Evaluating the effectiveness of physician counseling to promote physical activity in Mexico: an effectiveness-implementation hybrid study
Why this work is in the frame
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Bibliographic record
Abstract
Integrating physical activity (PA) counseling in routine clinical practice remains a challenge. The purpose of this study was to evaluate the implementation and effectiveness of a pragmatic strategy aimed to improve physician PA counseling and patient PA. An effectiveness-implementation type-2 hybrid design was used to evaluate a 3-h training (i.e., implementation strategy-IS) to increase physician use of the 5-As (assess, advise, agree, assist, arrange) for PA counseling (i.e., clinical intervention-CI) and to determine if the CI improved patient PA. Patients of trained and untrained physicians reported on PA and quality of life pre-post intervention. Medical charts (N = 1700) were examined to assess the proportion of trained physicians that used the 5-As. The RE-AIM framework informed our evaluation. 305/322 of eligible physicians participated in the IS (M age = 40 years, 52% women) and 683/730 of eligible patients in the CI (M age = 49 years, 77% women). The IS was adopted by all state regions and cost ~ $20 Mexican pesos (US$1) per provider trained. Physician adoption of any of the 5-As improved from pre- to post-training (43 vs. 52%, p < .01), with significant increases in the use of assessment (43 vs. 52%), advising (25 vs. 39%), and assisting with barrier resolution (7 vs. 15%), but not in collaborative goal setting (13 vs. 17%) or arranging for follow-up (1 vs. 1%). Patient PA and quality of life did not improve. The IS intervention was delivered with high fidelity at a low cost, but appears to be insufficient to lead to broad adoption of the CI.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it