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Wattanapisit A, Lapmanee S, Chaovalit S, Lektip C, Chotsiri P. Prevalence of physical activity counseling in primary care: A systematic review and meta-analysis. Health Promot Perspect 2023; 13:254-266. [PMID: 38235006 PMCID: PMC10790122 DOI: 10.34172/hpp.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 01/19/2024] Open
Abstract
Background This systematic review aimed to summarize and evaluate the prevalence of physical activity (PA) counseling in primary care. Methods Five databases (CINAHL Complete, Embase, Medline, PsycInfo, and Web of Science) were searched. Primary epidemiological studies on PA counseling in primary care were included. The Joanna Briggs Institute critical appraisal checklist for studies reporting prevalence data was used to assess the quality of studies. The review protocol was registered with PROSPERO (CRD42021284570). Results After duplicate removal, 4990 articles were screened, and 120 full-text articles were then assessed. Forty studies were included, with quality assessment scores ranging from 5/9 to 9/9. The pooled prevalence of PA counseling based on 35 studies (199830 participants) was 37.9% (95% CI 31.2 to 44.6). The subgroup analyses showed that the prevalence of PA counseling was 33.1% (95% CI: 22.6 to 43.7) in females (10 studies), 32.1% (95% CI: 22.6 to 41.7) in males (10 studies), 65.5% (95% CI: 5.70 to 74.1) in people with diabetes mellitus (6 studies), 41.6% (95% CI: 34.9 to 48.3) in people with hypertension (5 studies), and 56.8% (95% CI: 31.7 to 82.0) in people with overweight or obesity (5 studies). All meta-analyses showed high levels of heterogeneity (I2=93% to 100%). Conclusion The overall prevalence of PA counseling in primary care was low. The high levels of heterogeneity suggest variability in the perspectives and practices of PA counseling in primary care. PA counseling should be standardized to ensure its optimum effectiveness in primary care.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Sarawut Lapmanee
- Department of Basic Medical Sciences, Faculty of Medicine, Siam University, Bangkok, Thailand
| | - Sirawee Chaovalit
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Charupa Lektip
- Department of Physical Therapy, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Palang Chotsiri
- Department of Clinical Pharmacology, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Castro E, Kelly NR, Budd EL. Healthcare provider-delivered healthy eating recommendations among U.S. Hispanic/Latino adults. Prev Med Rep 2023; 33:102216. [PMID: 37223558 PMCID: PMC10201819 DOI: 10.1016/j.pmedr.2023.102216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
U.S. Hispanic/Latino adults are at heightened risk for developing diet-related chronic diseases. Healthcare provider recommendations have shown to be effective for promoting health behavior change, but little is known about healthcare provider healthy eating recommendations among Hispanics/Latinos. To investigate the prevalence of and adherence to healthcare provider-delivered healthy eating recommendations among a U.S. sample of Hispanic/Latino adults, participants (N = 798; M = 39.6±15.1 years; 52% Mexican/Mexican American) were recruited via Qualtrics Panels to complete an online survey in January 2018. Most (61%) participants reported having ever received a healthcare provider-delivered dietary recommendation. Higher body mass index (AME = 0.015 [0.009, 0.021]) and having a chronic health condition (AME = 0.484 [0.398, 0.571]) were positively associated with receiving a dietary recommendation while age (AME = -0.004 [-0.007, -0.001]) and English proficiency (AME = -0.086 [-0.154, -0.018]) were negatively associated. Participants reported adhering regularly (49.7%) and sometimes (44.4%) to recommendations. There were no significant associations with patient characteristics and adherence to a healthcare provider-delivered dietary recommendation. Findings inform next steps toward increasing implementation of brief dietary counseling from healthcare providers to support prevention and management of chronic diseases among this under-studied population.
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Affiliation(s)
- Esmeralda Castro
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Elizabeth L. Budd
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, USA
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
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Rosenfeld RM, Kelly JH, Agarwal M, Aspry K, Barnett T, Davis BC, Fields D, Gaillard T, Gulati M, Guthrie GE, Moore DJ, Panigrahi G, Rothberg A, Sannidhi DV, Weatherspoon L, Pauly K, Karlsen MC. Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine. Am J Lifestyle Med 2022; 16:342-362. [PMID: 35706589 PMCID: PMC9189586 DOI: 10.1177/15598276221087624] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Objective The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA (RMR)
| | - John H Kelly
- Loma Linda University School of Medicine, Loma Linda, CA, USA (JHK)
| | - Monica Agarwal
- Department of Medicine Division of Endocrinology, Diabetes, & Metabolism, Birmingham, University of Alabama at Birmingham, AL, USA (MA)
| | - Karen Aspry
- Lipid and Prevention Program, Lifespan Cardiovascular Institute, East Greenwich, RI, USA (KA)
| | - Ted Barnett
- Rochester Lifestyle Medicine Institute, Rochester, NY, USA (TB)
| | - Brenda C Davis
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
| | | | - Trudy Gaillard
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL, USA (TG)
| | - Mahima Gulati
- Middlesex Health Multispecialty Group, Middletown, CT, USA (MG)
| | | | | | | | - Amy Rothberg
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, USA (AR)
| | - Deepa V Sannidhi
- University of California San Diego Department of Family Medicine and Public Health, La Jolla, CA, USA (DVS)
| | | | - Kaitlyn Pauly
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
| | - Micaela C Karlsen
- American College of Lifestyle Medicine, Chesterfield, MO, USA (BCD, KP, MCK)
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Hu R, Hui SSC, Lee EKP, Stoutenberg M, Wong SYS, Yang YJ. Provision of physical activity advice for patients with chronic diseases in Shenzhen, China. BMC Public Health 2021; 21:2143. [PMID: 34814878 PMCID: PMC8611940 DOI: 10.1186/s12889-021-12185-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA) may best be promoted to patients during clinical consultations. Few studies investigated the practice of PA advice given by physicians, especially in China. This study aimed to investigate the prevalence and contents of PA advice given by physicians in China and its association with patients' characteristics. METHODS Face-to-face questionnaire asking the prevalence and contents of PA advice given by physicians was administered to adult patients in three major hospitals in Shenzhen, China. Attitude of compliance, stature, PA level, and socio-demographic information were also collected. Data was analyzed via descriptive statistics and binary logistic regression. RESULTS Of the 454 eligible patients (Age: 47.0 ± 14.4 years), only 19.2% (n = 87) reported receiving PA advice, whereas 21.8%, 23.0%, 32.2%, and 55.2% of patients received advices on PA frequency, duration, intensity, and type, respectively. Male patients were more likely to receive PA advice from physicians [odds ratio (OR): 1.81; 95% confidence interval (CI): 1.08-3.05], whereas patients who were unemployed (OR: 0.16; 95% CI: 0.04-0.67), and who already achieved adequate amount of PA (OR: 0.29; 95% CI: 0.12-0.71) were less likely to receive PA advice. CONCLUSIONS Prevalence of physicians providing physical activity advice to patients is low, there is a pressing need to take intervention measures to educate healthcare providers.
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Affiliation(s)
- Rui Hu
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
| | - Stanley Sai-Chuen Hui
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong.
| | - Eric Kam-Pui Lee
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
| | - Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Samuel Yeung-Shan Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
| | - Yi-Jian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
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Sánchez Urbano RE, Paredes A, Vargas Chambi FR, Guedes Ruela P, Olivares DEV, Souza Pereira BT, Pacheco SOS, Pacheco FJ. Reception of Dietary and Other Health-Related Lifestyle Advice to Address Non-communicable Diseases in a Primary Care Context: A Mixed-Method Study in Central Argentina. Front Nutr 2021; 8:622543. [PMID: 33585541 PMCID: PMC7873357 DOI: 10.3389/fnut.2021.622543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
An effective way to address risk factors for non-communicable chronic diseases (NCD) and reduce healthcare costs is by using sound health-related advice (HRA) to promote healthy lifestyle habits. In Argentina, however, few studies have examined the context in which HRA is communicated and undertaken by patients at the primary care level. In this study, we assessed the reception of HRA using a mixed-method approach in a central area of Argentina. A total of 1,044 participants from the community were contacted and sociodemographic characteristics, health-related lifestyle factors, and medical history were collected. A calendar with health messages was provided to participants and its usage was assessed after 1 year. Additionally, semi-structured interviews were conducted with 34 patients attending a local primary healthcare center. The results show that HRA was given more frequently to individuals with higher mean age, lower educational level, and to females. Participants with a chronic health condition are at a higher chance of receiving advice to reduce salt intake and maintain a healthy weight. Dietary advice is offered along with other lifestyle recommendations. The use of alcohol and tobacco is usually addressed together. HRA was primarily received in the context of an NCD diagnosis and advice was directed, especially, to risky behaviors. The HRA to increase the intake of fruits and vegetables was mentioned less frequently. Patients at the healthcare center greatly appreciated receiving an HRA, especially when given in a tailored, written, and detailed form, and acknowledged its importance to prevent or control a chronic health condition as part of the medical treatment but showed concern regarding the ability to fully incorporate the advice. Lifestyle recommendations are highly appreciated by patients but are still underutilized since they are offered mostly in the context of illness. The health calendar was shown to be useful to complement health intervention programs at the community level. The findings of our study underscore the acknowledged value of HRA by participants to tackle the risk factors of chronic diseases. If properly used HRA constitutes a simple and highly valued tool to help address patient's needs to prevent and control NCD in Argentina.
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Affiliation(s)
- Raúl E Sánchez Urbano
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Ariel Paredes
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Frank R Vargas Chambi
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Pedro Guedes Ruela
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - David E V Olivares
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Benicio T Souza Pereira
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Sandaly O S Pacheco
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina.,Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Fabio J Pacheco
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina.,Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, Argentina
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Arem H, Duan X, Ehlers DK, Lyon ME, Rowland JH, Mama SK. Provider Discussion about Lifestyle by Cancer History: A Nationally Representative Survey. Cancer Epidemiol Biomarkers Prev 2020; 30:278-285. [PMID: 33268489 DOI: 10.1158/1055-9965.epi-20-1268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Providers are uniquely positioned to encourage health-promoting behaviors, particularly among cancer survivors where patients develop trust in providers. METHODS We utilized the National Health Interview Survey to identify adults who reported a visit to a provider in the prior year (44,385 individuals with no cancer history and 4,792 cancer survivors), and reported prevalence of provider discussions on weight loss, physical activity, diet, and smoking. We used generalized linear mixed models to examine predicted prevalence of provider lifestyle discussions by cancer history overall, and among those who do not meet body mass index (BMI), activity, or smoking guidelines. RESULTS Among those with a BMI of 25-<60 kg/m2, 9.2% of those with a cancer history and 11.6% of those without a cancer history reported being told to participate in a weight loss program (P < 0.001). Overall, 31.7% of cancer survivors and 35.3% of those with no cancer history were told to increase their physical activity (P < 0.001). Only 27.6% of cancer survivors and 32.2% of those with no cancer history reported having a general discussion of diet (P < 0.001). Among smokers, 67.3% of cancer survivors and 69.9% of those with no cancer history reported counseling on smoking (P = 0.309). CONCLUSIONS Fewer cancer survivors, who are at increased risk for health complications, are reporting provider discussions about critical lifestyle issues than those with no cancer history. IMPACT Our nationally representative results suggest that providers are missing an opportunity for influencing patient lifestyle factors, which could lead to mitigation of late and long-term effects of treatment.
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Affiliation(s)
- Hannah Arem
- Department of Epidemiology, George Washington Milken Institute School of Public Health, Washington, DC.
- George Washington Cancer Center, Washington, DC
| | - Xuejing Duan
- Department of Biostatistics, George Washington Milken Institute School of Public Health, Washington, DC
| | | | | | | | - Scherezade K Mama
- Division of Cancer Prevention and Population Sciences, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Sundaresan N, Roberts A, Thompson KJ, McKillop IH, Barbat S, Nimeri A. Examining the Hispanic paradox in bariatric surgery. Surg Obes Relat Dis 2020; 16:1392-1400. [DOI: 10.1016/j.soard.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
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Hu YL, Junge K, Nguyen A, Hiegel K, Somerville E, Keglovits M, Stark S. Evidence to Improve Physical Activity among Medically Underserved Older adults: A Scoping Review. THE GERONTOLOGIST 2020; 59:e279-e293. [PMID: 29668895 DOI: 10.1093/geront/gny030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Participation in leisure physical activity (PA) and engagement in PA interventions among older adults is influenced by socioeconomic status (SES), race/ethnicity, and environment. However, studies of PA for medically underserved older adults have not yet been systematically evaluated. The objective of this study is to map the nature and extent of research conducted on PA participation, interventions, and components of effective leisure PA programs for medically underserved older adults. RESEARCH DESIGN AND METHODS The five-stage approach was used to conduct this scoping review. We searched PubMed, CINAHL, and Cochrane Library for peer-reviewed studies published between 2006 and 2016. Data extracted from selected studies included study population, study type, purpose of intent, evidence level, barriers to PA participation, and components of PA intervention. RESULTS Three hundred and ninety-two articles were identified, and 60 studies were included in the final data charting. Existing literature showed that most studies remained descriptive in nature, and few intervention studies have achieved a high level of evidence. Among 21 intervention studies, only 4 were explicitly conducted for older adults. Culturally adapted materials, race/ethnicity-specific barriers and facilitators, and form of intervention were important components for intervention programs. DISCUSSION AND IMPLICATIONS Findings indicate that more studies are needed to reduce health disparities related to PA participation for medically underserved older adults. Intervention components such as race/ethnicity-relevant barriers and facilitators and culturally sensitive materials are also needed for PA interventions targeting underserved older adults in order to provide evidence for best practices.
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Affiliation(s)
- Yi-Ling Hu
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Kristin Junge
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - An Nguyen
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Kelsey Hiegel
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Emily Somerville
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Marian Keglovits
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
| | - Susan Stark
- Washington University School of Medicine, Program in Occupational Therapy, Saint Louis, Missouri
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Simões MDO, Dumith SC, Gonçalves CV. Adults and the elderly who received nutritional counseling in a city of southern Brazil: a population-based study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190060. [PMID: 31826115 DOI: 10.1590/1980-549720190060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nutrition counseling has played a critical role in the prevention and treatment of various diseases. OBJECTIVE To evaluate how adults and elderly people, who are residents in an urban area of Southern Brazil, received nutritional counseling. METHODS This was a cross-sectional population based study. Data was collected through a questionnaire applied at home. The outcome was the prevalence of nutritional counseling received in the past year that came from different means, including means of communication. Sociodemographic variables, doctor visits in the past year, nutritional state and other healthcare variables were analyzed. RESULTS The sample included 1,296 individuals (rate of answer of 90.7%). The results indicate that the majority of the people interviewed were females (56.6%), with their age ranging from 18 to 59 years-old (75.3%). The prevalence of people receiving nutritional counseling was 19.9% (95%CI 17.3 -22.5). It was higher among women than men (p = 0.01). The sex-adjusted analyses showed a statistically significant (p < 0.05) association in men for the variables: schooling ≥ 12 years; medical consultation in the last year; low weight; obesity; diabetes and hypertension. Among the women, the following variables were associated with the outcome: health insurance; medical consultation in the last year; obesity and diabetes. CONCLUSIONS The low prevalence of nutritional counseling and its association with diseases exposes the need for it to be implemented not only for treatment purposes but also as preventive health actions.
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Affiliation(s)
- Milena de Oliveira Simões
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Samuel Carvalho Dumith
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Carla Vitola Gonçalves
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
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Grabovac I, Smith L, Stefanac S, Haider S, Cao C, Waldhoer T, Jackson SE, Yang L. Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016. Am J Med 2019; 132:489-497.e1. [PMID: 30521796 DOI: 10.1016/j.amjmed.2018.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Health care providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample. METHODS Adults ages 20-64years (n = 11,467) from the National Health and Nutrition Examination Survey between 2011 and 2016 were analyzed, with weight status and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease, and type 2 diabetes mellitus). Lifestyle modification advice by health care providers included: increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of the above. RESULTS High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared with osteoarthritis (7.4%), type 2 diabetes (5.7%), and coronary heart disease (3.7%). Those with type 2 diabetes received considerably more frequent advice (56.5%; 95% confidence interval [CI], 52.4%-60.6%) than those with high blood pressure (31.4%; 95% CI, 29.3%-33.6%) and cholesterol (27.0%; 95% CI, 24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded body mass index and comorbidity (all P < .001). After adjusting for comorbid conditions, advice was more commonly reported among women, those overweight/obese, nonwhite, or insured. A remarkably low proportion of overweight (21.4; 95% CI, 18.7%-24.3%) and obese (44.2%; 95% CI, 41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice. CONCLUSIONS Prevalence of lifestyle modification advised by health care providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions, however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainable strategies to reduce chronic condition burden.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, UK
| | - Sinisa Stefanac
- Institute of Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria; Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria.
| | - Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Austria
| | - Chao Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, StLouis, Mo
| | - Thomas Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria
| | - Sarah E Jackson
- Department of Behavioral Science and Health, University College London, UK
| | - Lin Yang
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada; Preventive Oncology & Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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11
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Trends and disparities in the prevalence of physicians' counseling on exercise among the U.S. adult population, 2000-2010. Prev Med 2017; 99:1-6. [PMID: 28161645 DOI: 10.1016/j.ypmed.2017.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/08/2016] [Accepted: 01/29/2017] [Indexed: 11/21/2022]
Abstract
Recognizing the undisputed health benefits of exercise, physicians' counseling has been included in the Healthy People Objectives since 2000. To address the paucity of data on such counseling at the national level, we examined changing trends and disparities in receiving physicians' counseling on exercise among the physically-able, non-institutionalized U.S. adult population. Data from the 2000, 2005, and 2010 National Health Interview Surveys (NHIS) were examined using logistic regression that included race/ethnicity, age, gender, education, insurance status, number of physician visits in the past year, and body mass index. In 2000, only 22.9% of NIHS respondents had received counseling on exercise, increasing to 33.6% in 2010. Compared with non-Hispanic Whites, non-Hispanic Blacks were 27% less likely to receive exercise advice in 2000 (adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.61-0.87). In later years, they were equally likely to receive advice. Although decreased over the years, male respondents were significantly (34% to 23%) less likely to report receipt of exercise counseling than female patients (in 2010: AOR 0.77, CI 0.72-0.83). Uninsured respondents were 35% less likely to report receiving exercise advice from their provider in all study years (2010: AOR 0.64, CI 0.59-0.72). Patients with increasing levels of education were increasingly more likely to report receipt of counseling in each successive survey year. The overall prevalence of physicians' counseling on exercise increased moderately between 2000 and 2010. Some disparities narrowed and even reversed but significant disparities continue to exist across gender, insurance status, and education level.
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Marquez B, Murillo R. Racial/Ethnic Differences in Weight-Loss Strategies among US Adults: National Health and Nutrition Examination Survey 2007-2012. J Acad Nutr Diet 2017; 117:923-928. [PMID: 28330732 DOI: 10.1016/j.jand.2017.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dieting, exercising, and seeking professional help have been associated with intentional weight loss among adults. OBJECTIVE This study examined the use of diet (eg, ate less, ate less fat, or switched to low-calorie foods), exercise, diet and exercise, and professional help (eg, weight-loss program or prescribed diet pills) for weight loss among non-Hispanic whites, Mexican Americans, and non-Hispanic blacks. DESIGN Cross-sectional data from the 2007-2012 National Health and Nutrition Examination Survey were used. PARTICIPANTS Males and females (n=9,046) aged 20 to 65 years were included. MAIN OUTCOME MEASURE The weight history questionnaire assessed weight-loss attempts and use of weight-loss strategies in the past year. STATISTICAL ANALYSES PERFORMED Multivariate logistic regression models were used to estimate associations of race/ethnicity with strategies to lose weight. Models controlled for age, sex, education, and body mass index. In fully adjusted models, interactions of race/ethnicity by sex were tested. RESULTS Lower proportions of Mexican Americans (35%) and non-Hispanic blacks (35%) than non-Hispanic whites (39%) reported trying to lose weight. Among those who tried to lose weight, non-Hispanic blacks were less likely than non-Hispanic whites to use diet (odds ratio [OR] 0.78, 95% CI 0.67 to 0.90) or exercise (OR 0.83, 95% CI 0.70 to 0.99) for weight loss. Mexican Americans (OR 0.71, 95% CI 0.53 to 0.95) and non-Hispanic blacks (OR 0.71, 95% CI 0.52 to 0.95) were also less likely than non-Hispanic whites to use professional help for weight loss. The relationships between race/ethnicity and weight-loss strategy were stronger for females than males. CONCLUSIONS Targeted efforts are needed to address racial/ethnic disparities in weight-loss attempts and use of recommended strategies especially among females.
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Ragsdale C, Wright J, Shokar G, Salaiz R, Shokar NK. Hispanic Patient Perspectives of the Physician's Role in Obesity Management. J Clin Med Res 2016; 9:170-175. [PMID: 28090233 PMCID: PMC5215021 DOI: 10.14740/jocmr2868w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Little is known concerning Hispanic patients' perceptions about the role of the physician in obesity management. This study seeks to describe the perspectives of Hispanic patients toward weight loss, and what they believe their doctor's role should be in the management of obesity. METHODS A cross-sectional study utilizing semi-structured interviews was conducted in a university-based family medicine clinic. Open-ended questions explored beliefs about the relationship between weight and health, previous weight loss experience, perceptions about the role of the physician in weight loss, past experiences with their physician, and preferences for how a physician could help facilitate weight loss. The free recall listing technique was used to elicit responses. Common themes were identified by a group coding process. RESULTS Patients were open to discussion from physicians concerning weight loss but many had not been approached. They wanted assistance from their doctors in the form of dietician referrals, specific weight loss goals, and encouragement. Patients' knowledge about the implications of excess weight on health was lacking. CONCLUSION Hispanic patients want more help and advice from their doctors. General knowledge of the health implications of obesity was lacking, indicating a need for more health education by the healthcare team.
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Affiliation(s)
- Colton Ragsdale
- Department of Pediatrics, Greenville Hospital System, University of South Carolina, 701 Grove Road, Greenville, SC 29601, USA
| | - Justin Wright
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, 9849 Kenworthy St. El Paso, TX 79924, USA
| | - Gurjeet Shokar
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, 9849 Kenworthy St. El Paso, TX 79924, USA
| | - Rebekah Salaiz
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, 9849 Kenworthy St. El Paso, TX 79924, USA
| | - Navkiran K Shokar
- Department of Family and Community Medicine & Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Paul L Foster School of Medicine, 9849 Kenworthy St. El Paso, TX 79924, USA
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An R, Yang Y. Diabetes Diagnosis and Screen-Based Sedentary Behavior Among US Adults. Am J Lifestyle Med 2016; 12:252-262. [PMID: 30202395 DOI: 10.1177/1559827616650416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022] Open
Abstract
Diabetes threatens a patient's health and quality of life, whereas disease diagnosis itself could potentially serve as a teachable moment for initiating behavior change. This study assessed diabetes diagnosis as a possible teachable moment for screen-based sedentary behavior among US adults. The nationally representative sample (n = 3690) came from the 2005-2006 and 2011-2012 National Health and Nutrition Examination Survey. Self-reported hours spent on screen-based sedentary behavior (television/video watching, computer/digital device use) were measured by the Global Physical Activity Questionnaire. Diabetes/prediabetes was identified by fasting plasma glucose and the glycated hemoglobin test. Logistic regressions were conducted to examine the relationship between diabetes diagnosis and screen-based sedentary behavior, adjusting for individual characteristics and sampling design. Compared with those with undiagnosed diabetes, the adjusted values for prevalence of daily television/video watching ≥2 hours (77.45% vs 65.14%), computer/digital device use ≥1 hour (43.20% vs 36.52%), and total screen time (ie, television/video watching plus computer/digital device use) ≥3 hours (66.75% vs 45.78%) were all noticeably higher among adults with diagnosed diabetes, although only the difference in the prevalence of daily total screen time was significant at P < .05. No evidence was found regarding diabetes diagnosis as a teachable moment in reducing screen-based sedentary behavior in US adults.
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Affiliation(s)
- Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Yan Yang
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois
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15
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Abstract
OBJECTIVE To assess the role of diabetes diagnosis as a potential teachable moment in nutrition facts label use among US adults. DESIGN Logistic regression analyses were conducted to examine the relationship between diabetes diagnosis status (diagnosed diabetes, undiagnosed diabetes, diagnosed prediabetes, undiagnosed prediabetes, no diabetes or prediabetes) and self-reported nutrition facts label use, adjusted by individual characteristics and survey design. SETTING Study sample came from the National Health and Nutrition Examination Survey 2005-2010 waves. SUBJECTS A total of 5110 US adults aged 20 years and older were included in the analyses. Diabetes/prediabetes was identified by fasting plasma glucose and glycated Hb testing. RESULTS People with diagnosed diabetes/prediabetes were substantially more likely to report nutrition facts label use when making daily food purchase decisions compared with those with undiagnosed diabetes/prediabetes, whereas the prevalence of nutrition facts label use was similar between people with undiagnosed diabetes/prediabetes and those without diabetes/prediabetes. The adjusted prevalence (95 % CI) of any and regular nutrition facts label use was 85·93 (82·91, 88·95) % and 55·60 (50·04, 61·16) % among those with diagnosed diabetes, respectively, in comparison to 71·50 (59·64, 83·37) % and 32·88 (19·11, 46·65) % among those with undiagnosed diabetes. Analogously, the adjusted prevalence (95 % CI) of any and regular nutrition facts label use was 81·16 (75·27, 87·06) % and 45·28 (37·28, 53·29) % among those with diagnosed prediabetes, respectively, in comparison to 72·83 (68·06, 77·59) % and 39·95 (34·02, 45·89) % among those with undiagnosed prediabetes. CONCLUSIONS As a potential teachable moment, diabetes diagnosis may positively impact nutrition facts label use and motivate diabetic patients to manage their condition through making healthier food choices.
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Xiang X, Hernandez R, Larrison CR. Provider Advice on Exercise and Diet Among Adults With Comorbid Serious Psychological Distress and Diabetes or Diabetes Risk Factors. DIABETES EDUCATOR 2015; 41:185-93. [DOI: 10.1177/0145721714567234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To examine the lifetime prevalence and correlates of provider advice to increase exercise and reduce dietary fat intake among adults with comorbid serious psychological distress (SPD) and diabetes or diabetes risk factors. Methods Study sample (n = 5942) was selected from the Medical Expenditure Panel Survey Household Component (MEPS-HC) series of 2007-2011. SPD was defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression was used to examine correlates of lifetime provider advice. Results Less than half of adults with SPD had been advised to increase exercise (49.4%) or reduce dietary fat intake (45.6%). The prevalence of receiving provider advice increased in a linear fashion as the number of diabetes risk factors increased and was the highest among those with diabetes. Provision of provider advice was strongly associated with clinical factors rather than individuals’ sociodemographic characteristics and current health behaviors. Conclusions Health care providers are missing opportunities to provide exercise and low-fat dietary advice to patients with SPD before they manifest clinical risk factors associated with diabetes. It is important that providers counsel them as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes.
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Affiliation(s)
- Xiaoling Xiang
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
| | - Rosalba Hernandez
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
| | - Christopher R. Larrison
- University of Illinois at Urbana-Champaign, Urbana, Illinois (Ms Xiang, Dr Hernandez, Dr Larrison)
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Villani J, Mortensen K. Patient-provider communication and timely receipt of preventive services. Prev Med 2013; 57:658-63. [PMID: 24021993 DOI: 10.1016/j.ypmed.2013.08.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/26/2013] [Accepted: 08/31/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To estimate the association between how patients rate their health care provider's communication and the receipt of six clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP). METHODS This study used national data from the 2009 Medical Expenditure Panel Survey (MEPS). The samples (sizes vary by service) included individuals aged 18 years and older who have a usual source of care (USC). The outcomes indicated whether or not individuals received screening for breast cancer, cervical cancer, colon cancer, high cholesterol, hypertension, or were vaccinated against influenza per clinical guidelines. Multivariate logistic regression models were created for each dependent variable. The main independent variables consisted of ratings of four patient-provider communication behaviors. RESULTS In unadjusted analyses, respondents who rated their providers' communication higher reported greater utilization of preventive services. After controlling for confounding variables, only receipt of mammograms remained significantly associated with better communication (p<0.05). Screening for cervical cancer, colon cancer, high cholesterol, and influenza vaccination approached significance with better communication (p<0.10). CONCLUSIONS Patient-provider communication is associated with receipt of regular mammograms. Clinicians should consider their medical dialogue with patients as a stimulus for appropriate screenings and vaccinations.
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Affiliation(s)
- Jennifer Villani
- Department of Health Services Administration, 3310 School of Public Health Building, University of Maryland, College Park, MD 20742-2611, USA.
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Acculturation among Latino Primary Caregivers and Physician Communication: Receipt of Advice Regarding Healthy Lifestyle Behaviors. J Community Health 2013; 38:113-9. [DOI: 10.1007/s10900-012-9588-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vaccaro JA, Huffman FG. Gender Differences in Medical Advice and Health Behavior of Obese African Americans With and Without Type 2 Diabetes. Am J Mens Health 2012; 6:383-94. [DOI: 10.1177/1557988312449853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study examined gender differences in medical advice related to diet and physical activity for obese African American adults ( N = 470) with and without diabetes. Data from the 2007-2008 National Health and Nutrition Examination Survey were analyzed using logistic regression analyses. Even after sociodemographic adjustments, men were less likely to report receiving medical advice as compared with women. Both men and women given dietary and physical activity advice were more likely to follow it. Men were less likely to report currently reducing fat or calories, yet men with diabetes were 5 times more likely to state that they were reducing fat and calories as compared with women with diabetes. Gender- and disease state–specific interventions are needed comparing standard care with enhanced patient education. Moreover, these findings necessitate studies that characterize the role of the health care professional in the diagnosis and treatment of obesity and underscore patient–provider relationships.
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Affiliation(s)
- Joan A. Vaccaro
- Robert Stempel College of Public Health and Social Work, Miami, FL, USA
| | - Fatma G. Huffman
- Robert Stempel College of Public Health and Social Work, Miami, FL, USA
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Basáñez T, Blanco L, Collazo JL, Berger DE, Crano WD. Ethnic groups' perception of physicians' attentiveness: implications for health and obesity. PSYCHOL HEALTH MED 2012; 18:37-46. [PMID: 22533465 DOI: 10.1080/13548506.2012.672750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Variables from the Health Tracking Household Survey 2007 were mapped to fit the "integrative model" of patient-doctor communication proposed by Ashton et al. (2003) to describe how communication patterns between patients and doctors influence patients' health outcomes. Patients' perceptions of their physician's attentiveness were examined to determine if perceived attentiveness mediated the relationship between physicians' recommendations (to diet and exercise) and health. Ethnic group differences related to these variables were explored. Overall, patient perception of physician attentiveness did significantly mediate the relationship between recommendations and patients' general health status. Hispanics and African Americans perceived their physicians as significantly less attentive to them, compared to Caucasians' perception of attentiveness. Across all ethnic groups, there was no evidence that doctors' recommendations to diet and exercise had an effect on patients' body mass index. The findings support previous research regarding the importance of physicians' communication skills and cultural sensitivity in promoting patient adherence to health recommendations.
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Affiliation(s)
- Tatiana Basáñez
- Department of Psychology, Claremont Graduate University, Claremont, California, USA.
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