title: Clinician reflections on promotion of healthy behaviors in primary care practice.
abstract: OBJECTIVE
  Recommendations to use integrated models for health behavior change abound, however, the translation to practice has been poor. We used stimulated reflections of primary care physicians and nurse practitioners to generate insights about current practices and opportunities for changing how health behavior advice is addressed.
  
  
  METHODS
  Twenty-one community practicing primary care clinicians invited to a nationally sponsored practice-based research network conference on promotion of healthy behaviors were asked to record aspects of health behaviors they addressed during a day of outpatient visits. In response to eight questions, clinicians reflected insights which were then analyzed by a multidisciplinary team to identify over-arching themes.
  
  
  RESULTS
  Health behavior discussions are initiated and carried out predominantly by the clinician. These discussions occur primarily during health care maintenance visits or visits in which presenting complaints or chronic illnesses can be linked to health behaviors. Clinicians' reflections on viable opportunities for change include different modes of patient education materials such as web-based materials. Suprisingly infrequent were solutions outside of the clinical encounter or strategies that engage other staff or other community partners.
  
  
  CONCLUSIONS
  Implementation of the integrated care model as an opportunity to enhance health promotion seems far from the current realities and future vision of even motivated network-based clinicians.
authors.affiliation: Department of Family Medicine, Case Western Reserve University, Cleveland, OH 44106-7136, United States. susan.flocke@case.edu
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
mesh_terms: D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D009722:Nurse Practitioners / Q000523:psychology; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014481:United States