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Beliefs and attitudes to lifestyle, nutrition and physical activity: The views of patients in Europe
Abstract
The aim of the EUROPREVIEW study was to explore patients' beliefs about the importance of lifestyle and preventive services, to assess their readiness to make changes in diet and physical activity and their willingness to receive support from GPs.
The study was done in 22 European countries, in 10 practices per country, with each 40 patients aged 30-70 years. The interview period was September 2008 to September 2009. The analysis was based on 7947 participants (52.2% females and 47.8% males).
More than half of the patients think their lifestyle is important for their health: eating habits 53%, physical activity 55% and normal body weight 59%. Almost half of the patients think they have to improve their lifestyle in terms of eating behaviour (43%), physical activity (48%) and body weight (48%). More than half of the patients say they have plans to change and two-thirds say they are confident to succeed. Two-thirds of the patients say that they would like to receive support by their GP. About half of patients reported that GPs initiated a discussion about these topics.
This study raises a number of health promotion and prevention issues of interest for primary health care providers. There is a discrepancy between the expectations of patients and the performance of GPs. A high proportion of patients who visited primary care with unhealthy lifestyles do not perceive the need to change and about half of the patients reported not having any discussion on these topics with GPs or primary care team.
... Patient-related issues were also identified as key barriers to general practitioners' implementation of other national guidelines (Lugtenberg et al. 2011). More recently Brotons et al. (2012) reported that, while two-thirds of patients in a large European study (n = 7947) would like weight-related advice from their general practitioner, not all the general practitioners met their patients' expectations in this regard. ...
... Secondly, although most practitioners agree that it is part of their role to tackle obesity, some may consider that obesity management falls outside their scope of practice with the guideline implementation not being their responsibility and belonging to another practitioner or organization (Gunther et al. 2012). Thirdly, care providers may have a decreased sense of urgency in addressing weight concerns relative to other health needs, such as acute illness and smoking when there are multiple demands upon their limited time (Brotons et al. 2012). Lastly, a briefly introduction to interventions in guidelines may not provide sufficient understanding to implement an intervention (Chen & Lu 2004). ...
Background:
Obesity is a growing global public health problem which requires all healthcare professionals to deliver weight management care within their roles.
Aim:
To describe nurses' perceived barriers, skills and practices regarding weight-related care and explore differences between English and Chinese nurses.
Methods:
A cross-sectional, self-administered questionnaire survey was distributed to 588 English nurses employed in a range of clinical settings and healthcare organizations and attending a large university in London (October-November 2010), and 519 Chinese nurses working in one of the largest hospitals in Shanghai, China (February-April 2011). Perceived barriers, skills and practices regarding weight-related care were measured. Data analysis was undertaken using responses from 399 English and 466 Chinese nurses.
Results:
English and Chinese nurses reported similar barriers to undertaking weight-related care practices which included two relatively new barriers, namely complex patients and the absence of clear practice guidelines. Both English and Chinese nurses reported being moderately skilled to perform weight-related care practices with the most mean skill scores at the moderate level. Up to 11-54% of the English nurses and 10-25% of the Chinese nurses reported providing recommended weight-related interventions for most of their patients. Generally, the English nurses reported more barriers, high-level skills and practices regarding weight-related care than the Chinese nurses.
Limitations:
The convenience samples and self-report data may have been sources of bias.
Conclusions:
A variety of barriers and limited skills may help explain the suboptimal weight-related practices among the nurses.
Implications for nursing and health policy:
Skill development of pre-registration and qualified nurses is indicated as well as the development of the nurse role to include weight management care of obese patients. Evidence-based guidelines should be readily accessible to support the nurse role in weight-related care.
... However, health promotion is challenging [2]; alcohol use, tobacco use, high blood pressure, high body mass index (BMI), high cholesterol, high blood glucose, low fruit and vegetable intake, and physical inactivity account for 61% of cardiovascular deaths [3]. The European Network on Prevention and Health Promotion (EUROPREV) [4] study indicated that of the participants with an assessed need for lifestyle change, 10-31% were willing and 13-60% were confident that they could succeed depending on the particular lifestyle issue. The authors concluded that special attention should be paid to men, patients over 50 years of age, and people who rarely go to a general practice. ...
... Theories of behavior can be classified according to their key determinants contained in the model, e.g., values, attitudes, self-efficacy, habits, emotions or whether they focus on understanding or changing behavior [7]. Some people tend to have a better ability and confidence than others in changing their lifestyles [4,8]. A persons' readiness to plan may vary a lot and they may have more or less positive expectations regarding the lifestyle choices [9]. ...
Background:
Promoting a positive lifestyle change is a challenge for primary health care. The aim of this study was to analyze health and risk-related beliefs and attitudes in relation to lifestyle and lifestyle change in a rural community.
Methods:
The study was based on a five-year follow-up data of the Lapinlahti study (N = 361). The same structured questionnaire was used at baseline and follow-up with lifestyle items. These were ranked as unhealthy (- 1), neutral (0) or healthy (+ 1). At baseline, participants took a stand on 29 statements related to beliefs and attitudes towards health and health promotion on a 5-point Likert scale. A factor analysis yielded two attitude factors (Factor 1 = underrating risks/resistant to change); (Factor 2 = helplessness/pessimism). The factors were divided into tertiles.
Results:
There was a linear positive trend (P < 0.001) in baseline lifestyle scores between the tertiles of Factor 1. A positive follow-up change of lifestyle score was found in all tertiles of Factor 1. For Factor 2, the difference between tertiles at baseline was non-significant. There was a significant positive change in all tertiles of Factor 2. Those who were underrating/ resistant but not helpless/pessimistic had the most significant positive lifestyle change. Those who were underrating/resistant and helpless/pessimistic did not improve their lifestyles.
Conclusions:
Beliefs and attitudes are related to lifestyle. Subjects with underrating and resistant attitudes with pessimism/helplessness seem to have a low potential for lifestyle change while those with resistant attitudes without pessimism and helplessness may have the most significant potential for lifestyle change. These findings suggest that it is possible to identify different groups of people with different needs and readiness and ability for health behavior change.
... A cross-sectional survey based on 7,947 Europeans, concluded that 43% think that they have to improve their eating habits and 48% think that they need to do more physical activity (Brotons, Drenthen, Durrer & Moral, 2012). Although the motivation to change health behavior exists, changing lifestyle habits is often a difficult process involving both behavioral and cognitive change, and it is well known that it is difficult for people to maintain new health habits (Hill, 2009;Roessler, 2011;Tuah, Amiel, Qureshi, Car, Kaur & Majeed, 2011). ...
... Meaning that citizens are on different stages of change and therefore also have to go through different stages to change according to The Transtheoretical Model of Health Behavior Change (Prochaska & Velicer, 1997). This is supported by Brotons et al. (2012) crosssectional study which concludes that up to 48% of the respondents in a sample believe that they have to change either physical activity or eating habits. The second possibility is that the citizens need an external motivation in order to sign up for health counseling. ...
Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi-structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short-term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.
... The use of routinely measured markers would enable transfer of this approach to the primary care setting where in conjunction with routine blood checks one could obtain tailored dietary advice. The primary care setting is an ideal location for the delivery of nutrition advice where two-thirds of the population visit their general practitioner (GP) at least once a year and with 90% visiting every 5 years [29]. There is a large body of evidence in the literature describing health The percentage number of times each dietary message was given using both individual (method 1) and targeted dietary advice (method 2). ...
... professionals' opinions and attitudes to delivering dietary advice [30][31][32]. A recent study investigating patient attitudes to lifestyle counselling reported that the majority of patients would like to receive more support from their GP in relation to nutrition [29]. However, in a study of more than 2000 GPs across Europe, significant gaps were highlighted between GPs' knowledge and practices in the use of evidence-based recommendations for health promotion and disease prevention [31]. ...
Scope:
Personalised nutrition can be defined as dietary advice that is tailored to an individual. In recent years, the concept of targeted nutrition has evolved, which involves delivering specific dietary advice to a group of phenotypically similar individuals or metabotypes. This study examined whether cluster analysis could be used to define metabotypes and developed a strategy for the delivery of targeted dietary advice.
Method and results:
K-means clustering was employed to identify clusters based on four markers of metabolic health (triacylglycerols, total cholesterol, direct HDL cholesterol and glucose) (n = 896) using data from the National Adult Nutrition Survey. A decision tree approach was developed for the delivery of targeted dietary advice per cluster based on biochemical characteristics, anthropometry and blood pressure. The appropriateness of the advice was tested by comparison with individualised dietary advice manually compiled (n = 99). A mean match of 89.1% between the methods was demonstrated with a 100% match for two-thirds of participants.
Conclusion:
Good agreement was found between the individualised and targeted methods demonstrating the ability of this framework to deliver targeted dietary advice. This approach has the potential to be a fast and novel method for the delivery of targeted nutrition in clinical settings.
... Факторе ризика за непрепознавање сопственог понашања које је везано за појаву кардиоваскуларних болести представљају и припадност мушком полу (УО=1, 19), брачни статус који не подразумева брачну или ванбрачну заједницу (УО=1,31), те нижи нивои образовања (УО=1,21 за завршену средњу школу, УО=1,35 за основно или ниже образовање). Испитаници који се према индексу благостања могу сврстати у средњи или сиромашни слој имају 1,3 пута већи ризик да своје ризично понашање не препознају као фактор који доприноси развоју болести кардиоваскуларног и цереброваскуларног система (УО=1,31 односно УО=1,34), (Табела 3). ...
... Идентификација популационих група са вишеструким облицима штетног понашања, а које сматрају да нису у кардиоваскуларном ризику и самим тим нису под сталним лекарским надзором, даје добре смернице изабраним лекарима у њиховом превентивном раду. У прилог томе говоре и чињенице из литературе које показују недостатак саветовања пацијената о факторима ризика, као и исказане ставове испитаника о жељи и потреби интензивније комуникације са лекарима опште медицине на тему ризичног понашања и повећаног кардиоваскуларног ризика 19 . ...
Introduction. Awareness of personal cardiovascular and cerebrovascular risk is relevant to risk behaviors modification. Objective. The aim of the study was to examine the correlation between demographic and socio-economic determinants and awareness of personal risk behavior related to increased cardiovascular risk. Methods. Used data derive from 2006 National Health Survey of the Serbian population. Study sample involved 14522 adults aged ³ 20 years. Participants with previous history of cardiovascular and cerebrovascular events were excluded. Multivariate logistic regression was used for analysis of relationship between risk behavior perception as dependent variable and lifestyle factors, demographic and socio-economic variables. Results. Among 12868 participants included in the study 16.7% perceived that their behavior contributed to their increased cardiovascular risk. Perceptions of own risky behavior that leads to increased cardiovascular risk was associated with older age, female gender (OR=1.22; 95% CI:1.10-1.35), higher education (OR=1.27; 95% CI:1.07-1.51), higher wealth index (OR=1.17; 95% CI:1.02- 1.34) and tobacco consumption (OR=1.54; 95% CI:1.38-1.71). Single, divorced and widowed (OR=0.86; 95% IP:0.76-0.98) persons, participants from rural areas (OR=0.87; 95% IP:0.78-0.98) and physically less active (OR=0.86; 95% IP:0.76-0.94) were less likely to perceive that their own behavior contributes to the increased personal cardiovascular risk. We didn't prove significant correlation between awareness of risky behaviors and household size or poor dietary habits. Conclusion. This study showed low level of awareness of own risky behavior for the development of cardiovascular and cerebrovascular risk. There is a need for public and individual interventions with special attention directed to young, low educated and poor population.
... People live longer lives and expect from their doctors', especially from primary care providers, advice for healthy lifestyles and for chronic care. In a study exploring preventive advice, a significant number of patients declared not having had any discussion about these concerns with their primary care doctor [1]. Advice about smoking cessation, of importance for the health of patients with chronic respiratory diseases, is also often neglected [11]. ...
In Romania, users’ perceptions about availability of services in primary care have not been explored since 2009, when a national report was produced, and little is therefore known about the subject. The study aims to identify perceptions of primary healthcare service users regarding the availability of services in primary care. This research is a pen-and-paper self-administered survey applied to an opportunity sample of people, addressing family doctor’s practices, from 17 selected settlements of Brasov county. Overall, the analysis of population’s perceptions on the primary care system in Brasov County shows a high degree of satisfaction among the patients despite a narrow spectrum of services offered by family doctors.
... An exploration of patients' beliefs about the importance of lifestyle and preventive services, and their readiness to change their life habits and receive support from GPs, performed in 22 European countries, indicated that more than half of the patients believe that lifestyle is important for their health and two thirds indicated they would like to receive support from GP (Brotons, Drenthen, Durrer, & Moral, 2012). Patients' willingness to receive GP support is encouraging and should motivate research commu- nity to keep searching for methods that may assist elderly patients to modify their lifestyle for the benefit of their health. ...
... Patients with chronic obstructive pulmonary disease (COPD) or type 2 diabetes usually know that they must improve their lifestyle in terms of physical activity (PA). 1 However, adhering to guidelines for healthy exercise is difficult. 2 By integrating PA counselling into routine practice, primary care providers can support patients in meeting this challenge. ...
We tested the performance, acceptance and user satisfaction of a tool to stimulate physical activity. The tool consisted of an accelerometer, a smartphone app and a server/web application. Patients received feedback concerning their physical activity relative to a goal, which was set in dialogue with their practice nurse. Nurses could monitor their patients' physical activity via a website. Twenty patients with COPD or type 2 diabetes used the tool for three months, combined with behaviour change counselling. Physical activity data were collected at the server and a log file was used to record technical problems. We interviewed patients and nurses after every consultation. At baseline, and after the intervention, patients completed questionnaires. Participants were positive about the tool, although motivation dropped when technical problems occurred caused by log-in and connectivity errors. On average, physical activity increased from 29 (SD 21) min per day in the first two weeks to 39 (SD 24) min per day in the last two weeks (P = 0.02), and quality of life scores increased from 0.76 (SD 0.21) to 0.84 (SD 0.17) (P = 0.04). Provided that no connectivity problems occur, the tool is a feasible intervention when embedded in primary care, and has a positive effect on physical activity levels.
... Since they are in regular contact with their patients, they have the opportunity to encourage patients to change potentially unhealthy dietary habits (2). A recent study on patients' attitudes towards lifestyle counselling showed that the majority of responders would like to receive more support regarding nutrition from their physicians (3). If delivered correctly, such interventions by physicians are known to bring beneficial changes in patients' dietary habits and thus lower cardiovascular risk factors, such as high blood pressure and high cholesterol levels (4,5). ...
Primary care physicians (PCPs) play an important role in the promotion of healthy dietary behaviour. However, little is known about the practice of and factors associated with the provision of dietary counselling in primary health care in Germany.
To explore the attitudes towards and factors associated with the routine provision of dietary counselling in Germany using data from the nationwide, representative sample of the Physician Survey on Cardiovascular Disease Prevention.
A total of 4074 randomly selected PCPs (response rate: 33.9%) provided data on dietary counselling for prevention of cardiovascular disease (CVD) based on the 5 A's (Assess, Advise, Agree, Assist, Arrange), attitudes towards dietary counselling and patients' and practice characteristics.
While the majority of PCPs (86%) reported having high levels of competence in providing dietary advice, only 49% felt they had been successful in counselling their patients on nutrition. PCPs routinely asked (68%) and advised patients to change their dietary habits more frequently (77%) compared to other counselling techniques based on the 5 A's. Female physicians and those with a higher percentage of privately insured patients and patients at higher risk of CVD were more likely to use the 5 A's to routinely counsel their patients on nutrition.
The data showed high levels of involvement by German PCPs in CVD prevention and dietary counselling. The rather low perceived success of dietary intervention and differences with respect to patients' health insurance status indicate a need to address both communication skills in medical training and appropriate reimbursement of preventive services.
... In this scenario, patients are undergoing routine checks and the framework could be implemented with minimal effort. Recent data demonstrates that patients would like to receive dietary information from their general practitioner (59) but general practitioners feel they are unequipped to do this due to reported barriers such as heavy workload and lack of skills or training (60) . However, by adopting this framework, delivery of personalised nutrition could become a reality in general practice clinics. ...
Over a decade since the completion of the human genome sequence, the promise of personalised nutrition available to all has yet to become a reality. While the definition was originally very gene-focused, in recent years, a model of personalised nutrition has emerged with the incorporation of dietary, phenotypic and genotypic information at various levels. Developing on from the idea of personalised nutrition, the concept of targeted nutrition has evolved which refers to the delivery of tailored dietary advice at a group level rather than at an individual level. Central to this concept is metabotyping or metabolic phenotyping, which is the ability to group similar individuals together based on their metabolic or phenotypic profiles. Applications of the metabotyping concept extend from the nutrition to the medical literature. While there are many examples of the metabotype approach, there is a dearth in the literature with regard to the development of tailored interventions for groups of individuals. This review will first explore the effectiveness of personalised nutrition in motivating behaviour change and secondly, examine potential novel ways for the delivery of personalised advice at a population level through a metabotyping approach. Based on recent findings from our work, we will demonstrate a novel strategy for the delivery of tailored dietary advice at a group level using this concept. In general, there is a strong emerging evidence to support the effectiveness of personalised nutrition; future work should ascertain if targeted nutrition can motivate behaviour change in a similar manner.
... The World Health Organisation has recommended that all health professionals should actively engage in promoting healthy dietary intake to improve public health outcomes [31]. Although general practitioners (GPs) and nurses provide nutrition care, and patients consider them reliable sources of information from who expect to receive dietary advice, this is often not included in the clinical consultations [32][33][34]. The most frequent reasons are high workload and lack of financial incentives, confidence and training [34][35][36][37]. ...
Background:
Targeted nutrition is defined as dietary advice tailored at a group level. Groups known as metabotypes can be identified based on individual metabolic profiles. Metabotypes have been associated with differential responses to diet, which support their use to deliver dietary advice. We aimed to optimise a metabotype approach to deliver targeted dietary advice by encompassing more specific recommendations on nutrient and food intakes and dietary behaviours.
Methods:
Participants (n = 207) were classified into three metabotypes based on four biomarkers (triacylglycerol, total cholesterol, HDL-cholesterol and glucose) and using a k-means cluster model. Participants in metabotype-1 had the highest average HDL-cholesterol, in metabotype-2 the lowest triacylglycerol and total cholesterol, and in metabotype-3 the highest triacylglycerol and total cholesterol. For each participant, dietary advice was assigned using decision trees for both metabotype (group level) and personalised (individual level) approaches. Agreement between methods was compared at the message level and the metabotype approach was optimised to incorporate messages exclusively assigned by the personalised approach and current dietary guidelines. The optimised metabotype approach was subsequently compared with individualised advice manually compiled.
Results:
The metabotype approach comprised advice for improving the intake of saturated fat (69% of participants), fibre (66%) and salt (18%), while the personalised approach assigned advice for improving the intake of folate (63%), fibre (63%), saturated fat (61%), calcium (34%), monounsaturated fat (24%) and salt (14%). Following the optimisation of the metabotype approach, the most frequent messages assigned to address intake of key nutrients were to increase the intake of fruit and vegetables, beans and pulses, dark green vegetables, and oily fish, to limit processed meats and high-fat food products and to choose fibre-rich carbohydrates, low-fat dairy and lean meats (60-69%). An average agreement of 82.8% between metabotype and manual approaches was revealed, with excellent agreements in metabotype-1 (94.4%) and metabotype-3 (92.3%).
Conclusions:
The optimised metabotype approach proved capable of delivering targeted dietary advice for healthy adults, being highly comparable with individualised advice. The next step is to ascertain whether the optimised metabotype approach is effective in changing diet quality.
... 3 In this context, nutrition care refers to any practice conducted by a health professional that aims to improve patients' nutrition behaviours and subsequent health. 4 Internationally, general practitioners (GPs) are viewed as reliable and trusted sources of infor-mation on nutrition, and patients with chronic disease expect to receive nutrition care from GPs. 5,6 However, GPs face challenges in providing nutrition care, including perceived inadequate nutrition training and low self-efficacy, 7 which may be due to insufficient nutrition education, knowledge, skills, or confidence. 8 The attitudes and confidence of students to provide nutrition care has been suggested to decline after graduation. ...
Introduction:
Improvements in individuals' nutrition behaviour can improve risk factors and outcomes associated with lifestyle-related chronic diseases.
Aim:
This study describes and compares New Zealand medical students, general practice registrars and general practitioners' (GPs') attitudes towards incorporating nutrition care into practice, and self-perceived skills in providing nutrition care.
Methods:
A total of 183 New Zealand medical students, 51 general practice registrars and 57 GPs completed a 60-item questionnaire investigating attitudes towards incorporating nutrition care into practice and self-perceived skills in providing nutrition care. Items were scored using a 5-point Likert scale. Factor analysis was conducted to group questionnaire items and a generalised linear model compared differences between medical students, general practice registrars and GPs.
Results:
All groups indicated that incorporating nutrition care into practice is important. GPs displayed more positive attitudes than students towards incorporating nutrition in routine care (p<0.0001) and performing nutrition recommendations (p<0.0001). General practice registrars were more positive than students towards performing nutrition recommendations (p=0.004), specified practices (p=0.037), and eliciting behaviour change (p=0.024). All groups displayed moderate confidence towards providing nutrition care. GPs were more confident than students in areas relating to wellness and disease (p<0.0001); macronutrients (p=0.030); micronutrients (p=0.010); and women, infants and children (p<0.0001).
Discussion:
New Zealand medical students, general practice registrars and GPs have positive attitudes and moderate confidence towards incorporating nutrition care into practice. It is possible that GPs' experience providing nutrition care contributes to greater confidence. Strategies to facilitate medical students developing confidence in providing nutrition care are warranted.
... General practice in the U.K. can offer an ideal opportunity to identify beneficial lifestyle changes as over 80 % of patients attend consultations annually [16]. Patients expect practitioners to discuss health behaviours and be a reliable source of advice [17]. Given that patients attend an average of 5.5 consultations per year [18], GPs and practice nurses have the unique opportunity of being able to intervene across a range of behaviours in the same individual over time. ...
Background:
Smoking, excessive drinking, lack of exercise and a poor diet remain key causes of premature morbidity and mortality globally, yet it is not clear what proportion of patients attending for routine primary care are eligible for interventions about these behaviours, the extent to which they co-occur within individuals, and which individuals are at greatest risk for multiple unhealthy behaviours. The aim of the trial was to examine 'intervention eligibility' and co-occurrence of the 'big four' risky health behaviours - lack of exercise, smoking, an unhealthy diet and excessive drinking - in a primary care population.
Methods:
Data were collected from adult patients consulting routinely in general practice across South Wales as part of the Pre-Empt study; a cluster randomised controlled trial. After giving consent, participants completed screening instruments, which included the following to assess eligibility for an intervention based on set thresholds: AUDIT-C (for alcohol), HSI (for smoking), IPAQ (for exercise) and a subset of DINE (for diet). The intervention following screening was based on which combination of risky behaviours the patient had. Descriptive statistics, χ2 tests for association and ordinal regressions were undertaken.
Results:
Two thousand sixty seven patients were screened: mean age of 48.6 years, 61.9 % female and 42.8 % in a managerial or professional occupation. In terms of numbers of risky behaviours screened eligible for, two was the most common (43.6 %), with diet and exercise (27.2 %) being the most common combination. Insufficient exercise was the most common single risky behaviour (12.0 %). 21.8 % of patients would have been eligible for an intervention for three behaviours and 5.9 % for all four behaviours. Just 4.5 % of patients did not identify any risky behaviours. Women, older age groups and those in managerial or professional occupations were more likely to exhibit all four risky behaviours.
Conclusion:
Very few patients consulting for routine primary care screen ineligible for interventions about common unhealthy behaviours, and most engage in more than one of the major common unhealthy behaviours. Clinicians should be particularly alert to opportunities to engaging younger, non professional men and those with multi-morbidity about risky health behaviour.
Trial registration:
ISRCTN22495456.
... As more patients now believe the importance of healthy lifestyle in their health, clinicians and healthcare practitioners have a unique opportunity in advocating lifestyle medicine for NCD prevention and treatment because patients see them as a reliable source of advice [19]. In fact, patients' active participation is a crucial component in personalized lifestyle medicine [20]. ...
In today’s aging society, more people are living with lifestyle-related noncommunicable diseases (NCDs) such as cardiovascular disease, type 2 diabetes, obesity, and cancer. Numerous opinion-leader organizations recommend lifestyle medicine as the first-line approach in NCD prevention and treatment. However, there is a strong need for a personalized approach as “one-size-fits-all” public health recommendations have been insufficient in addressing the interindividual differences in the diverse populations. Advancement in systems biology and the “omics” technologies has allowed comprehensive analysis of how complex biological systems are impacted upon external perturbations (e.g., nutrition and exercise), and therefore is gradually pushing personalized lifestyle medicine toward reality. Clinicians and healthcare practitioners have a unique opportunity in advocating lifestyle medicine because patients see them as a reliable source of advice. However, there are still numerous technical and logistic challenges to overcome before personal “big data” can be translated into actionable and clinically relevant solutions. Clinicians are also facing various issues prior to bringing personalized lifestyle medicine to their practice. Nevertheless, emerging ground-breaking research projects have given us a glimpse of how systems thinking and computational methods may lead to personalized health advice. It is important that all stakeholders work together to create the needed paradigm shift in healthcare before the rising epidemic of NCDs overwhelm the society, the economy, and the dated health system.
... We must clarify that lifestyle change decreases their risk, and it is not just an issue of aesthetics. Most patients want to discuss these topics with their primary care provider (31), and two thirds would like to receive support from their doctors (26) although only a quarter get it (32). ...
Background:
Cardiovascular diseases are prominent cause of death. Lifestyle change is effective in decreasing mortality. Perception of patients' cardiovascular risk by physicians is a drive for following preventive recommendations. Whether the hazard perceived by patients influences their attitude towards lifestyle is uncertain.
Objective:
We hypothesized that high perceived risk would be associated with a stronger determination for lifestyle change, while incorrectly optimistic patients would be less motivated.
Methods:
Two hundred patients visiting their family physicians were asked to fill out a questionnaire about demographic, clinical and lifestyle characteristics, about their attitude towards lifestyle change and their estimation of their cardiovascular risk. Actual risk was estimated by family physicians based on the national guideline.
Results:
Questionnaires were completed by 80.5% (161/200) of patients approached. Patients underestimated their risk (P < 0.001), mainly because high-/very high-risk patients classified themselves into lower risk categories. The majority of patients were planning a lifestyle change, losing weight being the most popular goal. It was the priority even for some normal weight subjects and for smokers, too. Perceived risk played a marginal role as a determinant of lifestyle change. Underestimation of perceived risk had no effect on patients' motivation. Self-rated obesity was the predictor of three out of five means of change (weight loss, diet, physical activity).
Conclusion:
Perceived cardiovascular risk and incorrect optimism about this hazard have minimal, if any, influence on attitude towards lifestyle change. Patients' motivation seems not to be primarily health related.
... Selon le Scanff en 2007, deux types d'approche complémentaires visent à améliorer la santé (27). ...
Introduction : De nombreuses études ont démontré les bénéfices de la pratique d’une activité physique régulière. Enjeu de santé publique, la parution récente du décret sur la prescription d’activité physique permet d’établir un cadre légal. Nous avons entrepris d’étudier les connaissances des médecins généralistes dans ce domaine et les obstacles à cette prescription dans le département des Vosges. Matériels et Méthodes : Une enquête quantitative a été réalisée auprès des médecins généralistes des Vosges au moyen d’un questionnaire créé sur le site « Google Formulaires », afin de connaître leurs pratiques et les obstacles à la prescription d’activité physique. L’étude s’est déroulée de mai à juillet 2017. Résultats : Un total de 60 réponses a été collecté sur les près de 200 questionnaires envoyés soit un taux de réponse de 30%. Les résultats ont montré que 68,3% des médecins donnaient souvent des conseils pratiques. Certaines pathologies n’étaient pas prises en compte comme les pathologies respiratoires, les cancers ou les syndromes anxio-dépressifs : la plupart des praticiens ne considérant pas ce type d’Affections de Longue Durée comme un obstacle à la pratique d’activité physique. Un praticien sur deux environ (48,3%) a estimé la prescription écrite comme un moyen plus adapté que la remise d’un document ou de consignes orales bien que cela ne soit pas le moyen le plus utilisé en pratique. Pour 88,3 % des médecins sondés, le principal obstacle s’est révélé être le manque de motivation du patient, suivi par son manque de temps pour 41,7% d’entre eux. Dans notre étude, seuls 37% des médecins interrogés travaillaient avec des structures adaptées ou réseaux de santé, alors que 92% estimaient nécessaire d’utiliser le travail avec ces structures. La majorité des médecins a confirmé son désir de participer à des séances de formation sur la prescription, de travailler sur la réalisation de fiches à remettre aux patients ainsi que de disposer « d’ordonnances type ». Enfin 86,6% pensent que le projet « sport-santé » pourra aboutir dans leur ville. Conclusion : Notre travail confirme l’engagement des médecins dans la promotion de l’activité physique et leur volonté à la prescrire. Cependant, ils manquent de formation, d’outils adaptés et de moyens humains. Il apparaît donc essentiel de poursuivre les actions menées tout en améliorant les outils existants par la diffusion d’informations, ce qui pourrait être facilité par le nouveau décret.
... On the other hand, patients may have unrealistic expectations about what healthcare professionals can deliver in terms of physical activity counselling, which in itself is a significant barrier to successful intervention [16]. In primary care this barrier to integrate physical activity promotion is compounded by reported lack of time, skills, cost reimbursement, as well as adequate screening [17]. ...
Background
Healthcare professionals are key informants to support individual behaviour change, and although there has been some progress in empowering clinicians to promote physical activity and health at work, an effective strategy overarching the whole medical educational journey is still lacking. This report provides an overview from the Moving Healthcare Professionals programme (MHPP), a whole-system educational approach to embed prevention and physical activity promotion into clinical practice.
Methods
The MHPP model integrates educational resources into three core domains of medical education: undergraduate education, postgraduate education and continuing professional development. The interventions are designed to spiral through existing educational approaches rather than as additional special study modules or bolt-on courses, thus reducing self-selection bias in exposure. Interventions include spiral undergraduate education materials, e-learning, embedded post-graduate resources and face-to-face peer-to-peer education.
Results
To date the MHPP model has been applied in two key areas, physical activity and health and work. The physical activity programme in a partnership between Public Health England and Sport England has delivered face-to-face training to 17,105 healthcare professionals, embedded materials in almost three quarters of English medical schools and overseen > 95,000 e-learning modules completed over two and half years. Evaluation of the individual elements of the model is ongoing and aims to show improvements in knowledge, skills and practice. Further evaluation is planned to assess patient impact.
Conclusions
The MHPP model offers a coherent whole-system approach to embed public health action into existing healthcare education models, and as such provides a framework for rapid change as well as upstream implementation to support the clinicians of today and tomorrow.
... Just as concerning are the findings of a large-scale European study of nearly 8000 patients in the primary care setting, designed to assess their attitudes towards lifestyle, nutrition and physical activity. The study concluded that a large proportion of patients with unhealthy lifestyles do not perceive the need to make change [8]. Compounding this issue is the fact that patients with PAD have a poor understanding of their risk factors and the need for secondary prevention strategies and they rely heavily on the provision of knowledge and education from health professionals, which, as highlighted earlier, is variable, if it is addressed at all [9]. ...
Those with peripheral arterial disease (PAD) require important considerations with respect to food and nutrition, owing to advanced age, poor diet behaviours and immobility associated with the disease process and co-morbid state. These considerations, coupled with the economic effectiveness of medical nutrition therapy, mandate that dietetic care plays a vital role in the management of PAD. Despite this, optimising dietetic care in PAD remains poorly understood. This narrative review considers the role of medical nutrition therapy in every stage of the PAD process, ranging from the onset and initiation of disease to well established and advanced disease. In each case, the potential benefits of traditional and novel medical nutrition therapy are discussed.
... correlated with changes in disease profiles, a higher prevalence of chronic diseases, the introduction of new and innovative treatments and health technologies, and the emergence of new social and economic contexts [1][2][3][4][5][6][7][8][9] . Healthcare systems need to adapt to these trends and aim to cover the health needs of the population 10 . ...
Background National health reports on Romania show that decisions in healthcare planning are not correlated with the health needs of the population and that there is a high degree of unmet healthcare needs of the population (related to cost, distance and waiting times), especially for low-income populations. Family medicine is facing underfinancing, slow pace of development.
Methods The research is part of a wider project of health services needs assessment in county Brasov, Romania. A subset of questions where dedicated to identifying the perception of population on primary healthcare services. Comparison with previous national and international studies was done.
Results The characteristics of the population questioned: predominantly women (67.2%), 61.1% graduates of high school or other professional schools. 97.4% are registered with a FD. The average number of visits at the FD is 11.25, higher than the national average of 7.7 reported in a previous study in 2009. Access to the FD is appreciated as satisfactory in terms of availability of doctors in the community (97.4%), opening times by (91.1%), phone access (90.5%). Only 26.6% of participants reported a same day opportunity to reach the FD. Continuity of care is reported as present in 58.7% of cases in out of hours centres. The population is appreciating the fact that FDs knows their history (90%), knows how to treat them (88.2%). Most of the preventative services are offered by FDs. 94.4% flu vaccination, 85.6% pregnancy monitoring, 90.7% well child visits. Procedures like blood draws, pap smear have less availability (46.2% respectively 63.1%).
Conclusions Despite limitations in the practice of family medicine in Romania and therefore a narrow spectrum of services offered by primary care in general, the level of contentment of the population with this healthcare resource is still high. Barriers to access are related to the lack of some essential services, especially preventive and out-of-hours services. Research at national level should be done in order to better categorize population’ perceptions on primary care and be able to use their opinion to influence policies and healthcare planning.
Key words: unmet health needs, population’s perception, primary care, Romania
... The latter was launched at the annual conference of GPs in late 2010. Brotons et al. 11 report on a questionnaire sent to 40 patients of 10 practices in 22 European countries. Many patients hoped to improve their eating habits and increase physical activity. ...
This supplement presents the papers from the Heelsum International Workshop on Nutrition in General Practice, held in Heelsum, near Wageningen in the Netherlands, on 13–15 December 2010.
The authors came from the Netherlands, USA, UK, Germany, Portugal, Spain, Iran and Australia. It was the 6th of these Heelsum workshops, held every 3 years, in 1995, 1998, 2001, 2003, 2007 and now 2010; all have been published in full in the American Journal of Clinical Nutrition,1 the European Journal of Clinical Nutrition,2 the American Journal of Clinical Nutrition,3 the European Journal of Clinical Nutrition,4 Family Practice5 and again in Family Practice.
This series of workshops have provided experiences and research from inside general practice. The last 15 years have seen major changes in general practice. Computers now routinely used by doctors in their consulting room capture clinical observations and access remote information. Patients increasingly search the Internet for their symptoms or disease name. Overweight and obesity have increased so much that GPs are expected to advise patients on its management even if this is not the presenting complaint. At the same time, it has become obvious that GPs cannot control the obesity epidemic on their own. Nor can they expect to be successful with most of their individual patients without referral, access and support to and from community resources. Community actions are also essential, requiring policy and resource support from national governments, mass media, municipalities, sports facilities, public transport, schools and the food industry.
Overweight/obesity now affects children, adolescents and adults. In the field of obesity, primary care and public health can form natural alliances with supermarkets, food industry, schools, gymnastics, sporting clubs, employers, child protection and medical insurance.6 The other theme of this 6th workshop is undernutrition in old …
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L.E.A.D.: A Framework for Evidence Gathering and Use for the Prevention of Obesity and Other Complex Public Health Problems
Health Educ Behav (2014) 41 (1): 85-99
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A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007
Fam Pract (2012) 29 (suppl_1): i61-i67
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Family Practice (2012) 29 (suppl 1): i6-i9.
doi: 10.1093/fampra/cmr058
This article appears in:Practice-based evidence for weight management: alliance between primary care and public health
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Background:
Evidence based recommendations for smoking cessation are not followed in routine primary care. A better understanding is needed why smoking cessation treatment is still underutilized.
Objectives:
To explore barriers and solutions of smoking cessation treatment, from the perspective of smokers and healthcare professionals in Dutch primary care.
Methods:
Focus groups were conducted with 14 smokers (smokers and ex-smokers) and semi-structured individual interviews with nine healthcare professionals (general practitioners and practice nurses). Data was analysed using the Constant Comparative Method.
Results:
Barriers that prevented successful smoking cessation treatment were the lack of awareness regarding the available smoking cessation treatments at the healthcare centre among smokers and the resistance against preventive tasks among healthcare professionals. Nonetheless, general practitioners (GPs) did not fear jeopardizing the doctor-patient relationship by discussing smoking. Quitting was regarded as the smokers' own responsibility and GPs felt that merely using medication was no guarantee for successful quitting. Even so, practice nurses and smokers preferred medication use. Proposed solutions were that GPs should advise smokers to quit, whereas someone else should deliver intensive behavioural support, preferably the practice nurse.
Conclusion:
Smokers and healthcare professionals seem to wait for each other to start smoking cessation. GPs should know that they could discuss smoking cessation with every patient without jeopardizing the doctor-patient relationship, preferably followed by referral to a practice nurse for intensive behavioural support. Furthermore, more patients should know that they could receive pharmacological treatment as well as behavioural support for smoking cessation in their healthcare centre.
This research investigates the Thai’s nutrition beliefs and food consumption behaviors, comparing healthy subjects with those that have non-communicable diseases (NCDs). Convenience sampling was used, and 430 Thai residents agreed to participate. They filled out a five-part questionnaire that included personal data, health status, food consumption behaviors, communication channels for nutrition information and nutrition beliefs. A majority of them worked in an office with a salary of at least 20,000 baht per month (35%). Over 58% were females and had at least an undergraduate degree (49%). Of the 23% of the participants that had NCDs, their nutritional beliefs and eating behaviors were not significantly different than those participants that had no NCDs. In a digital age that includes LINE, Facebook and YouTube, 43% of the participants still said most of the information about nutrition comes from local television programs. There was a significant negative correlation between nutrition beliefs and actual eating behaviors, but it was so small as to have no predictive effect.
Background:
The aim of the EUROPREVIEW study was to explore patients' beliefs about primary care prevention, to assess their needs to make changes in lifestyle and their willingness to receive support from GPs.
Methods:
A cross-sectional survey was undertaken in 22 European countries with 10 practices each that consecutively included 40 patients between 30 and 70 years. Validity of the structured questionnaire was evaluated by pilot testing after translation und back-translation for every country. This explorative analysis compared German data on lifestyle factors like smoking, body weight and physical activity to those from other European countries.
Results:
There were no differences in patients' needs for changes in unhealthy habits and the views of patients that GPs initiated a discussion on lifestyle factors. In Germany significantly less patients wish to receive advice by their GP [eating habits 41.1 (Germany %) vs. 66.6 (other countries %), physical activity 31.0 vs. 57.0, body weight 44.1 vs. 67.1, smoking 49.1 vs. 63.3, alcohol 43.5 vs. 55.9].
Conclusion:
Further research should firstly adress the reasons for the low demand by German patients for health advice on lifestyle factors and, if necessary, secondly evaluate the opportunities for a better range of preventive services in primary care.
Zielsetzung:
Analyse von Bedingungsfaktoren für die Umsetzung von alkoholbezogenen Interventionen in der hausärztlichen Praxis.
Methode:
Fragebogengestützte Befragung von 229 Hausärzten sowie leitfadengestützte Fokusgruppeninterviews mit 29 Hausärzten. Die Fokusgruppenteilnehmer wurden aus der teilnehmenden Grundgesamtheit randomisiert.
Ergebnisse:
Standardisierte Methoden zur Früherkennung von Patienten mit Alkoholproblemen kommen in der hausärztlichen Praxis kaum zur Anwendung. Die Umsetzung von alkoholbezogenen Maßnahmen korreliert mit den bisherigen Erfahrungen des Arztes sowie der patientenseitigen Motivation. Als strukturelle Barrieren werden fehlende zeitliche/finanzielle Ressourcen, fehlende Eigenqualifikation und die mangelnde Kooperation mit dem Suchthilfesystem angegeben. Vorhandene Fortbildungsangebote werden anscheinend nur unzureichend wahrgenommen.
Schlussfolgerung:
Diese Studie zeigt die Komplexität der patientenseitigen, arztbezogenen und strukturellen Gründe, die eine flächendeckende Umsetzung von alkoholbezogenen Interventionen in der hausärztlichen Praxis verhindern. Modelle zur Verbesserung der Versorgungssituation von Menschen mit Alkoholproblemen in der hausärztlichen Praxis müssen die Bedarfe an Qualifikation, Vernetzung und Finanzierung berücksichtigen.
Background:
Metabolic syndrome is a cluster of risk factors for cardiovascular disease and type 2 diabetes. Physical activity can decrease these risks. Many randomized clinical trials to increase physical activity have demonstrated disappointing results, and implementation in daily practice appeared to be difficult. The aim of this study was to investigate whether 3 years of usual care with available guidelines in a primary care setting result in change in physical activity in patients with screen-detected metabolic syndrome.
Methods:
After a population-based screening, 473 patients were diagnosed with metabolic syndrome and received advice to increase physical activity. Three years later, they were invited for follow-up. Physical activity was measured by means of the validated SQUASH questionnaire. The primary outcome measure was: % of metabolic syndrome patients that fulfill the Dutch Physical Activity Guideline (DPAG) criterion (30 min of moderately intensive physical activity at least 5 days per week) at screening and follow-up.
Results:
In the final study population (n=168), the proportion of patients fulfilling the DPAG criterion did not significantly increase between screening (56.0%) and follow-up (60.7%) (P=0.29). Female gender [odds ratio (OR)=3.59; 95% confidence interval (CI) 1.24-10.39] and body mass index (BMI) at baseline (OR=0.82; 95% CI 0.69-0.97) appeared to be independent predictors of increase in physical activity.
Conclusions:
In this real-world setting, despite the advice to increase physical activity, the number of metabolic syndrome patients with sufficient physical activity did not significantly increase after 3 years. This finding confirms the need for an intensified approach to achieve an increase in physical activity in this group, with special attention to men and patients with higher BMI values.
This paper reports on a 2004 survey of primary care experiences among adults in Australia, Canada, New Zealand, the United Kingdom, and the United States. The survey finds shortfalls in delivery of safe, effective, timely, or patient-centered care, with variations among countries. Delays in lab test results and test errors raise safety concerns. Failures to communicate, to engage patients, or to promote health are widespread. Aside from clinical preventive care, the United States performs poorly on most care dimensions in the study, with notable cost-related access concerns and short-term physician relationships. Contrasts across countries point to the potential to improve performance and to learn from international initiatives.
GPs play a role in prevention by giving nutrition education and advice on overweight. Over the years, GP's tasks and working environment changed.
To know how task perceptions, perceptions of own ability and perceived barriers regarding nutrition education and treatment of overweight of Dutch GPs have developed from 1992 to 2007.
In all, 488 GPs, first included in study in 1992, were asked in 2007 to return the Wageningen PCPs Nutritional Practices Questionnaire. Crohnbach's alphas and sum scores were calculated and differences between 1992 and 2007 were investigated using a paired t-test.
In all, 247 GPs responded (51%). 'Noticing patients overweight and guidance of treatment' did not change in GPs from 1992 to 2007. The task perception about health education and prevention did not change and the perception of daily activities shifted from the curative to the preventive side. Interest in the influence of nutrition on health increased in 2007. GPs less often managed to counsel on nutrition in daily practice. Their perceived capacity to counsel and their self-efficacy regarding overweight management declined over the years. In 2007, more GPs perceived the barriers 'lack of time' to treat overweight and to give nutrition education. The most important barrier in 2007 was lack of patient motivation.
The GPs perceived overweight and nutrition education as important and were still favourable towards prevention. However, their potential to give nutrition education or guide in treatment of overweight was not fully utilized because of decreased self-efficacy factors and perceived barriers.
Currently, overweight and obesity do not receive the attention they deserve from the Dutch GPs, mostly because of a lack of an effective intervention strategy to tackle this difficult health problem.
To develop a minimal intervention strategy (MIS) addressing overweight and obesity among adult primary care patients, resulting in a prototype.
Following the intervention mapping protocol, the MIS is based on literature study, existing interventions, psychosocial theories, stakeholder interviews and a questionnaire study among stakeholders. This led to the development of a prototype of the MIS materials: a screening flow chart and a treatment flow chart, a manual and patient education materials. A pre-test among 42 general practitioners and practice nurses was conducted to investigate the usefulness of the MIS materials at first sight.
The stakeholder interviews and the questionnaire study resulted in insight on what the MIS should look like. For instance, the stakeholders indicated that the treatment needs to focus on helping patients to eat more healthy and exercise more, using techniques like motivational interviewing. The pre-test showed that most participants were enthusiastic about the materials, although they made some suggestions on improvements.
The MIS materials seem to be useful and promising. A future pilot test is needed to investigate its usefulness in daily practice and to further improve the materials in preparation for a process and effect evaluation.
To examine the relation between subjects' level of cardiovascular risk and their beliefs about the harmfulness of their smoking habit, current diet, and level of exercise, together with their stated desire to modify such behaviour.
Self administered postal health and life-style questionnaire followed by a structured health check conducted by a nurse.
Five general practices in Luton and Dunstable, Bedfordshire.
5803 people aged 35-64 years enrolled in the OXCHECK trial who attended for a health check before 1 March 1992.
Perceived risk to health of lifestyle behaviours, desire to modify behaviour, and a reported serious attempt to modify behaviour in the preceding year.
A high proportion of smokers and those who were physically inactive perceived their behaviour to be harmful (1020; (76%; 95% confidence interval 74% to 79%) and 350 (74%; 70% to 78%) respectively) and wished to modify it (1212 (79%; 77% to 81%) and 375 (74%; 71% to 78%) respectively). In contrast, only 289 (45%; 41% to 48%) of obese people and 188 (14%; 12% to 16%) of people with a high dietary fat intake perceived their current diet to be harmful. The more cardiovascular risk factors present, the more likely subjects were to perceive a health risk attached to their diet and lack of exercise (p < 0.01 in both cases) and to want to improve their diet.
Awareness of the health risk from smoking and motivation to stop is high. Further efforts are required, however, to educate the public about the risks associated with a high dietary fat intake. Although the health risks of inactivity were widely recognised, motivation to take more exercise needs to be increased.
Recent health promotion guidelines reimbursed primary health care teams for targeting lifestyle advice to patients at risk of cardiovascular disease. However, it is unclear whether primary health care teams do target advice, who is targeted, and whether the advice is acted upon.
To assess which factors predict the targeting and recall of lifestyle advice.
A total of 370 patients with, and 192 without, a computer record of risk factors for cardiovascular disease (hypertension, diabetes, ischaemic heart disease/myocardial infarction/angina, a body mass index > or = 30) from two contrasting Wessex practices were sent a postal questionnaire about medical conditions, recall of lifestyle advice, current lifestyle, and their perceptions about the health of their lifestyle.
Seventy-seven per cent of patients responded. There was good agreement between listed risk factors and patients reporting a risk factor (kappa = 0.60), which was similar for both sexes and better in older age groups. Recall of lifestyle advice was not significantly affected by practice, but was more likely in patients with listed risk factors (adjusted odds ratio [OR] = 4.62, 95% confidence intervals [CI] = 2.89-7.37) and in men (OR = 1.64, 95% CI = 1.07-2.52), and less likely in older age groups (age < or = 64 years = 1.00; 65-74 years = 0.47, 95% CI = 0.27-0.81; 75+ years = 0.34, 95% CI = 0.20-0.60). Of patients with listed risk factors, 27% could not recall having received any advice, and recall varied with medical condition. Only 40% of patients with reported high blood pressure recalled being given advice about salt. Those who recalled advice were more likely to report a healthier current lifestyle. Of those with unhealthy lifestyles, 30-50% were unaware that their lifestyle was unhealthy.
Lifestyle advice is not recalled for some important risk factors, and some patients are unaware of their unhealthy lifestyle. Although advice is being preferentially targeted to those with risk factors, women and older patients recall advice less. Research is needed to assess the cost-effectiveness of advice for both sexes and different ages.
Disease prevention and health promotion are important tasks in the daily practice of all general practitioners (GPs). The objective of this study was to explore the knowledge and attitudes of European GPs in implementing evidence-based health promotion and disease prevention recommendations in primary care, to describe GPs' perceived barriers to implementing these recommendations and to assess how GPs' own health behaviors affect their work with their patients.
A postal multinational survey was carried out from June to December 2000 in a random sample of GPs listed from national colleges of each country.
Eleven European countries participated in the study, giving a total of 2082 GPs. Although GPs believe they should advise preventive and health promotion activities, in practice, they are less likely to do so. About 56.02% of the GPs answered that carrying-out prevention and health promotion activities are difficult. The two most important barriers reported were heavy workload/lack of time and no reimbursement. Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found. GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs (39.34% versus 48.18%, P < 0.01). GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs (59.14% versus 49.70%, P < 0.01).
Significant gaps between GP's knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention in primary care.
Most of the national colleges of general practitioners (GPs) do not have their own dietary/nutritional tools, and GPs and nurses do not have the time, knowledge, or skills to advise their patients about desirable dietary practices.
To assess the usefulness of a simple and practical guide on healthy diet to be used by European GPs and nurses.
A postal survey was mailed to 171 GPs and nurses from 12 European countries to obtain information about the usefulness of a guide on healthy diet developed by EUROPREV.
The perception of health professionals is that the main source of information on healthy diet for the population was the media. In all, 95% of GPs and nurses reported that the guide was useful; 93, 95, and 82% reported that the concepts were concise, easy to understand, and realistic, respectively. Also, 77% reported that the type of counselling recommended was feasible and could be applied, 94% reported that the implementation measures proposed could be effective and 88% reported that the Traditional Mediterranean Diet Pyramid is useful, but some concerns about the content were mentioned.
GPs and nurses from Europe think that a practical guide on healthy diet developed by EUROPREV could be used to advise patients in primary care, although the Traditional Mediterranean Diet Pyramid should be modified.
Lifestyle advice given by general practitioners (GPs) may be a cost-effective means of health promotion; however, it is not fully put into routine practice. The aim of this study was to explore to what extent GPs' patients expect and receive advice concerning alcohol, tobacco, exercise and diet in relation to sociodemographic characteristics, type of visit and patient satisfaction.
A postal questionnaire was sent to a representative sample (n = 9750) of patients who had consulted GPs in a county in Sweden. The response rate was 69% (n = 6734).
Exercise was the most (16%) and alcohol the least (5%) common type of advice. The patients received advice more often than they expected in all areas except alcohol. The patients reported the highest rate of unfulfilled advice expectation and the lowest rate of unexpected advice in the case of alcohol. Male gender, poorer self-rated health and scheduled appointment were independent predictors of all types of advice. Continuity of GP contact was only favourable for exercise and diet advice. The patients who received advice were more satisfied with their visit to the doctor.
A tertiary preventive perspective guides GPs' practice of giving advice. Male patients with advanced illnesses are given priority. Women and patients with long-term risk habits are more neglected. The GPs tend to misjudge the expectations and needs of their patients and are too restrained in their counselling practice. Alcohol is the most disregarded area of advice in proportion to the patients' expectations and needs.
Background. GPs play a role in prevention by giving nutrition education and advice on overweight. Over the years, GP's tasks and working environment changed. Objective. To know how task perceptions, perceptions of own ability and perceived barriers regarding nutrition education and treatment of overweight of Dutch GPs have developed from 1992 to 2007. Methods. In all, 488 GPs, first included in study in 1992, were asked in 2007 to return the Wageningen PCPs Nutritional Practices Questionnaire. Crohnbach's alphas and sum scores were calculated and differences between 1992 and 2007 were investigated using a paired t-test. Results. In all, 247 GPs responded (51%). `Noticing patients overweight and guidance of treatment¿ did not change in GPs from 1992 to 2007. The task perception about health education and prevention did not change and the perception of daily activities shifted from the curative to the preventive side. Interest in the influence of nutrition on health increased in 2007. GPs less often managed to counsel on nutrition in daily practice. Their perceived capacity to counsel and their self-efficacy regarding overweight management declined over the years. In 2007, more GPs perceived the barriers `lack of time¿ to treat overweight and to give nutrition education. The most important barrier in 2007 was lack of patient motivation. Conclusions. The GPs perceived overweight and nutrition education as important and were still favourable towards prevention. However, their potential to give nutrition education or guide in treatment of overweight was not fully utilized because of decreased self-efficacy factors and perceived barriers.
The health survey questionnaire was used to collect information about cigarette smoking, alcohol consumption, physical exercise, and dieting and weight. Completed questionnaires were received from 25,496 men and 36,657 women registered with 47 group practices in England and Scotland. The proportions of respondents who stated that they had a problem ranged from 1% (women and drinking, n = 406) to 34% (women and weight, n = 12,526). Between 49% (women and drinking, n = 18,048) and 67% (men (n = 17,095) and women (n = 24,550) and weight) thought that their general practitioners should be interested in their lifestyle. The proportions who could recall having received relevant advice ranged from 2% (women and drinking, n = 591) to 24% (women and weight, n = 8946). Advice about smoking had been given to 4055 (40%) of the women and 2941 (39%) of the men who smoked. Only 96 (10%) of the 989 women and 331 (17%) of the 1948 men who drank excessively could recall having received advice about alcohol consumption. These results suggest that patients are concerned about their lifestyle, that most would welcome relevant counselling, and that doctors should become more concerned with prevention of this kind.
Scotland has one of the poorest health records of all Western countries, and this has been linked to poor diet. A key part of efforts to improve health has been an action plan to improve the Scottish diet. General practice has been identified as an important setting for health promotion and the provision of healthy eating advice.
The objective was to investigate the views of general practitioners (GPs) and their patients about healthy eating and the provision of healthy eating advice in general practice.
This qualitative research study used semistructured in-depth interviews with 15 general practitioners (8 female and 7 male) and 30 patients (15 married couples in social class 3, 4, or 5 with young children).
The study found that health was only one priority in patients' everyday lives and that these patients were also questioning the relevance of healthy eating advice. GPs were divided in their opinions, with greater enthusiasm being displayed by the younger and female doctors. However, despite their differing views, GPs felt that general practice was better suited to specific rather than general health advice.
If programs in general practice to address dietary inequalities are to succeed, both patients' views and GPs' views must be taken into account.
Due to the increased prevalence of obesity GPs now have a key role in managing obese patients.
To explore GPs' views about treating patients with obesity.
An inner London primary care trust.
A qualitative study using semi-structured interviews.
Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis.
GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight.
GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.
The European definition of General Practice states that GPs should use their core competence, amongst others, in their communication with patients. Their communication skills are particularly challenged in the field of lifestyle improvements. Most GPs feel they lack efficacy in achieving lifestyle changes. In November 2002 the Prevention Department of the Scientific Society of Flemish GPs (now Domus Medica) decided to start a project "consulting & behaviour change". Under this project, every Flemish GP should by the year 2007, have (amongst others things) a basic knowledge of the principles of lifestyle improvements and should be able to give a short advice to high risk patients.
A literature search was conducted to make an inventory of models that could be used to train GPs. Experts at specific methods and topics were consulted to get acquainted with their specific approaches. Experts in the field of CME were gathered to discuss barriers and solutions to these barriers. During steering group meetings, several possible solutions were discussed.
The Trans Theoretical Model (TTM-as theoretical framework) and brief motivational interviews (MI-as communication skill) were evaluated as offering the best opportunities for adapting the work situation of the GP. We promoted this approach to the GPs as an ABC concept (Anamnesis/Ask; Be the guide/Decision tree ("Beslissingsboom" in Dutch); Continuity) applied on different topics (smoke stop, alcohol, healthy food, physical activity). In our guidelines we pay more attention to brief motivational interviews for health behaviour changes. Recently we started developing an e-learning website as part of a larger learning project, this in cooperaion with different Flemish partners and disciplines.
The Trans Theoretical Model and the brief motivational interviewing approach seem to be accepted by health care, educational and scientific organisations. The process of integrating this approach in the GP's daily practice has to be continued and needs better evaluation/follow up.
The integration of the brief motivational interviewing approach can facilitate health behaviour change in practice, without requesting more consultation time.
The European Definition of General Practice/ Family Medicine http://www.euract. org/html/page03a.shtml and http://www.woncaeurope.org/ Web documents/European Definition of family medicine/The European Definition of General Practice and Family Medicine
- Europe
Europe. The European Definition of General Practice/
Family Medicine. WONCA Europe, 2005. http://www.euract.
org/html/page03a.shtml and http://www.woncaeurope.org/
Web documents/European Definition of family medicine/The
European Definition of General Practice and Family Medicine.pdf.
Australian GPs' perceptions about child and adolescent overweight and obesity. The weight of opinion study
- L A King
- Jhm Loss
- R L Wilkenfeld
King LA, Loss JHM, Wilkenfeld RL et al. Australian GPs'
perceptions about child and adolescent overweight and
obesity. The weight of opinion study. Br J Gen Pract 2007;
57: 124-9.
Profiles of general practitioners in Europe. An international study of variation in the task of general practitioners
- Wgw Boerma
Boerma WGW. Profiles of general practitioners in Europe. An international study of variation in the task of general practitioners. 2003; Thesis. NIVEL, Utrecht.
Web documents/European Definition of family medicine/The European Definition of General Practice and Family Medicine
- Wonca Europe
WONCA Europe. The European Definition of General Practice/
Family Medicine. WONCA Europe, 2005. http://www.euract.
org/html/page03a.shtml and http://www.woncaeurope.org/
Web documents/European Definition of family medicine/The
European Definition of General Practice and Family Medicine.pdf.
The development of a minimal intervention strategy to address overweight and obesity in adult primary care patients in the Netherlands
- Gaj Franssen
- G J Hiddink
- M A Koelen
Franssen GAJ, Hiddink GJ, Koelen MA et al. The development
of a minimal intervention strategy to address overweight and
obesity in adult primary care patients in the Netherlands.
Fam Pract 2008; 25 (suppl 1): i112-15.