participants were recruited from the University of Limerick Education and Research Network of General Practitioners (ULEARN-GP). The membership of this network, involving 140 GP practices, is representative of the national demographic of GPs in terms of gender, age, practice structure and rurality.27 The recruitment of participants began 4 weeks before the interviews commenced; participants were informed about the study via email sent by a gatekeeper, who was the administrator of the ULEARN-GP network. Respondents were then contacted by the research team by email with further information on the study and a consent form.
Patient and public involvement
None.
Data collection
Data collection occurred from June 2022 to March 2023. The data collection team comprised three medical students (IB, CB, AB) who were trained and supervised by a clinical academic from the discipline of general practice with extensive experience in qualitative research in primary care (AOR). The interviewers were trained in the principles of conducting interviews for qualitative research, including how to set the scene so that participants are reassured that the interview is a safe space where their perspective is what matters and that there are no ‘right’ or ‘wrong’ answers; also participants were trained to use prompts effectively as a follow-up from initial questions to encourage reflection and to keep the direction of the interview on track. An interview template was developed; questions were formulated and piloted in June 2022 before commencing interviews (online supplemental material 2). Interviews were conducted on the Microsoft Teams platform during July and August 2022. Interviews ranged from 16 min to 47 min in duration (median time was 33 min). Microsoft Teams has a built-in transcription software (version 4.12) that was used to record and electronically transcribe interviews, and all participants consented to their input being transcribed. Field notes were taken by the interviewer during data collection.
Data analysis
Braun and Clark’s template for reflexive thematic analysis was the approach chosen for data analysis.28 This method allows researchers to analyse data from different perspectives, to identify patterns in the data and to generate unanticipated insights. Braun and Clark’s approach provides extra rigour through its six-step progressive protocol. While the formation of codes, groups of codes, themes and meta-themes is primarily an inductive approach, constructs from social cognitive theory, such as self-efficacy, social support and outcome expectations will inform the data analysis.23
In phase one, all transcripts were read and anonymised, a process that enabled the researchers to become familiar with the data. Next, line-by-line coding was completed independently by the researchers (IB, COB, AB) with peer-debrief sessions facilitated by the supervisor (AOR), to discuss individual interpretations of the data. As the main aim of the study was to identify GP perspectives, experiential orientation for the interpretation of the data was employed.29 Following this phase, initial themes were generated using a thematic map during an online and in-person meeting between the researchers and the primary supervisor (AOR). A subsequent in-person meeting occurred with the wider team of established researchers to review the key themes through repeated discussions between the team members. Any new emerging codes were checked against previous transcripts until saturation of new themes was reached; meta themes and subthemes were developed during the process. The analysis was completed in a reflexive non-linear way, returning to and repeating the six-step phases as necessary. The risk of personal bias and groupthink was minimised by reflection and discussion and by the involvement of an interdisciplinary team of experienced qualitative researchers from the disciplines of psychology (JMD), public health (VN) and physiotherapy (AMC) at this point and throughout the research.30
Findings
Twenty-one GPs participated in the study; the participant demographic profile is outlined in table 1. Thematic analysis of the data produced a single meta-theme, moving towards more physically active lifestyles through the art of medicine, with three subthemes identified—determining the extent of role and responsibility, adapting to the context and what I do and what I say. While participants agreed on the importance of physical activity for health, the discrepancy was noted regarding GPs’ own physical activity levels and how they promote physical activity in the consulting room. GPs had a strong, practical knowledge base of the benefits of physical activity and opinions varied regarding their understanding of their own scope of practice. An overview of the themes is presented in figure 1.
Figure 1. Meta theme and subthemes. GP, general practitioner; PA, physical activity.
Participant profile (n=21)
Gender | |
8 | |
13 | |
Working commitment | |
13 | |
8 | |
Number of years working in general practice | |
4 | |
4 | |
5 | |
3 | |
5 |
Meta theme: moving towards more physically active lifestyles through the art of medicine
A single core theme permeated the entire analysis: the mission of moving everybody towards a more physically active lifestyle can and should be achieved through the ‘art of medicine’. All participants agreed that the promotion (or not) of physical activity in a GP–patient consultation, and then how it is done is dependent on the dynamics of the individual consultation. The decisions on when and how to promote physical activity relate to doctors’ understanding of their patients, and the eliciting of patient concerns and expectations at that point and time. This was described as the 'art' rather than the ’science' of medicine. All participants shared the view that being physically active was essential for a full and healthy life, both for themselves and their patients. They shared concerns about their own personal circumstances and workload challenges and how small behavioural changes could make significant and long-term positive changes.
Subtheme 1: determining the extent of the role and responsibility
This theme brings up important points regarding how far the GP should go with physical activity promotion. Patients will have different expectations about the role of their GP and GPs themselves view the nature of their role in different ways. While participants agreed that they had a role in promoting physical activity, throughout the interviews, tension appeared between the need for the proactive doctor role and recognising the need for patients to take responsibility for their own health. However, the effectiveness of what they can do is limited particularly by individual patient views on their GP’s role in their healthcare. The understanding shared by GPs was that factors unique to each patient are critical in how physical activity promotion is understood and taken up. Similarly, GPs pointed to how some patients will respond to advice and others have come with different expectations.
[some] are looking for a quick fix and would rather take medications rather than fix the problems themselves. GP5
Most GPs agreed that they had a responsibility to discuss physical activity where appropriate and to provide education and support where possible. Often this was communicated through an ongoing dialogue, over several patient GP visits, where GPs helped patients to realise that physical activity is accessible and it is possible for them to incorporate it into their lives.
Having an open, honest discussion… about physical activity, … and broadening its definition outside of just routine structured exercise. GP6
All participants believed that physical activity promotion among patients is part of their role, but the exact nature and limit of the role were unclear. A minority was comfortable with exercise prescription, but most saw themselves as information providers in a broader sense, whereby they preferred to link in with a broader interdisciplinary team with referral pathways to physical education experts and to community-based programmes.
Participants appeared to be conscious of how their own physical activity behaviours matched the advice they were giving; many did not see themselves ‘as fantastic role models’; they were aware of how their own lifestyle choices affected their ability to promote healthy physical activity behaviour. Many expressed the opinion that being active themselves had an impact on the quality of the message they imparted.
Because if you don't do it for yourself, you won't be convincing when you're trying to tell (the) patients … and it'll be fairly obvious. GP1
All the GPs sought authenticity with their patients in their role as a medical practitioner. This authenticity extended to being a genuine role model for being physically active but not a ‘fitness guru’.
We are not expected to be an expert … don’t be too pious. GP14
Subtheme 2: adapting to context
Moving from the individual to the system level, a strong sense of frustration emerged from the data that GPs were keen to promote physical activity, but external factors were hindering their efforts. There was a palpable feeling of being overwhelmed. In relation to physical activity, GPs expressed the need for support for them to access nationwide referral pathways to multidisciplinary teams within the community and for access to these pathways to be clearer.
General practice has become such a Wild West of stuff … Maybe have a simple website link, maybe an app or something. GP1
Many GPs spoke about how effective use of funding and resources on physical activity would benefit the patient, as well as benefitting the state by minimising the economic impact of low physical activity on health system expenditure. Social prescribing emerged as a topic, more often in an implicit way. Some described successful initiatives elsewhere and many postulated ideas of software applications, community prescription pads, partnering with organisations or referring to physiotherapists and other professionals. The common underlying message was that general practice is being pulled in multiple directions and the most effective way to get GPs to promote something is to make it easier for them to do so and to provide proper supports and resources; some believed that incentivisation for GPs would improve physical activity promotion. The work environment makes both physical activity participation and promotion less likely—the intensity and unpredictability of the work in general practice was evident across the data set.
It’s (time) been eaten up by … unexpected calls … patient show up or emergencies… sometimes you're on break but still working on the computer. GP5
Workdays were long, practice staffing was short, GPs felt the need to work during their protected breaks and the consultation room was often never left during the day. Consequently, fatigue emerged as a major contributor to the limited engagement in physical activity because, although they had a little time in the evening that could be used for physical activity, they were too tired from the day’s work to go back outside.
Tiredness. Just you know, when you're working physically and mentally fairly hard, it’s difficult to get up the energy for it. GP1
Subtheme 3: what I do and what I say
The first two themes focused on individual roles and systems factors, respectively, but this theme is based on the experiences of transferring knowledge and aspirations (what I should and would like to do) to real-life habits (what I do). This disconnection expressed by GPs is an important and recurrent concept. All said they were aware of guideline recommendations and recognised the importance of looking after their own health. A number described using wearable devices and using simple behavioural techniques to enhance personal physical activity levels. The majority admitted that they did their best but did not achieve WHO recommendations or their personal goals, and only a few managed to ensure that they were consistently physically active.
It was evident that GPs appreciated that being physically active enhanced their own health. Several benefits were noted by each participant; they recognised from personal experience that even small amounts of lower-intensity exercise confer significant benefits. In the context of intense and pressurised work environments, physical activity was acknowledged as an important way of reducing stress and improving energy levels.
It’s important for not only physical well-being, but I suppose mental well-being. Even something as simple as a short walk …(can) make you feel so much better. GP2
Participants tended to bring their own personal physical activity experiences, including modest gains and strategies that worked for them, to the consultation room. There was a strong sense of compassionate understanding of human behaviour in GPs describing how they were able to improve the quantity and quality of patient physical activity by helping patients overcome perceived obstacles. Changing the perception of exercise from a pursuit for elites to a normal activity accessible to, and enjoyed by all, is a means to empower patients to take control of their physical activity. GPs also shared their experiences of physical activity: gardening, going for a brief daily walk at lunchtime and even setting the mobile phone alarm to go off hourly to remind them to walk about the room. Given their own experiences of availing of physical activity, there was consensus among GPs of the need to understand and match the time challenges in patients’ lives with GP suggestions on how to be physically active and take part in exercise.
You don’t need equipment… you don’t need specific (exercise) plans for specific conditions… you need time and explanation. IGP 14.
Discussion
This study seeks to understand GP perspectives on the physical activity of their patients and in their own personal and private lives and how their own physical activity informs their GP practice. The main finding of the study is that GPs view their primary role in physical activity promotion very much as providing an individually tailored approach for each patient. Physical activity promotion follows from the unique working knowledge GPs have of the interplay between physical activity and the experiences of their patients, based on their own self-knowledge and from many thousands of patient interactions. Related to this main outcome is the second finding that GPs do not position themselves as physical activity experts or role models but more as advocates who can educate patients about the benefits and help them overcome obstacles to participation.
It is critical that the voice of the GP is considered when planning and implementing physical activity strategies in primary care and community settings. Our study highlights how this group is aware of physical activity health benefits and is willing to promote them. While most acknowledged they are not physical activity experts, the strength of GPs in this context is in their understanding of their patients and in their ability to choose the optimum time and strategy for encouraging physical activity. Research has reported on how familiar GPs are with physical activity and exercise guidelines,13 but even small increases in physical activity levels can be beneficial to the individuals with most to gain, ie, those with the lowest baseline levels.31 32 Medical school and postgraduate specialist training curricula should focus on providing training on very brief behavioural interventions designed for the unique context of general practice33 to support patients in incorporating physical activity in their daily routines.
McWhinney, in his Textbook of Family Medicine, wrote that “family physicians are committed to the person rather than to a particular body of knowledge, group of diseases or particular technique”.34 This fundamental tenet of general practice is reflected in our study, where the GPs repeatedly mention the needs of their patients and the temporal and physical context of those needs. Viewing physical activity promotion in general practice through this lens helps clarify how GPs view their role: by playing to their strengths—their detailed understanding of their patients—they can make physical activity more accessible by communicating the simplicity of physical activity. Thus, they can help patients become more active through discussion and problem-solving of the best physical activity for each patient’s individual circumstances. The view expressed in this study of GPs viewing themselves less as role models and more as partners with their patients is consistent with international research on doctor–patient relationships.35 The process can be aided by pragmatic frameworks that can act as an aid during the consultation.36 Furthermore, an access to physical activity professionals and community-based programmes to which the doctor can refer patients are the most important resources identified by GPs in this study to support them in helping their patients become more physically active. The latter is consistent with international best practice guidelines that emphasise a multi-system approach.37
Personal physical activity by GPs in this study varied, but a common theme was the intense and high stress nature of the general practice work environment, a factor previously identified by GPs in Northern Ireland.38 This study highlights the need for doctors to develop the knowledge and skills to care for their own health and to identify time spots in their busy days, in work and in their private life, where they can be physically active. The concept of professional authenticity emerging from every interview relates to how doctors want to be able to demonstrate to patients that they are doing what they are saying to their patients and that they are trying to be physically active role models, although not ‘fitness gurus’. Interestingly, for most participants, the short-term benefits of engaging with PA, such as increased energy and less stress, appeared to be an important agent in its promotion. To do so requires resolution of the discrepancy between GP physical activity goals and behaviour and implicated in that is supporting GPs in developing physical activity self-care plans and regimes.
Strengths and weaknesses
This study had several strengths: recruitment was from the ULEARN-GP network, which is reflective of the national demographic of GPs in terms of personal and practice factors; analysis was conducted using a recognised inductive thematic framework by experienced qualitative researchers from different healthcare disciplines; and the findings are novel contributions to the literature. Limitations include the study’s restriction to a single national context and its exclusion of healthcare professionals who are not GPs, such as practice nurses. The application of the conceptual lens of Social Cognitive Theory to the data analysis was at the level of individual doctor–patient interaction. While this person-to-person interaction is a foundation stone of general practice, more practice, health system and policy-level factors could have been incorporated. Future research should examine this research question from a system perspective.
Implications for future research and practice
There is potential in future research to explore potential generational and/or cohort effects in the GP sample. There might also be a further exploration of GPs’ prior history of physical activity, that is, do GPs with a history of physical activity, perhaps in organised and competitive sports, tend to engage in more physical activity as a GP and find it easier to find opportunities to do so? Finally, this study did not explore sex differences per se, but it might be useful in future research to examine if there are differences between female and male GPs with respect to their levels of physical activity.
Recommendations from this study for policy include GPs in the design of primary care and community-based physical activity interventions plus the need for physical activity educational programmes and initiatives to support doctors in their public and private lives. It is imperative that GPs are aware of, and can work in tandem with, physical activity professionals in their communities and that an appropriate referral system is in place.
Conclusion
This study demonstrates that GPs struggle to incorporate physical activity into their own lives but that they understand its importance for themselves and their patients. Based on personal experience and enduring relationships with their patients, they are in a unique position to discuss appropriate physical activity with their patients and perform an important role in explaining and gaining access to physical activity for their patients. Support in the form of community-based resources and programmes as well as brief interventions skills could enhance their ability to further promote physical activity.
The authors are grateful to the general practitioners on the School of Medicine’s University of Limerick Education and Research Network for General Practice.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed.
Ethics statements
Patient consent for publication
Not applicable.
Ethics approval
This study involves human participants and was approved by the University of Limerick Department of Education and Health Sciences Research Ethics Committee. Participants gave informed consent to participate in the study before taking part.
Contributors All authors contributed to the planning, data review and drafting of the paper. IB, AB and CB (MB BCh BAO) were involved in the study design, data collection and analysis and helped to write the first draft; VN (PhD) was involved in the data analysis and write-up; AC (PhD) was involved in study design, oversight, analysis and write-up; JMD (PhD) was involved in the data analysis and write-up; AOR (MB BCh BAO, MMedSc) was involved in all stages of the project. Each author contributed to all drafts of the paper and read and approved the final manuscript. AOR is the author acting as the guarantor.
Funding Funding for publication was provided by the University of Limerick
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
1 Katzmarzyk PT, Friedenreich C, Shiroma EJ, et al. Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries. Br J Sports Med 2022; 56: 101–6. doi:10.1136/bjsports-2020-103640
2 Santos AC, Willumsen J, Meheus F, et al. The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis. Lancet Glob Health 2023; 11: e32–9. doi:10.1016/S2214-109X(22)00464-8
3 Cunningham C, O’ Sullivan R, Caserotti P, et al. Consequences of physical inactivity in older adults: A systematic review of reviews and meta‐analyses. Scandinavian Med Sci Sports 2020; 30: 816–27. doi:10.1111/sms.13616
4 Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451–62. doi:10.1136/bjsports-2020-102955
5 Strain T, Flaxman S, Guthold R, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants. Lancet Glob Health 2024; 12: e1232–43. doi:10.1016/S2214-109X(24)00150-5
6 DiPietro L, Al-Ansari SS, Biddle SJH, et al. Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group. Int J Behav Nutr Phys Act 2020; 17: 143. doi:10.1186/s12966-020-01042-2
7 Orrow G, Kinmonth A-L, Sanderson S, et al. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2012; 344: e1389. doi:10.1136/bmj.e1389
8 van der Wardt V, di Lorito C, Viniol A. Promoting physical activity in primary care: a systematic review and meta-analysis. Br J Gen Pract 2021; 71: e399–405. doi:10.3399/BJGP.2020.0817
9 Kettle VE, Madigan CD, Coombe A, et al. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ 2022; 376: e068465. doi:10.1136/bmj-2021-068465
10 Hall LH, Thorneloe R, Rodriguez-Lopez R, et al. Delivering brief physical activity interventions in primary care: a systematic review. Br J Gen Pract 2022; 72: e209–16. doi:10.3399/BJGP.2021.0312
11 Ribera AP, McKenna J, Riddoch C. Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system. Eur J Public Health 2005; 15: 569–75. doi:10.1093/eurpub/cki045
12 Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med 2012; 46: 625–31: 625. doi:10.1136/bjsports-2011-090734
13 Lowe A, Myers A, Quirk H, et al. Physical activity promotion by GPs: a cross-sectional survey in England. BJGP Open 2022; 6: BJGPO.2021.0227. doi:10.3399/BJGPO.2021.0227
14 Selvaraj CS, Abdullah N. Physically active primary care doctors are more likely to offer exercise counselling to patients with cardiovascular diseases: a cross-sectional study. BMC Prim Care 2022; 23: 59. doi:10.1186/s12875-022-01657-3
15 Fie S, Norman IJ, While AE. The relationship between physicians’ and nurses’ personal physical activity habits and their health-promotion practice: A systematic review. Health Educ J 2013; 72: 102–19. doi:10.1177/0017896911430763
16 McKenna J, Naylor PJ, McDowell N. Barriers to physical activity promotion by general practitioners and practice nurses. Br J Sports Med 1998; 32: 242–7. doi:10.1136/bjsm.32.3.242
17 Mayne RS, Hart ND, Heron N. Sedentary behaviour among general practitioners: a systematic review. BMC Fam Pract 2021; 22: 6. doi:10.1186/s12875-020-01359-8
18 Marshall M, Ikpoh M. The workforce crisis in general practice. Br J Gen Pract 2022; 72: 204–5. doi:10.3399/bjgp22X719213
19 Antonovsky A. New perspectives on mental and physical well-being. In: Health, stress, and coping. 1979: 12–37.
20 Chater N, Loewenstein G. The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray. Behav Brain Sci 2023; 46: e147. doi:10.1017/S0140525X22002023
21 Health Service Executive, 2024. Available: https://www.hse.ie/eng/services/list/2/gp/gp.html [Accessed 23 Sep 2024 ].
22 Health servie executive. 2024. Available: https://www.hse.ie/eng/about/who/gmscontracts/2019agreement/chronic-disease-management-programme/ [Accessed 23 Sep 2024 ].
23 Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004; 31: 143–64. doi:10.1177/1090198104263660
24 Young MD, Plotnikoff RC, Collins CE, et al. Social cognitive theory and physical activity: a systematic review and meta-analysis. Obes Rev 2014; 15: 983–95. doi:10.1111/obr.12225
25 Bak M, Chin J. The potential and limitations of large language models in identification of the states of motivations for facilitating health behavior change. J Am Med Inform Assoc 2024; 31: 2047–53. doi:10.1093/jamia/ocae057
26 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349–57. doi:10.1093/intqhc/mzm042
27 O’Regan A, Hayes P, O’Connor R, et al. The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives. BMC Fam Pract 2020; 21: 25. doi:10.1186/s12875-020-1100-y
28 Braun V, Clarke V. Thematic Analysis: A Practical Guide. London: SAGE Publications, 2022.
29 Janis IL. Victims of Groupthink: A Psychological Study of Foreign-Policy Decisions and Fiascoes. 1972.
30 Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health 2019; 11: 589–97. doi:10.1080/2159676X.2019.1628806
31 Ekelund U, Brown WJ, Steene-Johannessen J, et al. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. Br J Sports Med 2019; 53: 886–94. doi:10.1136/bjsports-2017-098963
32 Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ 2019; 366. doi:10.1136/bmj.l4570
33 Lamming L, Pears S, Mason D, et al. What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews. Prev Med 2017; 99: 152–63. doi:10.1016/j.ypmed.2017.02.017
34 McWhinney IR, Freeman T. Textbook of Family Medicine. Oxford University Press, 2009.
35 Kowalski CJ, Redman RW, Mrdjenovich AJ. The Doctor-Patient Relationship, Partnership Theory, and the Patient as Partner: Finding a Balance Between Domination and Partnership. Health Care Anal 2024; 32: 205–23. doi:10.1007/s10728-023-00473-9
36 O’Regan A, Pollock M, D’Sa S, et al. ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients. BMJ Open Sport Exerc Med 2021; 7: e001050. doi:10.1136/bmjsem-2021-001050
37 Milton K, Cavill N, Chalkley A, et al. Eight Investments That Work for Physical Activity. J Phys Act Health 2021; 18: 625–30. doi:10.1123/jpah.2021-0112
38 Mayne RS, Hart ND, Tully MA, et al. GPs’ perspectives regarding their sedentary behaviour and physical activity: a qualitative interview study. BJGP Open 2022; 6. doi:10.3399/BJGPO.2022.0008
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Abstract
Objectives
This study explored general practitioners’ (GPs) understanding of physical activity advocacy to patients and their own self-care, how GPs perceive their own physical activity behaviours, how their personal experience of physical activity affects how they promote it in practice and how they define the limitations of their role in this.
Design
A qualitative design, involving online semi-structured interviews, was employed. Data was analysed by an interdisciplinary team of researchers using an inductive thematic approach.
Setting and participants
Participants were GPs (n=21) and were recruited from an education and research network.
Findings
A single meta-theme was identified—moving towards more physically active lifestyles through the art of medicine—with three related subthemes. Subthemes relate to how GPs determine the extent of their role and responsibilities, how physical activity promotion is adapted to the context and how ‘what I’ say is not necessarily ‘what I do’. After many consultations, mutual trust can develop when the GP’s role is clarified, and the GP can educate and support the initiation and maintenance of physical activity behavioural change by sharing personal experiences of physical activity behaviour.
Conclusion
Based on personal experience and enduring relationships with their patients, GPs are in a unique position to discuss appropriate physical activity with their patients and perform an important role in explaining and gaining access to physical activity for their patients. Support in the form of community-based resources and programmes as well as brief intervention skills could enhance GP ability to further promote physical activity.
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Details

1 School of Medicine, University of Limerick, Limerick, Ireland
2 Technological University Dublin, Dublin, Ireland
3 School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
4 Department of Public Health, Health Service Executive, Dublin, Ireland; Assistant professor of Public Health, University of Limerick, Limerick, Ireland
5 School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland