While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation.
Methods
Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach.
Results
Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP–patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations.
Discussion
When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach.
AlburyCHallASyedA, et al.Communication practices for delivering health behaviour change conversations in primary care: a systematic review and thematic synthesis. BMC Fam Pract2019; 20: 111.
2.
KeyworthCEptonTGoldthorpeJ, et al.Patients’ experiences of behaviour change interventions delivered by general practitioners during routine consultations: a nationally representative survey. Health Expect2021; 24: 819–832.
3.
LundahlBMoleniTBurkeBL, et al.Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Educ Couns2013; 93: 157–168.
4.
ArmstrongMJMottersheadTARonksleyPE, et al.Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev2011; 12: 709–723.
5.
HettemaJSteeleJMillerWR. Motivational interviewing. Annu Rev Clin Psychol2005; 1: 91–111.
6.
BallLJohnsonCDesbrowB,et al.General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease. J Prim Health Care2013; 5: 59–69.
7.
GreeneJHibbardJHAlvarezC,et al.Supporting patient behavior change: approaches used by primary care clinicians whose patients have an increase in activation levels. Ann Fam Med2016; 14: 148–154.
8.
The Royal Australian College of General Practitioners. General practice: health of the nation 2020. East Melbourne: RACGP, 2020.
9.
KeyworthCEptonTGoldthorpeJ, et al.Perceptions of receiving behaviour change interventions from GPs during routine consultations: a qualitative study. PLoS One2020; 15: e0233399.
10.
van RossemCSpigtMViechtbauerW, et al.Effectiveness of intensive practice nurse counselling versus brief general practitioner advice, both combined with varenicline, for smoking cessation: a randomized pragmatic trial in primary care. Addiction2017; 112: 2237–2247.
11.
SturgissEvan WeelC. The 5As framework for obesity management: do we need a more intricate model?Can Fam Physician2017; 63: 506–508.
12.
The Royal Australian College of General Practitioners. Smoking, nutrition, alcohol, physical activity (SNAP): a population health guide to behavioural risk factors in general practice. Melbourne: The Royal Australian College of General Practitioners, 2015.
13.
The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. East Melbourne: RACGP, 2018.
14.
National Aboriginal Community Controlled Health Organisation and The Royal Australian College of General Practitioners. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. East Melbourne: RACGP, 2018.
15.
The Royal Australian College of General Practitioners. Management of type 2 diabetes: a handbook for general practice. East Melbourne: RACGP, 2020.
16.
SturgissEAClarkAM. Using critical realism in primary care research: an overview of methods. Fam Pract2020; 37: 143–145.
17.
PawsonRTilleyN. Chapter 29: An introduction to scientific realist evaluation. In: Chelimsky E and Shadish WR (eds) Evaluation for the 21st century: a handbook [Internet]. Thousand Oaks, CA: Sage Publications, Inc., 1997, pp.405–418. Available at:https://methods.sagepub.com/book/evaluation-for-the-21st-century.
18.
AstburyBLeeuwF. Unpacking black boxes: mechanisms and theory building in evaluation. Am J Eval2010; 31: 363–381.
19.
ClarkALisselSDavisC. Complex critical realism: tenets and application in nursing research. ANS Adv Nurs Sci2008; 31: E67–E79.
20.
ClarkA. What are the components of complex interventions in healthcare? Theorizing approaches to parts, powers and the whole intervention. Soc Sci Med2013; 93: 185–193.
21.
Sturgiss E and van Weel C. The 5 As framework for obesity management: Do we need a more intricate model? Can Fam Physician 2017; 63(7): 506–508. PMID: 28701434; PMCID: PMC5507219.
22.
BurchEWilliamsLTMakepeaceH, et al.How does diet change with a diagnosis of diabetes? Protocol of the 3D longitudinal study. Nutrients2019; 11: 158.
23.
Australian Bureau of Statistics. Information paper: an introduction to Socio-Economic Indexes for Areas (SEIFA). Canberra: Australian Bureau of Statistics, 2006.
24.
JacksonSKollaG. A new realistic evaluation analysis method: linked coding of context, mechanism, and outcome relationships. Am J Eval2012; 33: 339–349.
25.
BraunVClarkeVTerryG,et al.Thematic analysis. In: LiamputtongP (ed.) Handbook of research methods in health and social sciences. Singapore: Springer, 2019, pp.843–860.
26.
DaviesLLeClairKLBagleyP, et al.Face-to-face compared with online collected accounts of health and illness experiences: a scoping review. Qual Health Res2020; 30: 2092–2102.
27.
SturgissEAPeartARichardL, et al.Who is at the centre of what? A scoping review of the conceptualisation of ‘centredness’ in healthcare. BMJ Open2022; 12: e059400.
28.
StewartM. Towards a global definition of patient centred care. Br Med J2001; 322: 444–445.
29.
DewhurstAPetersSDevereux-FitzgeraldA,et al.Physicians’ views and experiences of discussing weight management within routine clinical consultations: a thematic synthesis. Patient Educ Couns2017; 100: 897–908.
30.
KeyworthCEptonTGoldthorpeJ, et al.‘It’s difficult, I think it’s complicated’: health care professionals’ barriers and enablers to providing opportunistic behaviour change interventions during routine medical consultations. Br J Health Psychol2019; 24: 571–592.
31.
HamiltonKHendersonJBurtonE,et al.Discussing lifestyle behaviors: perspectives and experiences of general practitioners. Health Psychol Behav Med2019; 7: 290–307.
32.
JoshiCJayasingheUWParkerS, et al.Does health literacy affect patients’ receipt of preventative primary care? A multilevel analysis. BMC Fam Pract2014; 15: 171.
33.
SchillingerDBindmanAWangF, et al.Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns2004; 52: 315–323.
