GPs' assessment of patients' readiness to change diet, activity and smoking.
BACKGROUND
The Stages of Change Model is increasingly used for lifestyle counselling. In general practice, the use of algorithms to measure stage of change is limited, but for successful counselling it is important to know patients' readiness to change.


OBJECTIVE
To assess the accuracy of the assessment of patients' readiness to change fat consumption, physical activity, and smoking by GPs and general practice registrars.


METHODS
Cross-sectional questionnaire-based survey.


METHODS
One hundred and ninety-nine patients at elevated cardiovascular risk aged 40-70 years, 24 GPs, and 21 registrars in Dutch general practices.


METHODS
Patients were asked to complete an algorithm to measure their motivation to change fat consumption, physical activity, and smoking. GPs and registrars were given descriptions of the stages of change for the three lifestyles, and were asked to indicate the description that matched their patient. Cohen's kappa was calculated as measure of agreement between patients and GPs/registrars.


RESULTS
Registrars' patients were younger, and less often overweight and hypertensive than GPs' patients. Cohen's kappa for smoking was moderate (0.50, 95% confidence interval [CI] = 0.34 to 0.67 for GPs and 0.47, CI = 0.27 to 0.68 for registrars). Agreement for fat and activity was poor to fair. No differences in accuracy were observed between GPs and registrars (P = 0.07-0.83).


CONCLUSIONS
Low accuracy indicates that counselling in general practice is often targeted at the wrong people at the wrong time. Improvements can possibly be achieved by making registration of lifestyle parameters in patient records common practice, and by simply asking patients where they stand in respect to lifestyle change.
Verheijden
Marieke W
MW
Nutritionist, Division of Human Nutrition, Wageningen University, The Netherlands.
Bakx
J Carel
JC
Delemarre
Ine C G
IC
Wanders
Anne J
AJ
van Woudenbergh
Nellie M
NM
Bottema
Ben Jam
BJ
van Weel
Chris
C
van Staveren
Wija A
WA
D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005194:Family Practice / Q000592:standards*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010349:Patient Compliance; D016540:Smoking Cessation