Factors underlying variation in receipt of physician advice on diet and exercise: Applications of the behavioral model of health care utilization

Purpose. To identify factors associated with receipt of physician advice on diet and exercise, including patient sociodemographic characteristics, health-related needs, and health care access, using Andersen's model of health care utilization. Design. A cross-sectional analysis was performed using data from the 2000 National Health Interview Survey (NHIS). Setting. NHIS data were collected through personal household interviews by Census interviewers. The overall response rate for the 2000 NHIS adult sample was 82.6%. Subjects. Subjects were a representative sample of the American civilian, noninstitutionalized population aged 18 and older. After eliminating missing data and respondents who reported they did not see a doctor in the past 12 months, sample sizes for physician advice on diet and exercise were n = 26,255 and n = 26,158, respectively. Measures. Using the 2000 NHIS, the prevalence of receipt of physician advice on diet and exercise was assessed. Multiple logistic regression analyses were performed to examine the associations between receipt of physician advice on diet and exercise and potential predictors, adjusting for all covariates. Results. By self-report, 21.3% and 24.5% of respondents received physician advice on diet and exercise, respectively. Being middle-aged (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI], 1.0-1.29 for diet; AOR = 1.55, 95% CI = 1.33-1.79 for exercise) and having a baccalaureate degree or higher (AOR = 1.78, 95% CI = 1.52-2.08 for diet; AOR = 1.75, 95% CI = 1.47-2.07) were associated with a higher likelihood of receiving physician advice on diet and exercise. African-Americans (AOR = .78, 95% CI = .67-.92) and foreign-born immigrants (AOR = .57, 95% CI = .38-.86) were less likely to receive physician advice on exercise. The prevalence of physician advice was higher for persons who chose hospital outpatient departments as a usual source for care (A OR = 2.36, 95% C1 = 1.66-3.36 for diet; AOR = 2.39, 95% CI = 1.68-3.4 for exercise) than for adults with other types of usual care sites. Poorer self-rated health status (AOR = 5.2, 95% CI = 4.12-6.57 for diet; AOR 2.63, 95% CI = 2.04-3.38 for exercise) and obesity (AOR = 2.32, 95% CI = 2.02-2.66 for diet; AOR = 3.01, 95% CI = 2.46-3.69 for exercise) was positively associated with the likelihood of receiving physician advice on diet and exercise. Conclusions. Effective strategies to increase receipt of physician advice should include efforts to improve access to regular source of care and patient-physician communication. Sociodemographic factors remain independent and important Predictors of who obtains such advice.