Health behaviour counselling in primary care : general practitioner-reported rate and confidence.

Abstract

Aims The main aim of the study was to identify variables associated with GPs' self-reported rate of health behaviour change counselling and confidence in counselling abilities. The study also tried to elucidate the association of doctors' personal health behaviours with self-reported rate of health behaviour counselling and confidence in counselling abilities. Methodology A repetition of a study done at the Mayo Clinic, Rochester, USA, by Vickers, et al., (2007) was done using the same tool which was a self-filled questionnaire. 326 questionnaires were mailed to all GPs on the specialist register. The survey was completely anonymous. Self-reported items assessed rate of health behaviour change counselling, perceived importance of counselling, extent of counselling training, confidence in counselling abilities, and GP personal health behaviours. Comparison of the results of the 2 studies was made. Using the same questionnaire a semi-qualitative approach was used to identify GPs' barriers to and perceptions about health behaviour counselling. Results The response rate was 70 per cent. The male doctors were slightly overweight and their exercise frequency on a regular basis was low. Almost 74 per cent of the doctors never smoked. Quantitative analysis showed that perceived importance of counselling and confidence in counselling were associated with GP self-reported rate of health behaviour counselling. Years in practice, extent of training, and importance of counselling were significantly associated with confidence in counselling in a multiple regression model. Qualitative analysis revealed that the main perceived barriers to counselling were insufficient time, patients' non-compliance and patients not ready to change. Further analysis revealed that most of the doctors believed that counselling in health behavior change in primary care was very important and that they had to be role models for their patients as regards health behaviour. Discussion & Limitations Objective, validated measurement of health behaviour and counselling behaviour is preferable to the single self-reported items developed for use in this study. Only the general confidence in abilities to deliver health behaviour change counselling was assessed and not the confidence in overcoming the specific barriers to counselling. Additional research is needed to understand the relationship between doctor personal health behaviour, perception of patient opinion regarding doctor's health behaviour, and how these issues interact and impact doctor-patient communication about health behaviour. Further research in this area is needed to determine if multi-disciplinary training could improve the rate or impact of health behaviour counselling in primary care. Conclusions Perceived importance of counselling and confidence in counselling were associated with GP self-reported rate of health behaviour counselling. But extent of training in health behaviour counselling was not associated with GP self-reported rate of health behaviour counselling. This could be due to the lack of training for GPs in health behaviour counselling. Years in clinical practice, extent of training, and perceived importance of counselling were significantly associated with confidence in health behaviour counselling. One third of GPs reported difficulty counselling patients on behaviours that they struggled with themselves. Recommendations Doctors should be trained in motivational interviewing and the trans-theoretical method, which are so important in helping patients recognise the need for a change in their health behaviours.