Motivation and decision-making in referrals to lifestyle interventions by primary care general practitioners

Abstract

Background: There still is little empirical evidence on factors that influence GPs’ referral behavior to lifestyle interventions. The aim was to explore 1) GPs´ motivation to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle-behaviors and their referral behavior, and 2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed, considering referral and self-reported actual referral, and their own self-reported lifestyle behaviors: physical activity, dieting, being overweight. Decision-making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and by case-based referring (vignettes). Descriptives, a multiple linear regression analysis, a Pearson correlation and open coding indexing technique were conducted to analyze outcomes. Results: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ refer behavior was significantly (p <.01) associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important patient indicators in referral to lifestyle interventions were somatic indicators, and patients’ motivation for lifestyle interventions. Conclusions: GPs motivation and referral behavior might be improved by providing them with tailored resources about evidence based lifestyle interventions, with support from allied health professionals, and with official guidelines for a more objective and systematic screening of patients.