Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients’ expectations and experiences

Abstract

Background: Despite various guidelines, shortcomings in lifestyle counseling in primary care have been demonstrated. Comparisons between countries may provide insight on how to improve such counseling. To the best of our knowledge, studies comparing patients’ views of lifestyle counseling beween the United States (US) and European countries have not been reported. Objectives: To quantify and compare patients’ perspectives in the US and Sweden on primary care providers’ counseling on weight, eating habits, physical activity, smoking, and alcohol consumption. Methods: In a cross-sectional study, 629 patients from Sweden and the US completed a telephone interview about their experiences after a visit to a physician in primary care. The survey focused on patients’ perception of the importance of healthy lifestyle habits, their need to change, their desire to receive support from primary care, and the support they had actually received. Data were analyzed using chi-square or Fisher’s exact test. Results: For three of the four lifestyle habits, the proportion saying they needed to change was higher in the US. The exception was for alcohol, where Swedish subjects indicated a greater need to change. Among those stating a need to change, the proportion saying that they would like to have support from primary care was generally above 80% in both countries. The proportion of US patients reporting that their primary care provider had initiated a discussion of lifestyle modification was, with the exception of alcohol, roughly double the level reported by the Swedish patients. Conclusions: This study demonstrates high and quite similar patient expectations concerning lifestyle counseling in both countries, but more frequent initiation of discussions of most lifestyle issues in US primary care. Further studies, e.g. qualitative interviews with physicians, and medical record reviews, are required to better understand what can explain the differences between countries indicated by the study.

Optimisation of a metabotype approach to deliver targeted dietary advice

“…The World Health Organisation has recommended that all health professionals should actively engage in promoting healthy dietary intake to improve public health outcomes [ 31 ]. Although general practitioners (GPs) and nurses provide nutrition care, and patients consider them reliable sources of information from who expect to receive dietary advice, this is often not included in the clinical consultations [ 32 – 34 ]. The most frequent reasons are high workload and lack of financial incentives, confidence and training [ 34 – 37 ].…”

Predictors of Counselling Related to a Healthy Lifestyle Carried Out by a General Practitioner

“…In the Jerdéna study carried out in Sweden and the US, the proportion of people declaring their willingness to get help from primary care in both countries was generally over 80%. The percentage of US patients who reported that the doctor had initiated a discussion on lifestyle modifications was, with the exception of alcohol, approximately twice the level reported by Swedish patients [10]. The EUROPREVIEW study (conducted in 22 European countries) shows that there are patient expectations regarding counselling.…”

“…According to the assumptions of primary health care, the task of medical workers is not only to treat diseases, but first and foremost to care for the health needs of patients and to build their health potential. This model does not only apply in the USA but also in European countries, including Poland [9,10]. Polish regulations in the field of activities aimed at maintaining health of a recipient mention, among others, that a primary health care practitioner conducts health education and systematic, periodic health assessments as part of balance sheet tests.…”

Primary Care Nurses' Perceptions and Experiences of Patients Being Overweight, as well as Visions and Attitudes About Working with Lifestyle Issues: A Qualitative Interview Study

“…A comparison between Sweden and the US regarding patients' views of lifestyle counselling by their physician in a PHCC showed similar gaps between the patient's expectations for lifestyle counselling and primary care provider delivery [18]. Men in the US wanted more advice about eating habits than Swedish men, but US patients reported more frequent discussions of healthy lifestyle habits with their provider than Swedish patients [18].…”