Assessing Factors That Influence Healthcare Provider Attitudes and Practices regarding Place-Based Exercise Prescriptions: Results of Principal Components Analysis of a Newly Developed Survey Instrument.

Introduction: The purpose of this paper is to describe development and preliminary assessment of an instrument designed to assess facilitators and barriers of provider-provided, place-based exercise prescriptions, including provider attributes, perceptions, knowledge, and resource needs. Although the American Medical Association-Supported "Exercise is Medicine" initiative encourages the practice of exercise prescription among member providers, only a small proportion engages in this practice. Additionally, little is known about the role of place-based exercise prescriptions, although access to physical activity resources differs based on residence, access to transportation, income, and other factors. To utilize potential for prescriptions to encourage physical activity, better understanding of the role of place is essential.

Methods: Previously validated and newly developed items were combined to create an 88-item survey that was administered to 166 healthcare providers.

Results: Results of principal components analysis suggested a five-factor structure; three factors-provider belief in exercise benefits, provider training needs, and place-based concerns-demonstrated high internal consistency. Factors demonstrating low internal consistency included provider attitudes about their role in exercise prescription and providers' perceptions of patient barriers.

Conclusions: Following this stage in survey validation, the 88-item developed survey could be shortened by eliminating items with low loadings. Providers may be more receptive to a shorter instrument, which could facilitate reliability and validity testing of a revised instrument. Further steps to validate the instrument include assessing consistent responses over time and considering predictive ability of the survey as an additional measure of validity. Results from the initial survey administration indicate that providers' lack of training regarding how to prescribe exercise and lack of knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise present barriers to wider use of exercise prescriptions. Community-clinical linkages which network providers with area physical activity and exercise resources may present a partial solution. Knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise presents a barrier to place-based exercise prescriptions.