Exploring lifestyle counselling in routine primary care consultations: the professionals role

It is generally acknowledged that GPs and practice nurses (PNs) may significantly contribute to a patients healthy lifestyle behaviour. Two counselling techniques are known to strengthen this process: tailoring information and advice about lifestyle behaviour to a patient and motivational interviewing (MI). It is not clear to what extent GPs and PNs actually apply these techniques during routine consultations. To examine how GPs and PNs discuss patients lifestyle behaviour, in terms of the level of tailoring of information and advice and their application of MI. We randomly videotaped GP-patient and PN-patient consultations within Dutch general practices and selected 124 and 141 consultations, respectively, that included any discussion about the patients lifestyle. These were analysed, using the Behaviour Change Counselling Index, level of tailoring and content of lifestyle counselling. Information about lifestyle is mainly given in generic terms by GPs and PNs. In contrast, advice about smoking behaviour more often seems to be tailored to the patient. GPs hardly ever applied MI in their consultations about patients lifestyle behaviour. PNs trained in MI did apply this technique, but to some extent only. Both GPs and PNs somehow perform lifestyle counselling according to generally acknowledged criteria. However, for both, there is room for improvement in the application of MI skills and in tailoring of information and advice about lifestyle behaviour. Effort needs to be put into integrating such techniques into busy daily practice while simultaneously complying with the many other clinical demands.