Nurses' Own Physical Activity And Associated Health Promotion: A Cross-sectional Survey In Uk And China

Background: Physical inactivity has been identified as major risk factor for theprevalence of non-communicable diseases worldwide. Many studies have shown thatengaging regularly in moderate physical activity can improve health, and decreasemortality. Encouraging health professionals to promote physical activity (PA) is amore cost-effective and safer approach in public health. An empirical link betweenhdoctors' personal health habits and their tendency to raise health issues with clientshas been proved in many studies since1970s. However, most of these studies havefocused on doctors' health behaviours and health promotion. While there is a growingbody of evidence about doctor involvement in physical activity counselling, less isknown about nurses' practice.Objective: The purpose of this studies was to examine the attitudes toward, behaviorsof nurses' physical activity (PA) from UK and China, and evaluate the proportion ofnurses' who meet WHO's physical activity guideline. Also it examins the theknowledge of, attitudes toward, confidence in, and practices of nurses' PA healthpromotion from both country, and explores the relationship between personal PAlevel and associated health promotion.Method: This research project was mainly based on a cross-sectional survey design.We used a structured questionnaire established on comprehensive literature review tocollect the data. In UK, the sample included qualified nurses who enrolled on modulesin King's College London Waterloo Campus. With the consent of the module leaders,the researcher met and provided the potential participants with information about thestudy and gives them each an information sheet. One week later, the researcherpersonally handed out the questionnaires, which will take approximately about10minutes to complete. Completed questionnaires will be collected immediately orreturned in the mail to the researcher. In China, nurses from3hospitals in Shanghaiwere invited to participate in the survey using a convenience sampling method.The data were analysed by SPSS19.0. Chi-square test and Mann-Whitney U testwere adopted for analysis of categorical variable. T test was used for analysis ofcontinuous variable. Binary logistic regression (enter,forward LR or backward wald)analysis was carried out to explore the factors may influence nurses' own physical activity and their PA health promotion. All reported differences were at the P<0.05level unless otherwise stated. Missing data was excluded in the data analysis. Thequalitative data from open-ended question was analyzed by the sorting and codingmethod.Results: The response rate was83.9%(631out of744) in UK and74%in China(888out of1100).The major findings of this study were as follows:1. General health and lifestyleMost UK nurses rated their health as good or very good (94.2%), and86.3%ofthem reported they didn't have any long term health problems that limit their physicalactivity. However, nurses from China reported significant lower rate of good healthand higher rate of long term health problems (p=0.000). The percentage of currentsmoker in UK nurses was11.0%, but only0.6%in China (p=0.000). The drinkinghabit in each sample has dramatic difference with50.7%hazardous drinker in UK andonly1.5%prevalence of "drinking more than4times per month" in Chinese nurses.The body shape of UK nurses was significant larger than Chinese nurses.2. Nursing workMore Chinese nurses' reported they worked more than40hrs per week than theircounterparts(OR=4.8,p=0.000). However, more UK nurses reported higherpercentage of walking or standing≥9hrs during the shift(51.9%vs21.3%,OR=3.2,p=0.000). The percentage of nurses worked with night shifts in both sample wassimilar, but the frequency of night shifts in UK nurses was significant lower thanChinese nurses(OR=1.3,p=0.020). The steps nurse climbed up each day and theirlifting behavior didn't demonstrate any significant differences in both samples.3. The attitude toward and behavior of nurses' PAMore UK nurses reported being in the "maintenance" stage or "action"stage thanChinese nurses (55.0%vs22.5%,OR=2.3,p=0.000). More than half of the Chinesenurses were in "Precontemplation"or "Contemplation"stage.Comparing with Chinese nurses, UK nurses had good exercise habit. One thirdChinese nurses never participated in light exercise, and percentage of not taking partin moderate or vigorous PA was more than60%. The percentage of Chinese nursesreported neither did moderat PA nor did vigorous PA was54.5%, significantly higherthan the prevalence in UK nurses. As the most popular approach of exercise,prevalence of walking in Chinese nurse was significant lower than that of UK nurses (χ2=120.6,p=0.000). Out of our expectation, Chinese nurses reported lower rate ofany kinds of household PA (p<0.000).The percentage of meeting WHO's PA guideline was65.8%in UK nurses,and45.6%in Chinese nurses(OR=2.5,p=0.000). The percentage of highly active UK nurses wasalso more than that of Chinese nurses(41.2%in UK vs24.4%in China,χ2=63.9,p=0.000). when we excluede PA component of less than10min bouts from the totalPA, the percentage of Chinese nurses who met WHO's guideline decreased to20.9%.The mean score of EBBS of UK nurse was28.1±6.3,significantly lower than thatof Chinese nurses(32.3±6.0),p=0.000. EBBS score was related with personal PA.Nurses reported sufficient PA got lower score of EBBS(p=0.000in UK, p=0.010inChina). Also, nurses in regular active stage reported less barriers of PA(p=0.000ofUK nurses,p=0.010in Chinese sample).Personal dichotomized PA stage was correlated with personal PA level. The predictconsistency between these two variables was73.4%and75%, respectively.The factors affected UK nurses were, PA level(OR=2.1,p=0.005),EBBS(OR=0.9,p=0.000),actual bodyshape(OR=0.6,p=0.076),work time as a nurse(OR=0.5,p=0.021)and frequency of night shifts(OR=2.4,p=0.007).Factors that influenced Chinese nurses own PA were sex(OR=0.1,p=0.015),yearsas RN(OR=0.969,p=0.004),knowledge of PA(OR=2.0,p=0.076),EBBS(OR=0.968,p=0.050),andgeneral health(OR=1.5,p=0.008).4. Knowledge of,attitude toward,and behavior of PA health promotion(HP)UK nurses showed higher acceptance of own PA HP role model,better knowledgeof PA HP,and stronger PA HP confidence. Moreover,more UK nurses were in regularpromoting stage than Chinese nurses(OR=0.5,p=0.000).The first three HP barriers frequently reported by UK nurses were:"Patients expectdrug treatments for their health problems"(71.2%),"There is a lack of availableeducation for health professional regarding physical activity promotion"(67.8%),and"Educational materials for patients are insufficient"(63.4%). Those reported byChinese nurses were:"Educational materials for patients are insufficient"(91.1%),"There is a lack of available education for health professional regarding physicalactivity promotion"(90.6%),and "I would be more likely to promote physical activityif there was a financial incentive"(75.9%). 5. The relationship between nurses' own PA and associated HPUK nurses in regular active PA stage (OR=1.8, p=0.002), or personally met theWHO recommendation (OR=2.0, p=0.000) reported higher propotion of regular HPpromotion.Chinese nurses in regular active PA stage (OR=1.5, p=0.016), or personally met theWHO recommendation (OR=1.5, p=0.011) reported higher propotion of regular HPpromotion.6. The predictors of nurses' PA HPThe positive predictors of UK nurses' HP practice were:acceptance of own rolemodel (OR=7.6,p=0.030), PA stage of change(OR=4.7,p=0.018), and age(OR=3.8,p=0.098)；the negative preditors were "Patients expect drug treatments for their healthproblems"(OR=0.4,p=0.102),race(OR=0.1,p=0.012)and obesity(OR=0.018,p=0.006)The positive predictors of Chinese nurses'HP practice were:PA stage ofchange(OR=3.1,p=0.009),confidence(OR=11.0,p=0.000),"Educational materialsfor patients are insufficient"(OR=2.8,p=0.081),manager(OR=3.8,p=0.099)；thenegative preditors were"lack of time"(OR=0.3,p=0.003),"financialincentive"(OR=0.4,p=0.059),"Patients expect drug treatments for their healthproblems"(OR=0.6,p=0.111),obesity(OR=0.2,p=0.071)and years as RN(OR=0.926,p=0.003).7. Results from analysis of open-ended question answerNurses felt the heavy workload of nursing work was an important barrier for theirpersonal PA. UK nurses demonstrated comprehensive understanding of PA and PA HP,and reported positive attitude toward their own role model in PA HP. Chinese nursesconcerned more about their own PA than their PA HP, and they were lack ofmotivation to participate in PA. Nurses from both country appealed the institutionshould provide PA facilities or easy access to gym or other sport center.Conclusion:This study tested the empirical relationship between nurses' own PA andassociated HP. there were significant differences among UK and Chinese nurses withregard to key study variables (Behavior, Attitudes, and Knowledge of physical activity,and physical activity health promotion).The PA level of Chinese nurses wassignificantly lower than UK nurses,and their barrier score of EBBS was significantly attitude toward,confidence in,and salient role identity. Chinese nurses reportedpositive view to the HP statements,but demonstrate lower rate of regular promotionbehavior. Except personal PA,other influential factors of PA HP were obviouslydifferent between UK nurse and Chinese nurse. Implications for future research andpractice are noted...