Physical activity as a treatment in primary health care. The role of the GP and Somali women’s views and levels of physical activity

Sammanfattning: Physical inactivity has been identified as the fourth leading risk factor for global mortality and healthcare systems play a major role in increasing physical activity among the population. Physical activity on prescription (PAP) is a non-pharmacological method used in Swedish healthcare to prevent and treat disease. Primary health care is the first level of care, in a strong position to work for increasing physical activity on a primary and secondary level among the population, patients and vulnerable groups. Somali women living in Sweden are vulnerable and susceptible to bad health, due to physical inactivity. The general aim was to increase the numbers of prescribed PAP, investigate GP´s view and use of PAP and to elucidate facilitators and barriers to a physical active lifestyle among Somali women and their actual level of physical activity and inactivity. The thesis comprised four studies with three different designs conducted within primary health care in southern Sweden. The intervention in paper I was to alter routines prescribing PAP. Paper II and III were qualitative focus group studies where GPs views of PAP and Somali women’s views of physical activity were elucidated. In Paper IV Somali women’s physical activity levels were monitored. We found that an increase of PAP prescribed by GPs was possible when involving a physiotherapist to individualize the prescription. GPs see it as their responsibility to optimize the total use of healthcare resources to ensure the best possible access for those in need of care, and thus prescribing PAP is regarded by GPs as a task with low priority that should involve physiotherapists and nurses in the team. Somali women living in Sweden are a vulnerable group susceptible to non-communicable diseases indicating low levels of physical activity and sedentary behaviours. Life post migration gives little incentive to adopt a physically active lifestyle even though physical activity is considered to be a part of health. This thesis indicates that in order for PAP to become everyday practice among GPs there is a need to create routines involving personnel with knowledge of how to individualize the prescription, preferably a physiotherapist. Somali women living in Sweden need individualized, tailored interventions with respect for Somali traditions to meet global guidelines of physical activity.