Promoting the Health Benefits of Walking and Bicycling to Work: A Qualitative Exploration of the Role of Healthcare Providers in Addressing Barriers to Active Commuting

Abstract

Background: Active commuting (walking or bicycling to work) is a beneficial form of exercise; its health benefits include lower rates of heart disease and stroke, improved mental health, and lower overall mortality. Given these health benefits, healthcare providers are well positioned to promote active commuting. We conducted a study that qualitatively explored the barriers to and solutions for active commuting, and the role of healthcare providers in encouraging active commuting. The study was done in a primary care population that was in close contact with a healthcare provider (within reach of a healthcare intervention).
Methods: Drawing on a sample of 17 participants (11 who actively commute and 6 who do not) recruited through random selection at a family practice, we facilitated focus groups to explore the barriers patients face in active commuting, strategies that patients use or could use in overcoming those barriers, and the role of healthcare providers in promoting active commuting. The focus groups were recorded and transcribed. Responses were organized into themes and analyzed by the research team according to a grounded theory approach until a saturation point was met.
Results: Participants identified a number of internal, external, and cultural barriers to active commuting. Active commuters had a number of motivating factors apart from physical health; these included mental health benefits, interaction with people and the environment, and financial savings. Participants outlined several opportunities for healthcare provider intervention, including individualized education around the health benefits of active commuting, problem solving and motivational interviewing, and advocacy.
Interpretation: The patient-identified barriers to active commuting fell into 3 main categories: internal barriers, external barriers, and cultural barriers. We used these categories to create a framework to understand areas of possible healthcare provider intervention. Motivational inter viewing, education, and counseling are all areas of intervention for internal barriers. External and cultural barriers may be more difficult to address, and a physician’s most valuable role in addressing systemic barriers may be through advocacy at the local, provincial, and federal level. We suggest that healthcare providers should be some of the many team members required to get the Canadian population more physically active through walking and bicycling to work.