Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-017297 on 27 September 2017. Downloaded from Development of a physical activity monitoring tool for Thai medical schools: a protocol for a mixed methods study Apichai Wattanapisit,1,2 Surasak Vijitpongjinda,1,2 Udomsak Saengow,1,2 Waluka Amaek,3 Sanhapan Thanamee,4 Prachyapan Petchuay1 To cite: Wattanapisit A, ABSTRACT Strengths and limitations of this study Vijitpongjinda S, Saengow U, Introduction Physical activity (PA) is important in et al. Development of a promoting health, as well as in the treatment and ► The mixed methods design of the study will include physical activity monitoring prevention of diseases. However, insufficient PA is still a tool for Thai medical schools: comprehensive metrics about physical activity (PA) global health problem and it is also a problem in medical a protocol for a mixed in a medical school. schools. PA training in medical curricula is still sparse methods study. BMJ Open ► The data analysed from this study will be presented or non-existent. There is a need for a comprehensive 2017;7:e017297. doi:10.1136/ as an innovative tool, the Medical School Physical understanding of the extent of PA in medical schools bmjopen-2017-017297 Activity Report Card (MSPARC), for exploring, through several indicators, including people, places and monitoring and reporting on PA prevalence. ► Prepublication history for policies. This study includes a survey of the PA prevalence this paper is available online. ► The MSPARC will provide concise and understandable in a medical school and development of a tool, the Medical To view these files please visit infographics and information on PA at the medical School Physical Activity Report Card (MSPARC), which the journal online (http:// dx. doi. school. Users can read the results at a glance. will contain concise and understandable infographics org/ 10. 1136/ bmjopen- 2017- ► The study is limited by its cross-sectional design and information for exploring, monitoring and reporting 017297). presenting data from only one medical school. information relating to PA prevalence. However, the methodology can be adopted for Received 13 April 2017 Methods and analysis This mixed methods study will subsequent surveys and for other medical schools. Revised 6 July 2017 run from January to September 2017. We will involve the The data collection can be adjusted for the conditions Accepted 2 August 2017 School of Medicine, Walailak University, Thailand, and its present at each medical school. medical students (n=285). Data collection will consist of http://bmjopen.bmj.com/ both primary and secondary data, divided into four parts: general information, people, places and policies. We will well as increased economic costs.2 Globally, investigate the PA metrics about (1) people: the prevalence physical inactivity leads to about 1.6 million of PA and sedentary behaviours; (2) place: the quality and deaths a year, 15% of the burden of disease accessibility of walkable neighbourhoods, bicycle facilities and recreational areas; and (3) policy: PA promotion from colorectal cancer, 11% of ischaemic programmes for medical students, education metrics and stroke, 9% of ischaemic heart disease and 3 investments related to PA. The MSPARC will be developed 7% of diabetes mellitus. The economic cost using simple symbols, infographics and short texts to of physical inactivity was estimated to be on September 24, 2021 by guest. Protected copyright. evaluate the PA metrics of the medical school. $53.8 billion in 2013.2 The WHO set a goal of Ethics and dissemination This study has been approved reducing physical inactivity by 10% by 2025.4 by the Human Research Ethics Committee of Walailak In response to this, global recommendations 1 School of Medicine, Walailak University (protocol number: WUEC-16-005-01). Findings on physical activity (PA) for health were University, Nakhon Si will be published in peer-reviewed journals and presented launched in 2010.5 Reducing physical inac- Thammarat, Thailand at national or international conferences. The MSPARC and 2 tivity or increasing PA requires understanding Center of Excellence in Health full report will be disseminated to relevant stakeholders, System and Medical Research, of multiple factors, including individual policymakers, staff and clients. Walailak University, Nakhon Si characteristics, environmental resources and Thammarat, Thailand 6 7 3 public policies. It also entails a multisector, School of Architecture and 8 Design, Walailak University, multidisciplinary public health response. Nakhon Si Thammarat, Thailand INTRODUCTION In Thailand, about 30% of adults are phys- 4Department of Family Medicine, Physical inactivity is a global health chal- ically inactive, and this leads to about 5.1% Faculty of Medicine, Chiang Mai lenge. The estimated prevalence of physical of the mortality nationally.9 Reducing the University, Chiang Mai, Thailand inactivity is 23.3% among adults, 76.3% in high rates of physical inactivity in the adult Correspondence to adolescents, 78.4% for boys and 84.4% for population will be a challenging task. In 2015 1 Dr Apichai Wattanapisit; girls. The pandemic of physical inactivity and 2016, the first national conference on apichai. wa@ wu. ac. th leads to increased mortality and morbidity, as health and PA, as well as an international Wattanapisit A, et al. BMJ Open 2017;7:e017297. doi:10.1136/bmjopen-2017-017297 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-017297 on 27 September 2017. Downloaded from conference, were held in Thailand. The slogan at the 2. develop the MSPARC for monitoring and reporting national conference was ‘Active Living for All’ and was PA prevalence to clients (medical students), staff, adopted to encourage active people, places and poli- policymakers and stakeholders. cies.10 11 Subsequently, PA campaigns have been widely The secondary aim was to develop the MSPARC protocol promoted. A nationwide PA campaign was announced for further surveillance and for additional medical school by the Prime Minister, and all government agencies were settings. to arrange exercise sessions every Wednesday afternoon from 15:00 to 16:30.12 Regular monitoring and reporting on the progress being made to increase PA were insti- METHODS AND ANALYSIS tuted as a sustainable development goal.13 Study design Thus, a national policy for promoting PA and reducing A mixed methods study will be conducted, and will consist physical inactivity emerged from these efforts, with a of both quantitative and qualitative approaches. Quanti- focus on the healthcare system and medical schools. tatively, a cross-sectional observational study will be imple- Nevertheless, physical inactivity still occurs commonly mented to survey the relevant outcomes, including the among medical students, with about half (50.5%) of them prevalence of PA, the prevalence of sedentary behaviours, in Southern Thailand not being physically active.14 This and the quality and accessibility of active environments. is problematic because the evidence shows a strong asso- Qualitatively, a case study will focus on an in-depth ciation between the personal PA behaviours of medical description to develop a detailed analysis of the medical 24 students and their PA counselling attitudes and prac- school policies. The study will be carried out over a tices.15 16 However, the education provided in medical 9-month period (from January to September 2017). schools to promote PA is either sparse or non-existent.17 18 This issue is an individual concern as well as a substan- Setting and participants tial issue for provision of an appropriate medical curric- The study will involve the medical students at three ulum, given the ongoing gap in the understanding of the campuses of the School of Medicine, Walailak University, role of PA in health maintenance and its determinants in Thailand (in Nakhon Si Thammarat main campus, Trang medical schools. Hospital and Vachira Phuket Hospital). All students are The approaches that have been used to increase PA in enrolled in preclinical years (years 1–3) study at the main different populations include comprehensive explora- campus. The rest of the medical students (clinical years, tion and monitoring. The Global Observatory for Phys- years 4–6) receive clinical training and hospital attach- ical Activity launched PA report cards (‘country cards’) as ments at Trang Hospital and Vachira Phuket Hospital. a single slide infographic tool for presenting the informa- The total number of medical students is 285, with 46–48 tion on country-specific PA profiles for surveillance of PA students in each class. 19–21 prevalence and relevant metrics. The Report Card on http://bmjopen.bmj.com/ Physical Activity for Children and Youth, PA surveillance among children, has been released annually since 2005 to Box 1 Questions to survey places for physical activity assess PA.22 23 The evidence suggests that PA report cards can ‘get people moving’.23 This approach might be bene- 1. Usage: Do you use walkable neighbourhoods* (or bicycle facilities or ficial for medical schools. Therefore, a specific PA report recreational areas)? card designed for medical students might be an effective □ Yes (go to item 1.1) tool for exploring, monitoring and reporting the preva- □ No (go to item 1.2) 1.1 How often do you use walkable neighbourhoods* (or bicycle lence of PA in a particular cohort at one or more medical on September 24, 2021 by guest. Protected copyright. facilities or recreational