title: Physician Gender and Lifestyle Counselling to Prevent Cardiovascular Disease: A Nationwide Representative Study.
abstract: BACKGROUND
  Primary care physicians (PCPs) have a key role in the prevention of cardiovascular diseases (CVD). However, it is not clear whether lifestyle counselling behaviour differs between female and male PCPs. Nonetheless, this information might be helpful to develop need-based advanced training for female and male PCPs. Therefore, our aim was to identify potential gender differences in the implementation of health promotion and the prevention of CVD in primary care.
  
  
  METHODS
  In a Germany-wide survey called the ÄSP-kardio Study, we collected data from 4074 PCPs (40% female; from October 2011 to March 2012). We compared the provision of prevention measures, the attitude towards counselling, and the potential barriers in counselling among female and male German PCPs. We used chi(2) tests, Mann-Whitney U tests, and logistic regression analysis.
  
  
  RESULTS
  We found differences in all of the above-mentioned aspects. Female PCPs were less likely to perceive barriers than male and more likely to ask patients about lifestyle, for example, nutrition (OR=1.62, P≤0.001). Additionally, female PCPs were more likely to feel well prepared (84.2% vs. 76.0%, P≤0.001) and successful (75.6% vs. 68.0%, P≤0.001). Male PCPs were more likely to mention barriers in daily practice that hinder lifestyle counselling.
  
  
  CONCLUSIONS
  Overall, both female and male PCPs had a positive attitude towards lifestyle counselling. Nevertheless, in view of the barriers that they indicated, incentives such as better reimbursement may help output-oriented PCPs to translate their positive attitude into action. Moreover, awareness of gender differences may help PCPs to acquire the specific advanced training that they need for effective lifestyle counselling in CVD. Significance for public healthLifestyle counselling is an important instrument to reduce the burden of cardiovascular disease. Here, primary care physicians (PCPs) play an important role as health advisors. Our study was able to identify deficits in the health promotion behaviour of PCPs. Because of the gender differences revealed in our study, male PCPs in particular should be sensitized to the importance and the potentials of prevention and health promotion. Overcoming the barriers of prevention and health promotion identified by the PCPs may be an important starting point. If, for instance, PCPs were better financially compensated for offering lifestyle counselling, which was rated as the most important barrier, it is conceivable that more PCPs would start to incorporate such measures into their daily routine. Additionally, a stronger focus on prevention and health promotion during advanced training programs for PCPs could increase the use of lifestyle counselling.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty , Mannheim, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Diehl
authors.affiliation: Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH , Bremen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Gansefort
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty , Mannheim, Germany.
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Herr
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty , Mannheim, Germany.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Görig
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty , Mannheim, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bock
authors.affiliation: lnternistic Croup Practice Dr. med. Manfred Mayer und Dr. med. Angela Schmid , Mannheim, Germany ; Physician Network Ärztenetz Qu@linet e.V , Mannheim, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Mayer
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty , Mannheim, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schneider
keywords: Primary health care; cardiovascular disease; gender; general practice; prevention