Nutrition Care by Primary-care Physicians: Advancing Our Understanding Using the COM-B Framework

Overview

Journal Public Health Nutr

Publisher Cambridge University Press

Date 2019 Nov 19

PMID 31736453

Citations 10

Authors

Jennifer Crowley

Lauren Ball

Gerrit J Hiddink

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the nutrition education provided by primary-care physicians (PCP).

Design: An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms.

Setting: USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand.

Participants: Primary-care physicians.

Results: Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations.

Conclusions: The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice.

Citing Articles

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Chua A, Lee E, Lee P, Lew J, Sim S Prim Health Care Res Dev. 2025; 26:e11.

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References

Hiddink G, Hautvast J, van Woerkum C, Fieren C, van t Hof M . Consumers' expectations about nutrition guidance: the importance of primary care physicians. Am J Clin Nutr. 1997; 65(6 Suppl):1974S-1979S. DOI: 10.1093/ajcn/65.6.1974S. View

Coppell K, Kataoka M, Williams S, Chisholm A, Vorgers S, Mann J . Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment--Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ. 2010; 341:c3337. PMC: 2907481. DOI: 10.1136/bmj.c3337. View

Sturgiss E, Haesler E, Elmitt N, van Weel C, Douglas K . Increasing general practitioners' confidence and self-efficacy in managing obesity: a mixed methods study. BMJ Open. 2017; 7(1):e014314. PMC: 5278274. DOI: 10.1136/bmjopen-2016-014314. View

van Dillen S, Hiddink G, van Woerkum C . Determinants of Dutch general practitioners' nutrition and physical activity guidance practices. Public Health Nutr. 2012; 16(7):1321-31. PMC: 10271698. DOI: 10.1017/S1368980012003564. View

Ball L, Johnson C, Desbrow B, Leveritt M . General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease. J Prim Health Care. 2013; 5(1):59-69. View

Truswell A, Hiddink G, Van Binsbergen J, Kok F, van Weel C . Empowering family doctors and patients in nutrition communication. Eur J Clin Nutr. 2005; 59 Suppl 1:S1-3. DOI: 10.1038/sj.ejcn.1602166. View

Spencer E, Frank E, Elon L, Hertzberg V, Serdula M, Galuska D . Predictors of nutrition counseling behaviors and attitudes in US medical students. Am J Clin Nutr. 2006; 84(3):655-62. DOI: 10.1093/ajcn/84.3.655. View

Gorig T, Mayer M, Bock C, Diehl K, Hilger J, Herr R . Dietary counselling for cardiovascular disease prevention in primary care settings: results from a German physician survey. Fam Pract. 2014; 31(3):325-32. DOI: 10.1093/fampra/cmu007. View

Lazarus K, Weinsier R, Boker J . Nutrition knowledge and practices of physicians in a family-practice residency program: the effect of an education program provided by a physician nutrition specialist. Am J Clin Nutr. 1993; 58(3):319-25. DOI: 10.1093/ajcn/58.3.319. View

10.

Crowley J, Ball L, Wall C . Nutrition advice provided by general practice registrars: an investigation using patient scenarios. Public Health. 2016; 140:17-22. DOI: 10.1016/j.puhe.2016.09.022. View

11.

Kushner R . Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med. 1995; 24(6):546-52. DOI: 10.1006/pmed.1995.1087. View

12.

Khandelwal S, Zemore S, Hemmerling A . Nutrition Education in Internal Medicine Residency Programs and Predictors of Residents' Dietary Counseling Practices. J Med Educ Curric Dev. 2018; 5:2382120518763360. PMC: 5865517. DOI: 10.1177/2382120518763360. View

13.

Whittemore R . Combining evidence in nursing research: methods and implications. Nurs Res. 2005; 54(1):56-62. DOI: 10.1097/00006199-200501000-00008. View

14.

Smith S, Seeholzer E, Gullett H, Jackson B, Antognoli E, Krejci S . Primary Care Residents' Knowledge, Attitudes, Self-Efficacy, and Perceived Professional Norms Regarding Obesity, Nutrition, and Physical Activity Counseling. J Grad Med Educ. 2015; 7(3):388-94. PMC: 4597949. DOI: 10.4300/JGME-D-14-00710.1. View

15.

. Empowering Family Doctors and Patients in Nutrition Communication. Proceedings of an international workshop, December 13-15, 2004, Heelsum, The Netherlands. Eur J Clin Nutr. 2005; 59 Suppl 1:S1-196. View

16.

Pollak K, Coffman C, Alexander S, Ostbye T, Lyna P, Tulsky J . Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents. Patient Educ Couns. 2014; 96(3):327-32. PMC: 4145021. DOI: 10.1016/j.pec.2014.07.025. View

17.

. Family doctors and patients: is effective nutrition interaction possible? Proceedings of an international workshop. Heelsum, the Netherlands, December 14-16, 1998. Eur J Clin Nutr. 1999; 53 Suppl 2:S1-114. View

18.

Fitzpatrick S, Dickins K, Avery E, Ventrelle J, Shultz A, Kishen E . Effect of an obesity best practice alert on physician documentation and referral practices. Transl Behav Med. 2017; 7(4):881-890. PMC: 5684083. DOI: 10.1007/s13142-017-0514-0. View

19.

Pluye P, Gagnon M, Griffiths F, Johnson-Lafleur J . A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews. Int J Nurs Stud. 2009; 46(4):529-46. DOI: 10.1016/j.ijnurstu.2009.01.009. View

20.

. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019; 393(10184):1958-1972. PMC: 6899507. DOI: 10.1016/S0140-6736(19)30041-8. View