title: Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study.
abstract: OBJECTIVE
  To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined.
  
  
  METHODS
  In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P<0.05.
  
  
  RESULTS
  PNs most frequently arranged follow-up, assessed the risk and current behavior and advised. However, they rarely assisted in addressing barriers and securing support. For weight or physical activity, most PNs used a motivational communication style. In discussions of nutrition, they mostly used an informational communication style. Moreover, PNs used a combination of communication styles. PN characteristics, including their behavior concerning the Five A's, were stronger related to communication styles than patient characteristics.
  
  
  CONCLUSIONS
  PNs reasonably complied with the Five A's Model. The quality of PNs' weight-loss counseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.
authors.affiliation: Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands.
authors.forename: S M E
authors.initials: SM
authors.lastname: van Dillen
authors.affiliation: NIVEL, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Noordman
authors.affiliation: 1] NIVEL, Utrecht, The Netherlands [2] Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands [3] Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
authors.forename: S
authors.initials: S
authors.lastname: van Dulmen
authors.affiliation: Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hiddink
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods*; D015444:Exercise; D005260:Female; D015438:Health Behavior; D058015:Health Communication / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D009726:Nurses; D009747:Nutritional Physiological Phenomena; D052756:Nutritional Sciences / Q000193:education; D050177:Overweight; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D015431:Weight Loss