Nutritional guidance in general practice--a conceptual framework.
OBJECTIVE
The general practitioner is the personal doctor for patients and families in the community. This paper explores the inclusion of nutrition guidance in the overall methods of general practice care.


METHODS
Three dominant factors of nutrition guidance have been identified: the disease or risk factor, the individual and the socio-cultural context. These factors were considered against the main features of general practice-the defined epidemiology, the focus on individual needs, family orientation and continuity of care.


RESULTS
General practice is particularly effective in individual counselling and addressing individual beliefs and values as many patients are consulting more than once each year. Approximately 16% of all presented episodes of illness relate directly to nutritional guidance and provide 'critical' individual incidents. For the large majority of situations nutrition guidance is promoting healthy food, on which individual needs require emphasis of specific aspects (salt, fat, fibre, starch).


CONCLUSIONS
It is proposed to focus nutrition guidance in general practice primarily on individual needs, and use identified health problems as critical incidents to enhance nutritional changes. Coordination with public campaigns can reinforce the effectiveness of this individual approach. Concepts like the Stages of Change provide a model for nutrition guidance that are based on continuity of care. From this a framework for individual nutrition guidance is presented, based on individual needs in the context of social values. Presented health problems over time are used as critical incidents to motivate nutritional change, implement it and preserve new nutritional behaviour.
Department of General Practice and Social Medicine, University of Nijmegen, The Netherlands. C.vanWeel@hsv.kun.nl
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D004032:Diet; D005194:Family Practice; D006801:Humans; D052756:Nutritional Sciences / Q000193:education*; D010353:Patient Education as Topic; D010819:Physician's Role