Attitudes of healthcare professionals towards discussing lifestyle in routine clinical practice.

Abstract

Despite the well-documented benefits of a healthy lifestyle for many patients, discussing lifestyle is currently not a structural part of routine clinical practice in hospital care. The aim of this study was to gain insight in the attitudes of healthcare professionals (HCPs) towards discussing lifestyle in their routine clinical practice, and explore differences between various types of HCPs. Semi-structured interviews were conducted with healthcare professionals (i.e. doctors, nurses, and allied health professionals (AHP)) from different departments (i.e. cardiology, gastrointestinal medicine, gynaecology, hepato-pancreato-biliary surgery, internal medicine, neurology, orthopaedics) in two university medical centers in the Netherlands. Interviews were audio-recorded and analyzed using a hybrid inductive-deductive analysis with Atlas.ti and MaxQDA. An existing framework by Van Aalderen et al. was utilized to explore attitudes, focusing on cognitive beliefs, affective states, and perceived control. The domain of cognitive beliefs had four distinguishing beliefs regarding perceived relevance (i.e. beliefs about: 1) relevance; 2) responsibility; 3) consequences; and 4) referral options), three sub-themes regarding perceived patient beliefs (i.e. patient motivation; patient capability; and patient opportunities) and one sub-theme regarding perceived difficulty. For the domain affective states the two themes were: enjoyment and anxiety. The domain of perceived control had two themes: self-efficacy and context dependency, which had three sub-themes (i.e. time, financial reimbursement and institutional policy). Overall, doctors seem more ambivalent in their attitudes than nurses and allied health professionals. A relatively large and diverse sample of healthcare professionals provided insight into health care professional's attitudes towards discussing lifestyle with patients during routine consultations. Research is needed to improve health promotion training for HCPs, patient-professional dynamics, and for implementation in routine clinical practice. HCPs need greater self-efficacy, support, and clear policies to integrate lifestyle discussions into routine care, requiring collaboration between educators, managers, and organizations.