Determinants of nutrition guidance practices of primary-care physicians

The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants of nutrition guidance practices as well as their working mechanism. In addition one study is described, on consumers expectations of such nutrition guidance.

The consumer study revealed that PCPs appeared to be in a unique position over the dietician and Food and Nutrition Education Bureau, because of the high referral score, the high perceived expertise and the reach of nearly all segments of the population.

A specifically developed questionnaire was sent to a nationwide random sample of 1000 PCPsin the Netherlands, in practice for between 5 and 15 years. The net response rate was 64%.

The most important perceived barriers of PCPs towards nutrition guidance were: a lack of nutrition training, lack of time to address nutrition issues and the perception that patients lack motivation to change lifestyle and/or dietary patterns. Driving forces in PCPs are: an active interest in the effect of nutrition in health and disease, a basic level of nutritional knowledge and positive attitudes towards nutrition guidance practices.

A postulated model on the working-mechanism of determinants of nutrition guidance practices of PCPs could be confirmed, using LISREL-analysis methodology. The predisposing factors, driving forces and perceived barriers in this model were identified. If solely multiple regression analysis (MRA) had been used to ascertain determinants in stead of both MIRA and LISREL-analysis, this would have led to a missing of important predisposing factors and of 'hidden' intermediary factors and therefore to an incomplete understanding of the mechanism of action. Policies to improve nutrition guidance practices of PCPs might in future benefit from a LISREL-analysis of determinants of these practices to become more effective.