Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians

Abstract

Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice (`noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a crosssectional and a longitudinal approach. Design: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992. Subjects: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20 y. Interventions: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997. Main outcome measure: To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable`noticing patients' overweight and guidance of treatment' with an adequate ®t of the empirical data, both in the cross-sectional and in the longitudinal approach. Results: The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time.Two dynamic LISREL-models were developed (the`determinant-longitudinal approach' and the`early behaviour longitudinal approach') which explain the dependent variable. The latter model has, as added value, a gain in explained variance. In 5 y time, the dependent variable decreased signi®cantly (P`0.001).Conclusions: This study recon®rms that PCPs' nutritional guidance practices are determined partly directly by predisposing factors, and indirectly via driving forces and barriers. However this study also reveals that an important nutrition guidance practice of PCPs,`noticing patients' overweight and guidance of treatment', shows a signi®cant decrease over the last 5 y. At the same time, two of the four predisposing factors and two of the three driving factors also decreased signi®cantly. As research ®ndings indicate that the role of diet in health and disease becomes of greater in¯uence PCPs need to be activated to apply their responsibility in this ®eld within a multi-faceted approach. Sponsorship: The study was supported by the Dutch Dairy Foundation on Nutrition and Health, Maarssen, The Netherlands.

The NECTAR-Study: development of nutrition modules for general practice vocational training; determinants of nutrition guidance practices of GP-trainees

“…In this way the total population of GP-trainees (in all stages of their training) received the questionnaire, which was based on the Wageningen GPs Nutrition Practices Questionnaire. This GP-questionnaire has been used and validated in cross-sectional and longitudinal investigations to determine the determinants of nutrition guidance practices of Dutch GPs (Hiddink, 1996;Hiddink, 1999).…”

Determinants of Dutch general practitioners’ nutrition and physical activity guidance practices

“…The Wageningen GPs Nutritional Practices Questionnaire (39) was developed on the basis of qualitative research (focus group discussions and in-depth interviews) and the tailored design method (44) , and has proved to be beneficial in research (13,14,21,39) . Self-reported nutrition and physical activity guidance practices, task perceptions, self-efficacy expectations and perceived barriers regarding these practices were assessed in the questionnaire.…”

Nutrition guidance by primary care physicians: models and circumstances

“…As Hiddink et al, (1999) have shown, four predisposing factors play a major role in nutrition guidance practices. Of these factors the ®rst relates to the perception of the ability of primary care physicians to in¯uence the life style and eating habits of patients with health problems (Hiddink et al, 1999).…”

“…Of these factors the ®rst relates to the perception of the ability of primary care physicians to in¯uence the life style and eating habits of patients with health problems (Hiddink et al, 1999).…”