title: Primary care nurses struggle with lifestyle counseling in diabetes care: a qualitative analysis.
abstract: BACKGROUND
  Patient outcomes are poorly affected by lifestyle advice in general practice. Promoting lifestyle behavior change require that nurses shift from simple advice giving to a more counseling-based approach. The current study examines which barriers nurses encounter in lifestyle counseling to patients with type 2 diabetes. Based on this information we will develop an implementation strategy to improve lifestyle behavior change in general practice.
  
  
  METHODS
  In a qualitative semi-structured study, twelve in-depth interviews took place with nurses in Dutch general practices involved in diabetes care. Specific barriers in counseling patients with type 2 diabetes about diet, physical activity, and smoking cessation were addressed. The nurses were invited to reflect on barriers at the patient and practice levels, but mainly on their own roles as counselors. All interviews were audio-recorded and transcribed. The data were analyzed with the aid of a predetermined framework.
  
  
  RESULTS
  Nurses felt most barriers on the level of the patient; patients had limited knowledge of a healthy lifestyle and limited insight into their own behavior, and they lacked the motivation to modify their lifestyles or the discipline to maintain an improved lifestyle. Furthermore, nurses reported lack of counseling skills and insufficient time as barriers in effective lifestyle counseling.
  
  
  CONCLUSIONS
  The traditional health education approach is still predominant in primary care of patients with type 2 diabetes. An implementation strategy based on motivational interviewing can help to overcome 'jumping ahead of the patient' and promotes skills in lifestyle behavioral change. We will train our nurses in agenda setting to structure the consultation based on prioritizing the behavior change and will help them to develop social maps that contain information on local exercise programs.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. r.jansink@iq.umcn.nl
authors.forename: Renate
authors.initials: R
authors.lastname: Jansink
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001521:Behavior Therapy; D003376:Counseling / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing* / Q000517:prevention & control; D005069:Evaluation Studies as Topic; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008875:Middle Aged; D009426:Netherlands; D009723:Nurse-Patient Relations; D010349:Patient Compliance; D010353:Patient Education as Topic; D059017:Primary Care Nursing / Q000379:methods* / Q000523:psychology; D016540:Smoking Cessation