Determination of factors influencing the desire and possibilities of prevention of inactivity and other behavi­oral risk factors by primary care physicians (REFLECTION). The results of a one-time survey

Aim    To evaluate clinical practice of primary care physicians with respect of preventing behavioral risk factors in patients as well as objective and subjective factors that influence their motivation for taking preventive measures. 
Material and methods    This study was a cross-sectional survey. The questionnaire was anonymous and included closed questions and multiple-choice questions. Based on the obtained results, prevalence of modifiable risk factors for chronic noninfectious diseases (CNID) was comprehensively evaluated in the survey population. Also, a special quantitative variable was introduced, the Index of Behavioral Risk Factors. that reflected the burden of risk factors. This composite index included the degree of risk factor in a specific respondent, for example, obesity degree, number of cigarettes smoked per day, severity of hypodynamia. Physicians’ knowledge and beliefs about the effect of physical activity (PA) on certain diseases were evaluated. 
Result    623 physicians (mean age 40 years (31-52), 85.5 % women) participated in the survey. The respondents included general practitioners (7.5%), cardiologists (2.9 %), preventive care physicians (4.8 %), internists (25.4 %), and other specialists (59.4 %). 70.8 % of respondents never smoked, 17.5 % were current smokers. 38.5% (240) of the surveyed had a normal body weight index (BWI); 41.7 % (260) were overweight; 11.6 % (72) had degree 1 obesity; 3.7 % (23) had degree 2 obesity; and 0.8 % had degree 3 obesity. A very low PA level was noticed; most of the surveyed exercised not more than once a week (median, 1 (0-3) time). More than 90 % had behavioral risk factors, low PA and excessive body weight. The physicians with a higher index of behavioral risk factors 50% less frequently checked the body weight of patients (odds ratio (OR), 0.541; 95 % confidence interval (CI): 0.388–0.753, p<0.05); 33% less frequently asked whether the patient smoked (OR, 0.675; 95 % CI: 0.465–0.978, p=0.037); 50% less frequently asked the patients about his/her level of PA (OR, 0.482; 95 % CI: 0.343–0.678, p<0.001); and 60% less frequently recommended increasing the PA (OR, 0.408; 95 % CI: 0.292–0.570, p<0.001).
Conclusion    Most of the surveyed were aware of the benefits of PA for prevention and treatment of CNID, however, they related the mechanism of this effect only with weight loss. The most frequently mentioned barriers to behavioral risk counseling were uncertainty about whether such counseling was within the physician's professional competence, lack of time, lack of confidence in the provision of advice and the effectiveness of interventions, and lack of patients’ compliance.

1. World Health Organization. Noncommunicable diseases: progress monitor 2020. -Geneva: World Health Organization;2020. ISBN 978-92-4-000049-0

2. Peters R, Ee N, Peters J, Beckett N, Booth A, Rockwood K et al. Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction. Therapeutic Advances in Chronic Disease. 2019;10:204062231988039. DOI: 10.1177/2040622319880392

3. Balanova Yu.A., Kontsevaya A.V., Shal’nova S.A., Deev A.D., Artamonova G.V., Gatagonova T.M. et al. Prevalence of behavioral risk factors for cardiovascular disease in the Russian population: Results of the ESSE-RF epidemiological study. The Russian Journal of Preventive Medicine and Public Health. 2014;17(5):42–52.

4. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2021;42(34):3227–337. DOI: 10.1093/eurheartj/ehab484

5. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

6. Verbiest ME, Presseau J, Chavannes NH, Scharloo M, Kaptein AA, Assendelft WJ et al. Use of action planning to increase provision of smoking cessation care by general practitioners: role of plan specificity and enactment. Implementation Science. 2014;9(1):180. DOI: 10.1186/s13012-014-0180-2

7. Godin G, Shephard RJ. An Evaluation of the Potential Role of the Physician in Influencing Community Exercise Behavior. American Journal of Health Promotion. 1990;4(4):255–9. DOI: 10.4278/0890-1171-4.4.255

8. Avanzini F, Marzona I, Baviera M, Barlera S, Milani V, Caimi V et al. Improving cardiovascular prevention in general practice: Results of a comprehensive personalized strategy in subjects at high risk. European Journal of Preventive Cardiology. 2016;23(9):947–55. DOI: 10.1177/2047487315613664

9. De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L et al. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis. 2019;285:135–46. DOI: 10.1016/j.atherosclerosis.2019.03.014

10. Frank E, Bhat Schelbert K, Elon L. Exercise counseling and personal exercise habits of US women physicians. Journal of the American Medical Women’s Association (1972). 2003;58(3):178–84. PMID: 12948110

11. Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal Exercise Habits and Counseling Practices of Primary Care Physicians: A National Survey: Clinical Journal of Sport Medicine. 2000;10(1):40–8. DOI: 10.1097/00042752-200001000-00008

12. Sherman SE, Hershman WY. Exercise counseling: How do general internists do? Journal of General Internal Medicine. 1993;8(5):243–8. DOI: 10.1007/BF02600089

13. Morishita Y, Miki A, Okada M, Tsuboi S, Ishibashi K, Ando Y et al. Exercise counseling of primary care physicians in metabolic syndrome and cardiovascular diseases is associated with their specialty and exercise habits. International Journal of General Medicine. 2014;7:277–83. DOI: 10.2147/IJGM.S64031

14. Harsha DM, Saywell RM, Thygerson S, Panozzo J. Physician Factors Affecting Patient Willingness to Comply with Exercise Recommendations: Clinical Journal of Sport Medicine. 1996;6(2):112–8. DOI: 10.1097/00042752-199604000-00009

15. McKenna J, Naylor PJ, McDowell N. Barriers to physical activity promotion by general practitioners and practice nurses. British Journal of Sports Medicine. 1998;32(3):242–7. DOI: 10.1136/bjsm.32.3.242

16. Kobyakova O.S., Deev I.A., Kulikov E.S., Almikeeva A.A., Pimenov I.D., Starovoytova E.A. et al. The rate of risk factors for chronic non-communicable diseases among mid-level medical staff in the Russian Federation in case of the Tomsk Region. The Russian Journal of Preventive Medicine and Public Health. 2019;22(3):31–6. DOI: 10.17116/profmed20192203131

17. Ko DT, Chu A, Austin PC, Johnston S, Nallamothu BK, Roifman I et al. Comparison of Cardiovascular Risk Factors and Outcomes Among Practicing Physicians vs the General Population in Ontario, Canada. JAMA Network Open. 2019;2(11):e1915983. DOI: 10.1001/jamanetworkopen.2019.15983

18. Udalova O.N. The image and quality of life of doctors and nurses of psychiatric (narcological) institutions of Kabardino-Balkaria. Problems of healthcare management. 2010;3:39–43.

19. Rotar O.P., Orlov A.V., Boyarinova M.A., Solntsev V.N., Tanicheva A.A., Sviryaev Yu.V. et al. Assessment of healthy lifestyle compliance among private-practice doctors and students (medical students, interns and clinical residents). The Scientific Notes of the I.P. Pavlov St. Petersburg State Medical University. 2018;25(3):73–9. DOI: 10.24884/1607-4181-2018-25-3-73-79

20. Duperly J, Lobelo F, Segura C, Sarmiento F, Herrera D, Sarmiento OL et al. The association between Colombian medical students’ healthy personal habits and a positive attitude toward preventive counseling: cross-sectional analyses. BMC Public Health. 2009;9(1):218. DOI: 10.1186/1471-2458-9-218

21. Vogt F, Hall S, Marteau TM. General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review. Addiction. 2005;100(10):1423–31. DOI: 10.1111/j.1360-0443.2005.01221.x

22. Dewhurst A, Peters S, Devereux-Fitzgerald A, Hart J. Physicians’ views and experiences of discussing weight management within routine clinical consultations: A thematic synthesis. Patient Education and Counseling. 2017;100(5):897–908. DOI: 10.1016/j.pec.2016.12.017

23. Begrambekova Yu.L., Efremushkina A.Yu., Kozhedub Ya.A., Smirnova E.A., Terekhovskaya Yu.V., Adonina E.V. et al. Physical training in patients with chronic heart failure: level of involvement, as well as psychosocial, anamnestic and iatrogenic factors that determine the motivation to practice. Kardiologiia. 2020;60(4):18–23. DOI: 10.18087/cardio.2020.4.n738

24. Frank E, Wright EH, Serdula MK, Elon LK, Baldwin G. Personal and professional nutrition-related practices of US female physicians. The American Journal of Clinical Nutrition. 2002;75(2):326–32. DOI: 10.1093/ajcn/75.2.326