title: Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?
abstract: BACKGROUND
  Lifestyle advice from general practitioners (GPs) has been shown to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high risk or already have symptoms.
  
  
  OBJECTIVE
  To look in depth at GPs' attitudes towards adopting a population approach to lifestyle advice and to use these results to identify ways of maximising the potential of GPs to affect population health.
  
  
  METHODS
  Thirty-six GPs, purposively sampled by identifying characteristics likely to affect their health promotion activity, participated in a focus group study. Data from the focus groups were transcribed verbatim and analysed using standard methods.
  
  
  RESULTS
  The main themes that emerged suggested that GPs do not take a population approach to lifestyle advice because they prefer a high risk approach and doubt their ability to be effective in a population approach. GPs believed that social, cultural, and environmental factors were the most important determinants of population health. Furthermore, they were concerned about the detrimental effects on the doctor-patient relationship of providing lifestyle advice to all patients. GPs believed that a multi-agency, centrally co-ordinated approach was the preferred way to improve population health and that their role should be limited to secondary prevention.
  
  
  CONCLUSIONS
  Large amounts of resources would be necessary to convince GPs to adopt a population approach to lifestyle advice. Measures to tackle the social and environmental determinants of health may be a more effective and efficient means of improving the nation's health.
authors.affiliation: Division of Public Health, Nuffield Institute for Health, University of Leeds.
authors.forename: D A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: S
authors.initials: S
authors.lastname: Keen
authors.forename: R D
authors.initials: RD
authors.lastname: Neal
mesh_terms: D001291:Attitude of Health Personnel; D018672:Community Health Planning; D005260:Female; D006266:Health Education / Q000379:methods*; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D008297:Male; D010819:Physician's Role; D010821:Physicians, Family; D012423:Rural Health; D014504:Urban Health