Objective: Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.Design: An observational checklist was developed to assess goal and implementation intentions and 'missed opportunities for lifestyle counselling'. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.Setting: Dutch general practice.Subjects: One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.Results: Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important 'missed opportunity for lifestyle counselling'.Conclusions: Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

BACKGROUND/OBJECTIVE:To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined. SUBJECTS/METHODS:In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P<0.05. RESULTS:PNs most frequently arranged follow-up, assessed the risk and current behavior and advised. However, they rarely assisted in addressing barriers and securing support. For weight or physical activity, most PNs used a motivational communication style. In discussions of nutrition, they mostly used an informational communication style. Moreover, PNs used a combination of communication styles. PN characteristics, including their behavior concerning the Five A's, were stronger related to communication styles than patient characteristics. CONCLUSIONS:PNs reasonably complied with the Five A's Model. The quality of PNs' weight-loss counseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.

Background: In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care.Methods: Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers.Results: Especially in the last three years, many studies have been published. The majority of the studies were positive about PNs' actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs' role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this.Conclusion: The PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.

OBJECTIVE:General practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition and physical activity; and (iii) the extent to which these guidance practices have the same determinants.DESIGN:Cross-sectional study, mail questionnaire.SETTING:Dutch general practice.SUBJECTS:Four hundred and seventy-two GP in practice for 5–30 years.RESULTS:Our study showed that the majority of GP had similar practices for both nutrition and physical activity guidance. Fair associations were found between nutrition and physical activity guidance practices. More than half of the explained variance in the models of physical activity guidance practices was improved by the inclusion of nutrition guidance practices in the models. Moreover, GP reported higher frequencies of physical activity guidance practices than nutrition guidance practices. Nutrition guidance practices predicted the same physical activity guidance practices.CONCLUSIONS:The majority of GP had similar practices for nutrition and physical activity guidance. GP were more inclined to guide their patients on physical activity than on nutrition. Self-efficacy was found to be a determinant in most models for guidance practices. Guidance practices proved to be a mix of prevention and treatment components. Consequently, we advise raising the selfefficacy of GP by training in medical school and in continuing medical education. We also recommend the combination of both nutrition and physical activity guidance in general practice.

Several studies have shown a positive relationship between local greenspace availability and residents' health, which may offer opportunities for health improvement. This study focuses on three mechanisms through which greenery might exert its positive effect on health: stress reduction, stimulating physical activity and facilitating social cohesion. Knowledge on mechanisms helps to identify which type of greenspace is most effective in generating health benefits. In eighty neighbourhoods in four Dutch cities data on quantity and quality of streetscape greenery were collected by observations. Data on self-reported health and proposed mediators were obtained for adults by mail questionnaires (N = 1641). Multilevel regression analyses, controlling for socio-demographic characteristics, revealed that both quantity and quality of streetscape greenery were related to perceived general health, acute health-related complaints, and mental health. Relationships were generally stronger for quality than for quantity. Stress and social cohesion were the strongest mediators. Total physical activity was not a mediator. Physical activity that could be undertaken in the public space (green activity) was, but less so than stress and social cohesion. With all three mediators included in the analysis, complete mediation could statistically be proven in five out of six cases. In these analyses the contribution of green activity was often not significant. The possibility that the effect of green activity is mediated by stress and social cohesion, rather than that it has a direct health effect, is discussed.

BACKGROUND/OBJECTIVE:To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients.SUBJECTS/METHODS:A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices.RESULTS:About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices.CONCLUSIONS:Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs.

OBJECTIVE:The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. METHODS:Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria. RESULTS:In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality. CONCLUSION:We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs' provision of combined lifestyle advice to overweight and obese patients seems to be rather low. PRACTICE IMPLICATIONS:Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients.

Background Previous research shows a positive link between the amount of green area in one's residential neighbourhood and self-reported health. However, little research has been done on the quality of the green area, as well as on quantity and quality of smaller natural elements in the streetscape. This study investigates the link between the objectively assessed quantity and quality of (1) green areas and (2) streetscape greenery on the one hand and three self-reported health indicators on the other. Methods 80 Dutch urban neighbourhoods were selected, varying in the amount of nearby green area per dwelling, as determined by Geographic Information System analysis. The quality of green areas, as well as the quantity and quality of streetscape greenery, was assessed by observers using an audit tool. Residents of each neighbourhood were asked to complete a questionnaire on their own health (N=1641). In multilevel regression analyses, we examined the relationship between greenspace indicators and three health indicators, controlling for socio-demographic and socioeconomic characteristics. Results Both indicators for the quantity of greenspace were positively related to all three health indicators. Quantity and quality indicators were substantially correlated in the case of streetscape greenery. Nevertheless, the quality indicators tended to have added predictive value for the health indicators, given that the quantity information was already included in the model. Conclusions The quantity and also the quality of greenspace in one's neighbourhood seem relevant with regard to health. Furthermore, streetscape greenery is at least as strongly related to self-reported health as green areas.

Introduction: Promotion of nutrition and physical activity is important to slow down the increase of overweight. General practitioners (GPs) are in an unique position to communicate with their patients about nutrition and physical activity, because of the high referral score, high perceived expertise and reach to nearly all segments of the population. Our research group has a large history in the field of nutrition guidance practices by GPs. The aim of the present study is to gain insight into the similarities and differences in patterns between nutrition and physical activity guidance practices by GPs. Methods: In 1992, a mail questionnaire (The Wageningen GPs Nutritional Practices Questionnaire) was developed and sent to a nationwide sample of 1000 Dutch GPs, who had 5- 15 years of practice experience. Altogether, 633 GPs participated. All eligible 488 participants from 1992 were asked to participate again in the 2007 study. In total, 255 GPs (in practice for 20- 30 years) returned the questionnaire. The response rate appeared to be 52%. Additionally, a new cohort of GPs was asked to fill in the questionnaire, resulting in another 217 GPs in practice for 5- 20 years. The questionnaire was developed on the basis of qualitative research. Self-reported nutrition guidance practices, task perceptions, self-efficacy expectations and perceived barriers regarding this practices were assessed in the questionnaire. In 2007, the questionnaire also included questions about physical activity guidance practices and its determinants. This makes it possible to study whether GPs, who are communicating about nutrition, are the same GPs, who communicate about physical activity. In addition, special attention has been given to literature reviews about nutrition and physical activity guidance practices by GPs. Results: Around 80% of GPs mentioned that they often noticed their patients’ weight. Our study showed that GPs are more likely to communicate with overweight patients about physical activity than about nutrition. Moreover, GPs perceived their tasks concerning physical activity guidance more preventive than their tasks concerning nutrition guidance. Also, self-efficacy for physical activity guidance appeared to be higher than for nutrition guidance. Furthermore, 71% of GPs perceived lack of time as barrier for nutrition guidance, although only 54% mentioned this as barrier for physical activity guidance. Conclusions: This study indicates that Dutch GPs are more often inclined to promote physical activity than to promote nutrition to overweight patients. Likewise, they tend to rate determinants of physical activity guidance more positively than determinants of nutrition guidance. The preliminary results of in-depth analysis of the similarities and differences between nutrition and physical activity guidance practices will be discussed at the conference.

BACKGROUND:The potential contribution of allotment gardens to a healthy and active life-style is increasingly recognized, especially for elderly populations. However, few studies have empirically examined beneficial effects of allotment gardening. In the present study the health, well-being and physical activity of older and younger allotment gardeners was compared to that of controls without an allotment.METHODS:A survey was conducted among 121 members of 12 allotment sites in the Netherlands and a control group of 63 respondents without an allotment garden living next to the home addresses of allotment gardeners. The survey included five self-reported health measures (perceived general health, acute health complaints, physical constraints, chronic illnesses, and consultations with GP), four self-reported well-being measures (stress, life satisfaction, loneliness, and social contacts with friends) and one measure assessing self-reported levels of physical activity in summer. Respondents were divided into a younger and older group at the median of 62 years which equals the average retirement age in the Netherlands.RESULTS:After adjusting for income, education level, gender, stressful life events, physical activity in winter, and access to a garden at home as covariates, both younger and older allotment gardeners reported higher levels of physical activity during the summer than neighbors in corresponding age categories. The impacts of allotment gardening on health and well-being were moderated by age. Allotment gardeners of 62 years and older scored significantly or marginally better on all measures of health and well-being than neighbors in the same age category. Health and well-being of younger allotment gardeners did not differ from younger neighbors. The greater health and well-being benefits of allotment gardening for older gardeners may be related to the finding that older allotment gardeners were more oriented towards gardening and being active, and less towards passive relaxation.CONCLUSIONS:These findings are consistent with the notion that having an allotment garden may promote an active life-style and contribute to healthy aging. However, the findings may be limited by self selection and additional research is needed to confirm and extend the current findings.

BACKGROUND In recent years, we have investigated both patients' and family doctors' communicative characteristics towards nutrition communication in general practice with several qualitative and quantitative studies. A sound comparison of the survey results between both conversation partners has not been made before. OBJECTIVE The aim of the present study was to put together data obtained by earlier studies for the first time in order to make comparisons of patients' and family doctors' communicative characteristics regarding nutrition communication. METHODS In The Netherlands, 603 patients completed a face-to-face interview-assisted questionnaire (65% response rate) and 267 family doctors completed a questionnaire (45% response rate). RESULTS When comparing communicative characteristics, patients stronger believed that nutrition was an influence on health than family doctors. They also attributed a greater role to personal hygiene, stress and heredity, while family doctors were more convinced of the role of alcohol use and smoking on health. Patients more often rated their own nutrition knowledge as good than family doctors. In contrast, family doctors showed higher interest in nutrition and nutrition information than patients. As a result, a collinear model for family doctors and nutrition communication towards patients was provided. CONCLUSIONS Significant differences between patients and family doctors were found for several communicative characteristics towards nutrition communication. It is important that family doctors become convinced that patients perceive them as a reliable and expert source of nutrition information. It is recommended that family doctors raise nutrition awareness among patients. Finally, we advise family doctors to pay attention to nutrition communication styles.

This study explored whether social contacts are an underlying mechanism behind the relationship between green space and health. We measured social contacts and health in 10,089 residents of the Netherlands and calculated the percentage of green within 1 and a 3 km radius around the postal code coordinates for each individual's address. After adjustment for socio-economic and demographic characteristics, less green space in people's living environment coincided with feelings of loneliness and with perceived shortage of social support. Loneliness and perceived shortage of social support partly mediated the relation between green space and health.

OBJECTIVES:To unravel the concept of nutrition awareness, as it relates to risky personal nutrition-related behaviours, and to assess the sociodemographic and psychosocial correlates of nutrition awareness.DESIGN:Data were collected in a cross-sectional study with the aid of a face-to-face interview-assisted questionnaire that was based on the Precaution Adoption Process Model and Stages of Change Model.SETTING:Dutch consumer homes.SUBJECTS:Six hundred and three Dutch adults aged 18 to 80 years, selected from a panel.RESULTS:Our model explains nutrition awareness well (explained variance 53.7%). Psychosocial correlates were involvement with nutrition, health awareness, association with healthy food, perceived relevance of eating less fat, association with necessity, perceived relevance of vitamins, and perceived attributes of independent organisations. Sociodemographic correlates were gender and age. The relationship between nutrition awareness and nutrition-related behaviours proved to be very complicated.CONCLUSIONS:The value of our study is that it unravels the concept of nutrition awareness. Understanding the correlates of nutrition awareness can contribute to a more effective application of behavioural change models. Our results support increasing involvement with nutrition through personalising and tailoring to the motivational stage.

Van Dillen SME. Huisartsen merken behoefte aan deskundig voedingsadvies van hun patiënten vaak niet op. Huisarts Wet 2007;50(4):155-8.

General practitioners (GPs) are frequently confronted with patients who suffer from obesity or other nutritionrelated diseases, such as diabetes and coronary heart disease. There is increasing evidence that nutrition communication is effective in changing nutrition behaviour. Moreover, it is widely argued that GPs are ideally placed to provide nutrition information.The aim of this review is to provide an overview of the state of the art regarding nutrition communication in general practice.First, an overview of the occurrence of nutrition communication in general practice is provided. Next, it is established that patients' perceptions regarding nutrition communication are positive. Although there are many opportunities for nutrition communication in general practice, these opportunities are often not taken up. Even though GPs' perceptions regarding nutrition communication were positive, they also perceive barriers, like lack of time and patient non-compliance.For more effective nutrition communication between GPs and patients, GPs' perceived barriers should be overcome and GPs' self-efficacy should be strengthened. Moreover, we recommend that GPs adapt their nutrition communication style, dependent of the specific circumstances.

OBJECTIVE:The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables. METHODS:Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST. RESULTS:Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses. CONCLUSION:The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted. PRACTICE IMPLICATIONS:We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.