Aim. To explore (1) general practitioners' (GPs') motivations 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 decisionmaking 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-as well as their own 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 case-based referring (vignettes). Results. A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs' referral behavior was significantly 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 evidencebased lifestyle interventions, with support from allied health professionals and with official guidelines for a more objective and systematic screening of patients.

The BBs approach composes a way of counseling around the central construct of barrier-beliefs to stimulate engagement in PA independently, in the long term.

ObjectivesDespite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres.DesignA mixed methodologies study, using both online questionnaires and semi-structured interviews.SettingDutch university medical centres.ParticipantsClinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres.ResultsForty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints).ConclusionsOur study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.