title: "Should I and can I?" A mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care.
abstract: BACKGROUND
  Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.
  
  
  METHODS
  A cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management.
  
  
  RESULTS
  Role congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels.
  
  
  CONCLUSIONS
  PHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice.
authors.affiliation: Centre for Primary Health Care & Equity, University of New South Wales, Sydney NSW 2052, Australia. r.laws@unsw.edu.au
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Laws
authors.forename: Sue E
authors.initials: SE
authors.lastname: Kirby
authors.forename: Gawaine P Powell
authors.initials: GP
authors.lastname: Davies
authors.forename: Anna M
authors.initials: AM
authors.lastname: Williams
authors.forename: Upali W
authors.initials: UW
authors.lastname: Jayasinghe
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Amoroso
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003152:Community Health Nursing / Q000706:statistics & numerical data*; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012307:Risk Factors; D012308:Risk Management; D000078329:Workforce