title: GPs' assessment of patients' readiness to change diet, activity and smoking.
abstract: 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.
authors.affiliation: Nutritionist, Division of Human Nutrition, Wageningen University, The Netherlands.
authors.forename: Marieke W
authors.initials: MW
authors.lastname: Verheijden
authors.forename: J Carel
authors.initials: JC
authors.lastname: Bakx
authors.forename: Ine C G
authors.initials: IC
authors.lastname: Delemarre
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Wanders
authors.forename: Nellie M
authors.initials: NM
authors.lastname: van Woudenbergh
authors.forename: Ben Jam
authors.initials: BJ
authors.lastname: Bottema
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Wija A
authors.initials: WA
authors.lastname: van Staveren
mesh_terms: 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