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Weinehall, Lars
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Publications (10 of 159) Show all publications
Sorensen, J., Johansson, H., Jerdén, L., Dalton, J., Sheikh, H., Jenkins, P., . . . Weinehall, L. (2019). Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State. HEALTH SERVICES RESEARCH AND MANAGERIAL EPIDEMIOLOGY, 6, Article ID UNSP 2333392819862122.
Open this publication in new window or tab >>Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State
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2019 (English)In: HEALTH SERVICES RESEARCH AND MANAGERIAL EPIDEMIOLOGY, ISSN 2333-3928, Vol. 6, article id UNSP 2333392819862122Article in journal (Refereed) Published
Abstract [en]

Introduction: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. Methods: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. Results: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. Conclusions: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2019
Keywords
primary prevention, health-care guidelines, behavioral counseling, hospital administrators
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-162329 (URN)10.1177/2333392819862122 (DOI)000477857600001 ()31384624 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-22Bibliographically approved
Tinc, P. J., Jenkins, P., Sorensen, J. A., Weinehall, L., Gadomski, A. & Lindvall, K. (2019). Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research. Scandinavian Journal of Work, Environment and Health
Open this publication in new window or tab >>Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research
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2019 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes.

Methods: Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes.

Results: Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating.

Conclusions: The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.

Keywords
agriculture, consolidated framework for implementation research, correlation analysis, factor, implementation, National Rollover Protection Structure Rebate Program, occupational safety, rollover, safety, scale-up, stakeholder engagement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-162438 (URN)10.5271/sjweh.3844 (DOI)31365746 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-26
Jerdén, L. & Weinehall, L. (2019). Läkaren har en nyckelroll i vårdarbetet med levnadsvanor. Läkartidningen, 116, Article ID FF4S.
Open this publication in new window or tab >>Läkaren har en nyckelroll i vårdarbetet med levnadsvanor
2019 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FF4SArticle in journal, Editorial material (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Ohälsosamma levnadsvanor är vanliga i befolkningen. Hälften av alla kvinnor och två tredjedelar av männen har minst en ohälsosam levnadsvana. Tobaksbruk, riskbruk av alkohol, ohälsosamma matvanor eller otillräcklig fysisk aktivitet utgör viktiga riskfaktorer för många av våra stora folksjukdomar som hjärt–kärlsjukdom, cancer och typ 2-diabetes. Tillsammans bidrar dessa levnadsvanor till cirka en femtedel av den samlade sjukdomsbördan i Sverige.

I juni 2018 presenterade Socialstyrelsen »Nationella riktlinjer för prevention och behandling vid ohälsosamma levnadsvanor« [1]. Riktlinjerna omfattar åtgärder för att stödja personer att förändra levnadsvanor i syfte att förbättra hälsa samt förebygga och behandla sjukdom.

Abstract [en]

Updated Swedish National Guidelines on prevention and lifestyle habits: physicians' role

The recently updated Swedish National Guidelines on prevention and lifestyle habits (tobacco use, hazardous use of alcohol, insufficient physical activity and unhealthy eating habits) emphasize the importance of supporting lifestyle changes among risk individuals, such as already affected by disease, carriers of risk factors that increase the risk of disease, and people with social vulnerability. More measures targeting youth are included, as well as measures to avoid smoking and alcohol use prior to surgery. Physicians have a key role in implementation of the new guidelines, as a great majority of patients who attend healthcare and discuss lifestyle habits do so with a physician.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158201 (URN)30667514 (PubMedID)2-s2.0-85060249006 (Scopus ID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-17Bibliographically approved
Scribani, M., Norberg, M., Lindvall, K., Weinehall, L., Sorensen, J. & Jenkins, P. (2019). Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden. Global Health Action, 12(1), Article ID 1580973.
Open this publication in new window or tab >>Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1580973Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.

OBJECTIVE: To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.

METHODS: Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m2 (reference), 25-29.9 kg/m2, 30.0-34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.

RESULTS: 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).

CONCLUSIONS: This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.

Keywords
Obesity, all-cause mortality, circulatory disease mortality, longitudinal studies, premature mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158199 (URN)10.1080/16549716.2019.1580973 (DOI)000463650600001 ()30947624 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-05-23Bibliographically approved
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
Lindholm, L., Stenling, A., Norberg, M., Stenlund, H. & Weinehall, L. (2018). A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort. BMC Public Health, 18, Article ID 452.
Open this publication in new window or tab >>A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort
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2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 452Article in journal (Refereed) Published
Abstract [en]

Background: Several large scale community-based cardiovascular disease prevention programs were initiated in the 80s, and one was the Västerbotten Intervention Programme, Sweden. As an initial step in 1985, a pilot study was introduced in the Norsjö municipality that combined individual disease prevention efforts among the middle-aged population with community-oriented health promotion activities. All citizens at 30, 40, 50, and 60 years of age were invited to a physical examination combined with a healthy dialogue at the local primary health care centre. Västerbotten Intervention Program is still running following the same lines and is now a part of the ordinary public health in the county. The purpose of this study is to estimate the costs of running Västerbotten Intervention Programme from 1990 to 2006, versus the health gains and savings reasonably attributable to the program during the same time period. Methods: A previous study estimated the number of prevented deaths during the period 1990-2006 which can be attributed to the programme. We used this estimate and calculated the number of QALYs gained, as well as savings in resources due to prevented non-fatal cases during the time period 1990 to 2006. Costs for the programmes were based on previously published scientific articles as well as current cost data from the county council, who is responsible for the programme. Result: The cost per QALY gained from a societal perspective is SEK 650 (Euro 68). From a health care sector perspective, the savings attributable to the VIP exceeded its costs. Conclusion: Our analysis shows that Västerbotten Intervention Programme is extremely cost-effective in relation to the Swedish threshold value (SEK 500000 per QALY gained or Euro 53,000 per QALY gained). Other research has also shown a favorable effect of Västerbotten Intervention Programme on population health and the health gap. We therefore argue that all health care organizations, acting in settings reasonably similar to Sweden, have good incentive to implement programs like Västerbotten Intervention Programme.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Prevention, Community-based, Cost-effectiveness
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147306 (URN)10.1186/s12889-018-5339-3 (DOI)000429848700006 ()29618323 (PubMedID)
Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2018-08-21Bibliographically approved
Tinc, P. J., Gadomski, A., Sorensen, J. A., Weinehall, L., Jenkins, P. & Lindvall, K. (2018). Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review. American Journal of Industrial Medicine, 61(1), 51-62
Open this publication in new window or tab >>Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review
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2018 (English)In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 61, no 1, p. 51-62Article, review/survey (Refereed) Published
Abstract [en]

Background: Despite much research to develop life-saving innovations for the agriculture, forestry, and fishing workforce, these populations continue to face the highest fatal and non-fatal injury rates in the United States, as many of these solutions are not fully adopted.

Methods: A scoping review was conducted to provide an overview of research to practice efforts in this field. The language used to describe these initiatives, the utility of the NIH T0-T4 model, and the progress along the research to practice continuum were examined.

Results: Fourteen eligible references demonstrated that progress in implementation science is lacking and that there is little consistency in how researchers apply the T0-T4 model; thus, a new model is presented.

Conclusions: Researchers in this field face several challenges when moving from research to practice. While some challenges are addressed with the proposed model, additional resources and infrastructure to support such initiatives are necessary.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
diffusion, dissemination, implementation, occupational health and safety, research to practice, research translation, T0-T4, widespread adoption
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-143631 (URN)10.1002/ajim.22787 (DOI)000418124000006 ()29114898 (PubMedID)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2018-06-09Bibliographically approved
Tinc, P. J., Gadomski, A., Sorensen, J. A., Weinehall, L., Jenkins, P. & Lindvall, K. (2018). Applying the Consolidated Framework for implementation research to agricultural safety and health: Barriers, facilitators, and evaluation opportunities. Safety Science, 107, 99-108
Open this publication in new window or tab >>Applying the Consolidated Framework for implementation research to agricultural safety and health: Barriers, facilitators, and evaluation opportunities
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2018 (English)In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 107, p. 99-108Article in journal (Refereed) Published
Abstract [en]

Objectives: Within agriculture, forestry, and fishing safety and health research, little progress has been made to implement evidence-based interventions into practice. Beginning in the early 2000s, much work has been done to address the leading cause of agricultural fatalities: tractor overturns. In this time a Rollover Protective Structure Rebate Program has been developed to assist farmers in installing safety equipment to prevent these fatalities. In the current study, the Consolidated Framework for Implementation Research is adapted so that it may be used to evaluate and improve the scaling up of this intervention. Methods: Each construct specified in the Consolidated Framework for Implementation Research was incorporated into a survey, which was distributed to a 77 member Coalition of agricultural stakeholders. Stakeholders were asked to rate each construct based on how important the individual felt it was to the implementation of the National ROPS Rebate Program on a scale of 1 (not at all important) to 5 (extremely important). Results: Using the mean score for each construct as a starting point, 23 constructs were selected for inclusion in an evaluation tool which will be used, in future studies, to evaluate the implementation of the National ROPS Rebate Program. Conclusions: Though the Consolidated Framework for Implementation Research was designed for use in the clinical setting, this study is a first step in applying it to occupational health and safety. The insight gained through this study will provide a foundation for future work on this initiative, as well as in public health.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Research translation, Implementation science, Widespread implementation, Evaluation
National Category
Construction Management
Identifiers
urn:nbn:se:umu:diva-148705 (URN)10.1016/j.ssci.2018.04.008 (DOI)000432767800010 ()2-s2.0-85046366505 (Scopus ID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2019-04-24Bibliographically approved
Kardakis, T., Jerdén, L., Nyström, M. E., Weinehall, L. & Johansson, H. (2018). Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare: a two-year follow up. BMC Health Services Research, 18, Article ID 227.
Open this publication in new window or tab >>Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare: a two-year follow up
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 227Article in journal (Refereed) Published
Abstract [en]

Background: Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients' unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods: Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results: Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients' tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions: Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients' lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses' attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians' uptake and use of the CPGs.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Implementation, Lifestyle, Clinical practice guidelines, Primary health care, Preventive health services, alth promotion, Smoking, Counselling
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147310 (URN)10.1186/s12913-018-3023-z (DOI)000428883500004 ()29606110 (PubMedID)
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2018-06-09Bibliographically approved
Jerdén, L., Dalton, J., Johansson, H., Sorensen, J., Jenkins, P. & Weinehall, L. (2018). Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients' expectations and experiences. Global Health Action, 11(1), Article ID 1438238.
Open this publication in new window or tab >>Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients' expectations and experiences
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2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1438238Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Sweden, USA, alcohol drinking, counseling, health behavior, health promotion, lifestyle, prevention, primary health care, smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145657 (URN)10.1080/16549716.2018.1438238 (DOI)000427795600001 ()29495947 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
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