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Explaining the variation in the management of lifestyle risk factors in primary health care: a multilevel cross sectional study

Laws, Rachel A., Jayasinghe, Upali W., Harris, Mark F., Williams, Anna M., Powell Davies, Gawaine and Kemp, Lynn A. 2009, Explaining the variation in the management of lifestyle risk factors in primary health care: a multilevel cross sectional study, BMC public health, vol. 9, pp. 1-14, doi: 10.1186/1471-2458-9-165.

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Title Explaining the variation in the management of lifestyle risk factors in primary health care: a multilevel cross sectional study
Author(s) Laws, Rachel A.ORCID iD for Laws, Rachel A. orcid.org/0000-0003-4328-1116
Jayasinghe, Upali W.
Harris, Mark F.
Williams, Anna M.
Powell Davies, Gawaine
Kemp, Lynn A.
Journal name BMC public health
Volume number 9
Article ID 165
Start page 1
End page 14
Total pages 14
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2009
ISSN 1471-2458
Summary Background
Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice.

This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC.

Methods
A prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors.

Results
There was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers.

Conclusion
The findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices.
Language eng
DOI 10.1186/1471-2458-9-165
Field of Research 1117 Public Health And Health Services
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2009, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30083466

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.