RESEARCH

Nurses’ health behaviours and physical activity-related health-promotion practices Savita Bakhshi, Fei Sun, Trevor Murrells, Alison While Savita Bakhshi, Visiting Research Associate, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London; Fei Sun, Lecturer, School of Nursing, Second Military Medical University, Shanghai, People’s Republic of China; Trevor Murrells, Statistician, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London; Alison While, Emeritus Professor of Community Nursing, King’s College London. [email protected]

© 2015 MA Healthcare Ltd

T

he global obesity epidemic, which is also evident in the UK, has raised awareness of the need to promote healthy lifestyles within all health-care contacts (Department of Health (DH), 2014). Registered nurses (RNs) in all clinical settings, including those working in the community, have the ability to reach a large proportion of the population, making them an important part of the public health workforce. Moreover, health-care contacts provide ‘teachable moments’ (Stevens et al, 2003) that need to be maximised to promote healthy ageing. Regular physical activity improves physical and mental wellbeing and prevents long-term conditions, such as cardiovascular disease, obesity, type 2 diabetes, and depression (Orozco et al, 2008; World Health Organization (WHO), 2010; Cooney et al, 2013). Active people are also more likely to have a healthy weight and body mass composition. WHO (2010) recommends that adults aged 18–64 years should undertake at least 150 minutes of moderate-intensity aerobic physical activity per week or 75 minutes of vigorous-intensity aerobic physical activity per week as part of healthy ageing. Further, those over 64 years of age should also be engaging in aerobic physical activity as part of a healthy lifestyle (Sun et al, 2013), which for some may include domestic activities such as housework and gardening (Persson and While, 2012). RNs’ personal health behaviours can help to prevent the stress, fatigue, and burnout caused by their working lives (Han et al, 2012). Some health behaviours of RNs and nursing students, including physical activity, alcohol use, smoking, weight management, and influenza vaccination, have been investigated (Blake et al, 2011; Freeman et al, 2011; Malik et al, 2011; Stephens, 2011; Duaso and Duncan, 2012; Han et al, 2012; Zhang et al, 2012). The evidence suggests that RNs are not achieving the recommended daily levels of physical activity (Blackwell, 2004; Puig Ribera et al, 2005; Stephens, 2011), with 48.6% of RNs reporting that they do not participate in any physical activity of 30 minutes on most days of the week and citing lack of time and motivation, fatigue, and cost (Malik et al, 2011). In another study, despite having high

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levels of knowledge about the benefits of physical activity and the support of friends and family, only 46% of the RNs met current recommendations (Blake et al, 2011). The RNs’ selfefficacy and perceived health status have also been found to play a role in their personal physical activity behaviours (Piazza et al, 2001; Kaewthummanukul et al, 2006). In addition, RNs may translate their personal attitudes, beliefs, and behaviours into their professional practices related to health promotion (McDowell et al, 1997; Esposito and Fitzpatrick, 2011; Hébert et al, 2012).Three systematic reviews have reported varied findings regarding the relationships

ABSTRACT

Many registered nurses (RNs) are not achieving the recommended daily levels of physical activity. This study collected data from 623 RNs about their personal health behaviours and their professional, physical activityrelated health-promotion practices. The findings showed that 75% of the sample reported engaging in personal physical activity, 25% were at risk of hazardous drinking or active alcohol use disorders, 17% were past smokers and 11% were current smokers, 47% reported having a normal body weightsize, and 73% desired to be a normal body weight-size. Nearly half of the sample reported that they were promoting physical activity within their clinical practice. Personal physical activity behaviour, perceived health status, length of clinical practice, clinical specialty, and actual body weight-size were significantly related to the RNs’ professional, physical activity-related practices. This study highlights a need for training on physical activity-related counselling, including awareness of the latest recommendations and strategies to promote physical activity. Health-care employers should also consider addressing nurses’ barriers to the promotion of physical activity within their clinical practice so that all health-care contacts are able to maximise opportunities to promote active ageing.

KEY WORDS

w Registered nurse w Physical activity w Body weight w Physical fitness w Exercise w Health promotion

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RESEARCH Scale (Persson and While, 2012), which comprises 10 items with a 5-point Likert scale. The psychometric properties for this measure have not been reported by the authors. Some 4 items measured physical activity adoption and adherence based on the exercise Processes of Change Questionnaire (PCQ) (Marcus et al, 1992). The subscale has a test–retest reliability of 0.78 over a two-week period and good concurrent validity with the Seven Day Recall Physical Activity Questionnaire (Marcus and Simkin, 1993). Perceived barriers toward physical activity were assessed using the Perceived Barriers to Exercise subscale of the Exercise Benefits/Barriers Scale (EBBS) (Sechrist et al, 1987), which comprises 14 items with a 4-point Likert scale.This subscale has a test–retest score of 0.77 over 2 weeks, and a standardised Cronbach’s alpha score of 0.87 (Douglas et al, 2006).

Alcohol use The first three items of the Alcohol Use Disorders Identification Test (AUDIT-C) (Bush et al, 1998) were used to assess hazardous drinking or active alcohol use disorders. Some 18 studies have reported a median reliability coefficient of 0.83 (range of 0.75 to 0.97), with good test–retest reliability for this measure.

Smoking

Method

A pair of items collected data about smoking practices (‘Have you ever smoked cigarettes regularly?’ and ‘Are you currently smoking cigarettes regularly?’), which were used to categorise participants into never, former, and current smokers.The psychometric properties for these two questions are unavailable.

Design and participants

Actual and desired body weight-size

A cross-sectional survey was conducted from May to July 2011 using a self-administered questionnaire. All RNs, regardless of specialty, attending continuing professional and personal development teaching sessions at a university in London, UK, were approached on a voluntary basis. Questionnaire completion was voluntary and anonymous. Participants completed the questionnaires either while they were attending university or later, and returned them via a collection box or the university mail system.

The Figure Rating Scale (Stunkard et al, 1983) collected actual and desired body weight-size data. Reported test–retest reliability for the Figure Rating Scale (Stunkard et al, 1983) over a 2-week period is (Thompson and Altabe, 1991): ww Perceived actual body weight-size: men=0.92, women=0.89 ww Desired body weight-size: men=0.82, women=0.71. The scale was validated using the Eating Disorders Inventory (EDI) (Garner et al, 1983) and the Rosenberg Self-Esteem Inventory (Rosenberg, 1965).

Measures

Professional physical activity-related health promotion practices

A 67-item cross-sectional questionnaire was developed, drawing upon a review of the literature and relevant existing scales. A small expert panel (n=3) confirmed the content validity of the questionnaire. A small pilot study was conducted with RNs (n=16), to test the clarity and ease of completion of the questionnaire, and minor amendments were made to the questionnaire’s presentation. It was not possible to recruit a test–retest sample, and therefore, the questionnaire’s reliability was not measured.

Personal health behaviours

Health promotion practices Professional physical activity-related health-promotion practices were assessed using 2 items based on the Stages of Change Model (pre-contemplation, contemplation, preparation, action, maintenance, relapse) (Prochaska and DiClemente, 1983) and existing literature (Lawlor et al, 1999).The psychometric properties for these measures have not been reported by the authors.

Other attributes Physical activity The duration, intensity, and type of physical activity undertaken were assessed using the Personal Physical Activity

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Attitudes, knowledge, and confidence regarding the promotion of physical activity were assessed using 10 items with a 4-point Likert scale drawing upon literature (Lawlor et al,

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between RNs’ personal health behaviours and their professional health promotion practices (Zhang et al, 2010; Zhu et al, 2011; Bakhshi and While, 2014). A recent review found that RNs with positive attitudes toward physical activity and higher levels of personal physical activity were more likely to promote physical activity to their patients (Fie et al. 2013). Other studies have also reported that physically active RNs are more likely to promote physical activity to their patients compared with inactive RNs (McKenna et al, 1998; Esposito and Fitzpatrick, 2011; Puig Ribera et al, 2005). RNs have reported a number of barriers to promoting physical activity to their patients, which include: a lack of time, financial incentives and resources, discomfort about providing physical activity-related advice, uncertainty about the effectiveness of advice, insufficient training, and the absence of a systematic daily approach and protocols (McDowell et al, 1997; McKenna et al, 1998; Puig Ribera et al, 2005; Buchholz and Purath, 2007; Malik et al, 2011; Hébert et al., 2012). RNs’ personal knowledge, confidence, and self-efficacy may also play a role in determining their physical activity-related health promotion practices (Buchholz and Purath, 2007; Esposito and Fitzpatrick, 2011; Grimstvedt et al, 2012). As a result, the reported proportion of RNs promoting physical activity to their patients has been mixed (Puig Ribera et al, 2005; Buchholz and Purath, 2007; Grimstvedt et al, 2012). This study aims to examine a sample of RNs’ personal health behaviours and their relationships with physical activity-related health-promotion practices.

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RESEARCH 1999). Perceived barriers toward physical activity-related promotion subscale of 6 items with a 4-point Likert scale was also used (Douglas et al, 2006). The psychometric properties for these measures have not been reported.

Personal data

Table 1. Sample characteristics of respondents Health indicators

The data sought included: health indicators (perceived health status, long-term health problems), demographic variables (age, gender, ethnicity, education), and professional employment (place of work, length of clinical practice, clinical specialty, role title, work patterns).

Ethical considerations

Health problems

Demographics

All participants received information about the study and were assured confidentiality and anonymity. Voluntary participation was emphasised. Return of completed questionnaires was deemed consent, as stated in the study information sheet distributed to all potential participants. The study adhered to the Data Protection Act 1998, and the study protocol was approved by the university ethics committee.

© 2015 MA Healthcare Ltd

Results Sample characteristics Data were collected from 623 RNs, of whom 72 worked in the community, representing a response rate of 84%. The majority of the sample were female (89.5%) and worked in a hospital (87.7%). Nearly three-quarters of the sample (73.0%) believed that their health status was good and most (86.7%) had no long-term health problems (Table 1).

British Journal of Community Nursing June 2015 Vol 20, No 6

Age (years)

Gender

Ethnicity

Data analysis Predictors of the RNs’ physical activity-related health promotion practices analysed included: health behaviours, health indicators, and demographic variables. In order to refine the number of outcome variables, exploratory factor analysis (EFA) was conducted on 20 items using MPlus (n=617): current physical activity-related health promotion practices (4 items); attitudes, knowledge, and confidence (10 items); and perceived barriers toward physical activity-related promotion (6 items). The analysis revealed the presence of 6 components with eigenvalues exceeding 1: current practices; knowledge and confidence; attitudes; personal barriers; professional barriers; and health-care costs. Data were analysed using IBM SPSS Statistics 21. Non-parametric Pearson’s chi-squared test was used to investigate associations between the categorical predictor variables. Following statistical advice, multinomial logistic regression was used to assess the predictors of physical activity-related health promotion practices as assessed by the different Stages of Change Model (Prochaska and DiClemente, 1983). Relationships between the predictor and outcome variables were assessed using hierarchical multiple regression (Stevens, 2009). The predictor variables were entered into the analysis as blocks, as follows: health behaviours, health indicators, and personal variables (i.e. demographic and professional employment variables).

Health status

Education

Professional employment

Place of work

Length of practice (years)

Specialty

Role title

Hours worked per week

n

%

Very good

133

22.2

Good

438

73.0

Poor or very poor

29

4.8

Yes

81

13.3

No

526

86.7

20–29

170

28.1

30–39

218

36.0

40–49

160

26.4

50 or older

57

9.4

Men

63

10.5

Women

537

89.5

Caucasian

322

54.8

Other

266

45.2

Diploma HE

207

35.0

Bachelor’s

274

46.4

Postgraduate

110

18.6

Hospital

511

87.7

Community

72

12.3

0–10

219

37.4

Medical

262

44.7

Surgical

110

18.8

Mental health

31

5.3

Paediatrics

85

14.5

Midwifery

46

7.8

Primary care

52

8.9

Staff nurse

347

58.5

Senior nurse

246

41.5

None

10

1.6

1–20

25

4.1

21–40

430

70.6

41+

144

23.6

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RESEARCH Personal health behaviours

Table 2. Associations between nurses’ personal health behaviours and personal variables+ Personal variables

ChiSquared

df

Physical activity P

Physical activity

Health status

36.81

2

0.001**

Alcohol use

Age (years)

16.22

3

0.001**

Ethnicity

105.72

1

0.001**

Length of practice (years)

8.79

2

0.01**

From among the respondents, three-quarters (75%, n=449) reported being physically active. Over a quarter (29%, n=156) of the sample reported doing moderate-intensity exercise for less than 1 hour daily and 7% (n=42) reported doing so between 1-2 hours daily. Nearly half (42%, n=239) of the sample reported doing strength exercises (i.e. jogging or swimming) for less than 1 hour daily, and 36.7% (n=208) reported never doing this exercise.

Health problems

4.76

1

0.03*

Alcohol use

Age (years)

37.53

3

0.001**

Ethnicity

86.33

1

0.001**

Length of practice (years)

24.20

2

0.001**

Health problems

6.47

2

0.04*

Age (years)

17.75

6

0.01**

Ethnicity

78.18

2

0.001**

Length of practice (years)

15.73

4

0.003**

Role title

7.27

2

0.03*

More than two-thirds (72%, n=428) reported that they were neither past nor current smokers. Under one-fifth (17%, n=101) of the sample had smoked in the past, and 11% (n=66) were current smokers at the time of data collection.

Health status

26.20

4

0.001**

Actual and desired body weight-size

Age (years)

35.20

6

0.001**

Ethnicity

16.88

2

0.001**

Place of work

7.07

2

0.03*

Length of practice (years)

14.75

4

0.01**

Speciality

25.91

10

0.004**

Role title

12.53

2

0.002**

Hours worked (per week)

14.86

6

0.02*

Age (years)

27.86

6

0.001**

Gender

30.47

2

0.001**

Ethnicity

20.67

2

0.001**

Length of practice (years)

10.36

4

0.04*

Speciality

24.34

10

0.01*

Alcohol risk

Smoking

Actual body shape

Desired body shape

Includes health indicators, demographic variables, and professional employment **Significant at the 0.01 level *Significant at the 0.05 level +

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Around a quarter (22%, n=133) of the sample never consumed alcohol, and 25% (n=144) of those who drank it were at risk of hazardous drinking or active alcohol use disorders. A fifth (20%, n=29) of the high-risk drinkers reported drinking alcohol 4 or more times a week compared with 1% (n=6) of the low-risk drinkers. Most of the sample (88%, n=511) reported consuming between 1–4 drinks containing alcohol on a typical day when they drank.

Smoking

Just under half (47%, n=279) of the sample reported that they had a normal body weight-size, 44% (n=266) perceived that they were overweight, and a minority (8%, n=49) perceived themselves as underweight. Nearly three-quarters of the sample (73%, n=425) desired to have a normal body weightsize, 16% (n=97) wanted to be underweight, and 11% (n=61) wanted to be overweight.

Personal data Health indicators Most of the sample (73%, n=438) reported that their health status was ‘good’, while 22% (n=133) stated it was ‘very good’, and 5% (n=29) reported that their health was ‘poor’ or ‘very poor’. A minority of the sample (13%, n=81) reported having long-term health problems that limited their physical activity.

Interactions between personal health behaviours An analysis of the interactions between personal health behaviours showed that there were significant positive associations between personal physical activity and actual body weight-size (χ2=18.30, 2 df, P

Nurses' health behaviours and physical activity-related health-promotion practices.

Many registered nurses (RNs) are not achieving the recommended daily levels of physical activity. This study collected data from 623 RNs about their p...
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