Developing and testing the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide for primary care providers using think-aloud, near-live, and interview procedures.

BACKGROUND: Canada's 24-Hour Movement Guidelines for Adults have shifted the focus from considering movement behaviours (i.e., physical activity, sedentary behaviour, and sleep) separately to a 24-h paradigm, which considers how they are integrated. Accordingly, primary care providers (PCPs) have the opportunity to improve their practice to promote all movement behaviours cohesively. However, PCPs have faced barriers to discussing physical activity alone (e.g., time, competing priorities, inadequate training), leading to low frequency of physical activity discussions. Consequently, discussing three movement behaviours may seem challenging. Tools to facilitate primary care discussions about physical activity have been developed and used; however, few have undergone usability testing and none have integrated all movement behaviours. Following a synthesis of physical activity, sedentary behaviour, and sleep tools for PCPs, we developed the Whole Day Matters Tool and User Guide that incorporate all movement behaviours. The present study aimed to explore PCPs' perceptions on the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide to improve their relevancy among PCPs. METHODS: Twenty-six PCPs were observed and audio-video recorded while using the Tool and User Guide in a think-aloud procedure, then in a near-live encounter with a mock service-user. A debriefing interview using a guide informed by Normalization Process Theory followed. Recordings were transcribed verbatim and analysed using content analysis and a critical friend to enhance rigour. RESULTS: PCPs valued aspects of the Tool and User Guide including their structure, user-friendliness, visual appeal, and multi-behaviour focus and suggested modifications to improve usability and acceptability. Findings are further discussed in the context of Normalization Process Theory and previous literature. CONCLUSIONS: The Tool and User Guide were revised, including adding plain language, reordering and renaming sections, reducing text, and clarifying instructions. Results also informed the addition of a Preamble and a Handout for adults accessing care (i.e., patients/clients/service-users) to explain the evidence underpinning the 24-Hour Movement Guidelines for Adults and support a person-centered approach. These four resources (i.e., Tool, User Guide, Preamble, Handout) have since undergone a consensus building process to arrive at their final versions before being disseminated into primary care practice.

A qualitative study of adolescent perspectives on COVID-19 pandemic: considerations in the provision of primary virtual care.

Context: Amidst school shutdowns, sheltering in place, and social distancing, the COVID-19 pandemic uniquely affected adolescents. Understanding the experiences of adolescents with respect to social distancing, health changes, information sources and virtual care can inform effective health care for adolescents both during and after the pandemic. Objective: An exploration into their health care experiences during the beginning stage of the pandemic was undertaken to increase knowledge among family physicians to enable adjustments to the provision of care, primarily done virtually. Study Design: This was a qualitative study using semi-structured interviews. The interviews were used to understand the experiences of adolescents using virtual care during the pandemic, the impact of public health restrictions on their health, and their sources of information. Thematic analysis of interviews was conducted using a double-coding technique. Setting: This study took place in a family health team with eight primary care practices. Population studied: Adolescents, aged 14-17 years who had at least one virtual care appointment with their family physician in the first three months of the pandemic were included. Eleven participants were interviewed. Results: Most participants were compliant with social distancing guidelines, motivated by protecting family and community. Participants described both positive and negative impacts on their mental health. Some noted an increase in marijuana use. Sexual activity in pre-pandemic relationships did not change and one participant noted a decrease in casual sexual activity. Participants enjoyed the convenience offered by virtual care but acknowledged privacy and communication challenges. Parents were described as the most trusted source of information about the pandemic. Conclusions: Adolescents primarily look to parents for guidance and the increased family time promoted well-being. Physicians that are able to help adolescents negotiate privacy and mitigate communication challenges are able to provide effective virtual care.

Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep.

The Canadian Society for Exercise Physiology assembled a Consensus Panel representing national organizations, content experts, methodologists, stakeholders, and end-users and followed an established guideline development procedure to create the Canadian 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These guidelines underscore the importance of movement behaviours across the whole 24-h day. The development process followed the strategy outlined in the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A large body of evidence was used to inform the guidelines including 2 de novo systematic reviews and 4 overviews of reviews examining the relationships among movement behaviours (physical activity, sedentary behaviour, sleep, and all behaviours together) and several health outcomes. Draft guideline recommendations were discussed at a 4-day in-person Consensus Panel meeting. Feedback from stakeholders was obtained by survey (n = 877) and the draft guidelines were revised accordingly. The final guidelines provide evidence-based recommendations for a healthy day (24-h), comprising a combination of sleep, sedentary behaviours, and light-intensity and moderate-to-vigorous-intensity physical activity. Dissemination and implementation efforts with corresponding evaluation plans are in place to help ensure that guideline awareness and use are optimized. Novelty First ever 24-Hour Movement Guidelines for Adults aged 18-64 years and Adults aged 65 years or older with consideration of a balanced approach to physical activity, sedentary behaviour, and sleep Finalizes the suite of 24-Hour Movement Guidelines for Canadians across the lifespan.