Physical Activity Brief Counseling Tool in the Portuguese National Health Service

Key Contextual Factors

• Key stakeholders involved in the development of the PA brief counseling tool were the Portuguese Directorate-General of Health, through the National Physical Activity Promotion Program, and SPMS – Serviços Partilhados do Ministério da Saúde (Shared Services of the Ministry of Health).
• The software “PEM – Prescrição Eletrónica Médica” (electronic medical prescription) is the main prescription software used in the Portuguese National Health Service and was developed by SPMS. “PEM” is accessible to all medical doctors in Portugal for the prescription of pharmacological treatments, home respiratory care and other medical devices.

Key Components/Steps

The PA assessment tool allows the assessment of weekly moderate-to-vigorous PA (min/week) and daily sitting-time (hours/day) and was implemented in the database/software SClínico Cuidados de Saúde Primários in September 2017. This platform is used as the electronic medical record in the Primary Health Care (PHC) setting, either to track vital signs, code health problems, and support/record consultations with different health professionals. It is currently used in 300 PHC institutions by 13,000 health professionals.

A “traffic light” feedback system was included to support health professionals and facilitate the interpretation of the results based on the WHO PA recommendations for adults (150min/week) and also sedentary time (i.e. turning red if the answer is 7 or more hours/day; yellow if it is 4-6 hours/day; and green if it is 0-3 hours/day)

The PA brief counselling tool consists of five inter-related guides, adapted to the level of readiness and PA of the patients, developed to support the motivational and self-regulatory processes involved in the adoption of more active lifestyles. This tool was made available in December of 2017.

• The “Physical Activity Guide” was developed to be a key resource, including information regarding the PA recommendations for adults and easy-to-implement strategies to reduce sedentary behaviour and become more active in everyday life.
• The “Decision-Making Aid” guide was developed for inactive patients who do not yet consider becoming physically active. It aims to help the patient identify relevant reasons for becoming more active and think about barriers/facilitators to engage in PA.
• The “Action Plan – Initiation” guide was also developed for inactive patients who do not yet consider becoming physically active. It helps to set goals and define an implementation strategy, designed to be used when the individual is already inclined to increase their PA levels.
• The “Action Plan – Continuity” guide was designed for patients where PA is not yet a habit, to support the development of a PA routine and maintained engagement, fostering more effective planning, anticipation of potential barriers and establishing strategies to better cope.
• The “Maintenance Plan” guide was designed for patients who already meet the current PA recommendations, as a set of suggestions in order to help keep the interest in being active, such as the use of upgraded self-monitoring strategies, challenges to try new activities or change practice scenarios.

Main Impacts / Added Value

• Between December 2017 and February 2021, a total of de 200780 health consultations included an assessment of PA and  1967 per 100 000 adult residents in Portugal were assessed (1 per 100 adults signed in primary health care in all portugese health regions.
• Between December 2017 and February 2021, a total of 36 134 guides were delivered, and 160 per 100 000 adult residents in Portugal were reached.
• The guides are available for all medical doctors registered in Portugal, and they were also made available to other healthcare professionals, facilitating the scaling up of PA promotion and brief intervention to other health care settings.
• Evidence suggests that brief advice by clinicians (one to five minutes) may improve short and long-term engagement with active lifestyles.
• The provision of brief counseling for PA by health professionals is a key action recommended by WHO and the European Commission to promote health-enhancing PA at the country level.

Lessons Learned

• The guides aim to improve the quality of brief counseling intervention and save the clinician’s time and effort.
• Although the guides can be used autonomously, their effectiveness can be increased when they are facilitated by the healthcare professional in a motivational environment that is compatible with the development of autonomous motivation.
• Specific training will be needed to help health professionals acknowledge the role of PA in the prevention, treatment, and management of a vast array of diseases and, also, understand the importance of assessing current PA levels and motivating their patients to engage in a more active lifestyle.

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