Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese

Research Article

Survey of Australian practitioners’ provision of healthylifestyle advice to clients who are obesenhs_677 1..8

Samantha Ashby, mapp.sci, bsc(hons), dipcot, pgcert teaching and learning,1

Carole James, mhsc(ot), bsc(ot), dipcot, phd,1,3 Ronald Plotnikoff, ba, medustudies, phd,2,3

Clare Collins, bsc; pg dip nutrition & dietetics; pg dip clinical epidemiology; phd,1,3

Maya Guest, bohs, bmedsci(hons), pgcert teaching and learning,1,3

Ashley Kable, rn, dip teach nursing education, grad dip health service management, phd1 andSuzanne Snodgrass, bsc, atc, mmedss(physio), phd1,3

1Faculty of Health, 2Faculty of Education & Arts and 3Priority Research Centre for Physical Activity and Nutrition,University of Newcastle, Newcastle, NSW, Australia

Abstract Obesity is a global issue, with healthcare practitioners increasingly involved in clinical interactions with peoplewho are overweight or obese. These interactions are opportunities to provide evidence-based healthy lifestyleadvice, and impact on public health. This study used a cross-sectional survey of Australian healthcare practi-tioners to investigate what influenced the provision of healthy lifestyle advice to obese and overweight clients.A modified theory of planned behavior was used to explore knowledge translation processes. Knowledgetranslation was linked to three factors: (i) a healthcare practitioner’s education and confidence in the currencyof their knowledge; (ii) personal characteristics – whether they accepted that providing this advice was withintheir domain of practice; and (iii) the existence of organizational support structures, such as access toeducation, and best practice guidelines. To fulfill the potential role healthcare practitioners can play in theprovision of evidence-based health promotion advice requires organizations to provide access to practiceguidelines and to instill a belief in their workforce that this is a shared professional domain.

Key words Australia, education, health promotion, healthcare practitioners, knowledge translation, policy.

INTRODUCTION

This paper presents the findings of the first study with Aus-tralian health practitioners to investigate what impacts onthe translation of knowledge of healthy lifestyle advice intotheir practice. The study uses the modified theory of plannedbehavior (TPB) framework (Godin et al., 2008) to examinehow a health practitioner’s knowledge and provision ofhealthy lifestyle advice, including weight management inter-ventions, is translated into practice. In addition, it examinespractitioners’ perceptions of factors that impact upon theirbehavior, and identifies the factors that determine self-reported behavior. Thus, the paper aims to explore the edu-cational and personal factors that are associated with, orperceived to impact on, the practitioner’s health promotionactions and behaviors in the provision of weight managementadvice to obese and overweight clients.

The findings of this study build upon the work of others,such as Tse and Benzie (2004), who identified that practitio-ners, “through their close and direct contact with clients are

able to disseminate and reinforce the message of health pro-motions into evidence based practice for disease promotion”(p. 309). It is proposed that the use of the modified TPB offersa broader perspective of the factors involved.The conceptualframework developed by Godin and colleagues is based onthe TPB (Fig. 1) (Godin et al., 2008). This framework assistsresearchers to identify the factors that influence practitio-ners’ behaviors in clinical situations. This conceptual frame-work modified Azjen’s (1991) original ideas. Godin et al.(2008) identify factors about the characteristics of the healthpractitioner, which include educational background and dis-cipline, beliefs about the consequences of clinical practice,social influences (policy environment and practice contexts),moral norms for the individual, and the role and identity ofthe individual within their discipline. Additional factors con-sidered in Godin et al.’s (2008) framework are the practitio-ner’s beliefs about their capability in the application of newknowledge, and their past habit/past behavior. These factorssubsequently influence the intention to change behavior.

Literature review

Each health profession has unique characteristics, whichinclude their codified knowledge, and domains of practice

Correspondence address: Samantha Ashby, Faculty of Health, School of HealthSciences, University of Newcastle, Hunter Building, University Drive, Callaghan,NSW 2308, Australia. Email: [email protected] 23 September 2011; accepted 28 December 2011.

Nursing and Health Sciences (2012), ••, ••–••

© 2012 Blackwell Publishing Asia Pty Ltd doi: 10.1111/j.1442-2018.2012.00677.x

(Smeby, 2007). This knowledge includes the discipline-basedtheories and concepts that are integrated with practical,process, and procedural knowledge, and further influenced byimpressions, interpretations, and experiences to create prac-tice knowledge (Martirosyan et al., 2010). Within health care,professional domains are the recognized scopes of practicethat define and determine the specialized areas of interven-tion for a profession (Skjørshammer, 2002). Increasingly, inhealth and social care, practitioners are expected to workoutside of their professional domains and engage in shareddomains, such as health promotion (Tse & Benzie, 2004;Scaffa et al., 2008; Margalit et al., 2009; Calderon et al., 2011).Their practical actions are likely to be influenced by whetherthey consider health promotion to be within their scope ofpractice, and if they have current knowledge about healthpromotional advice (Al-Kandari et al., 2008).

Internationally, the need to provide healthy lifestyle adviceis required to grow to match the substantial increase in theprevalence of overweight and obesity over the past decade(Cornelissen et al., 2011). Obesity is classified by a body massindex (BMI) of 30 or more, established by dividing weight inkilograms by squared height in meters (World Health Orga-nization, 2000). There have been calls for policies and inter-ventions to address the adverse health effects associated witha high BMI (Brown & Velmahos, 2006). Within Australia, thenumber of adults classified as overweight or obese has risenfrom 56.3% in 1995 to 61.4% in 2007–2008 (Australian Insti-tute of Health and Welfare, 2008;Australian Bureau of Statis-tics,2009).This issue is one of the national health priority areasin Australia (Australian Institute of Health and Welfare, 2010)and in policy development internationally. However, littleattention is given to the feasibility of integrating this intohealthcare practice, or how to provide these interventions(Grandes et al.,2008;Calderon et al.,2011).While the majorityof weight loss interventions are provided by dietitians andgeneral practitioners (GPs), other practitioners are involvedin clinical interactions with people who are overweight orobese. During these interactions, practitioners are often in a

position where they could provide evidence-based healthylifestyle advice as part of client management, with the aim tocommence treatment early to reduce the number of clientswho are overweight and obese (Dean, 2009a,b).

Previous studies indicated that practitioners consider theprovision of weight loss advice to overweight and obeseclients to be an important component of client management.It has also been shown that practitioners benefit from addi-tional training to improve skills and confidence in providinghealthy lifestyle advice (Rea et al., 2004). However, little isknown about the current practice knowledge of healthy lif-estyle advice of practitioners, or what influences its transla-tion into the practical actions during clinical interactions.

Study purpose

The present study explored the educational and personalfactors that influence a practitioner’s actions in the provisionof health promotion education for clients who are obese oroverweight.

METHODS

Design

This study used a cross-sectional survey of practitioners whoworked within public and private health facilities in aregional area of New South Wales, Australia. This regionalarea services a population of over 650,000 people (AustralianBureau of Statistics, 2010).

Participants

Convenience sampling was used to recruit potential practi-tioners. Recruitment was stratified to represent practitionersfrom seven major disciplines that might provide healthy lif-estyle advice as part of their client care: dietitians, exercisephysiologists, nurses and occupational health nurses, occupa-tional therapists, physiotherapists, and psychologists.

Practitioners were contacted using either postal mail oremail, depending on the public availability of the types ofcontact details. In addition, department heads distributed thestudy package in the public sector, and community nurseswere contacted via a local community nurses’ group.

Prior to commencement, an announcement publicized thestudy. Following this, a study package, including an invitationto participate; an information statement; a questionnaire; anda pre-addressed, reply-paid envelope was sent. Four weekslater, a thank you/reminder postcard was sent to all potentialparticipants. Consenting participants anonymously com-pleted the questionnaire, either on the internet or on paper,and returned the latter by mail.

Ethical considerations

Ethical approval for the study was provided by Hunter NewEngland Health Area Human Research Ethics Committeeand the University of Newcastle Human Research EthicsCommittee. Participation in the study was voluntary, and the

Figure 1. Hypothesized theoretical framework for the study ofhealthcare professionals’ behaviors and intentions. (Reproducedfrom Godin et al., 2008 with permission.).

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© 2012 Blackwell Publishing Asia Pty Ltd

return of the survey was considered informed consent. Thesurvey was anonymous, and thus respondents’ anonymity waspreserved at all stages of the data collection and analysis.

Data collection

A study-specific questionnaire was developed based onpreviously-published studies on providing healthy lifestyleadvice (The Counterweight Project Team, 2004; Scaffa et al.,2008; Sack et al., 2009). The questionnaire included 50 ques-tions about general demographics and workplace informa-tion, level of education, nutritional knowledge, confidence inproviding healthy lifestyle advice, attitudes towards obesity,and healthy lifestyle advice currently provided for overweightclients.The face and content validity of the questionnaire wasestablished using focus group methodology, with an expertpanel of nine academics and practitioners who providedadvice on the structure and content of the questionnaire.

Data analysis

The responses in the survey were analyzed using descriptivestatistics. The statistical analysis package, STATA (version11.1; StataCorp, College Station, TX, USA), was used for theanalysis. The core components of the modified TPB wereused to evaluate the influence of health education on practi-tioners’ intent and behavior to provide clients with healthylifestyle advice.

RESULTS

Factors relating to the health practitioners’personal characteristics

A total of 1093 questionnaires were sent, with a responserate of 17.3%. Differences in the number of responses

between the different health professions are indicative ofrepresentations in practice, with a higher number of nursingstaff employed than allied practitioners (Australian Insti-tute of Health and Welfare, 2008). Of the 259 practitionerswho responded to this survey, most were female; half hadpostgraduate qualifications, and worked across a range ofpractice areas: 40% in major regional cities, and 60% inregional and rural areas. Table 1 outlines this demographicinformation, and provides details of the characteristics ofthe practitioners.

Twenty-nine percent of respondents indicated theyhad received initial training in weight management. Theseincluded 100% (n = 36) of dietitians, 26% (n = 19) of phy-siotherapists, 22% (n = 17) of nurses, and 8% (n = 4) ofoccupational therapists, but no psychologists. Continuingprofessional development training in weight managementhad been received by 26% of respondents, comprising 83%(n = 30) of dietitians, 19% (n = 14) of physiotherapists, 19%(n = 4) of psychologists, 18% (n = 14) of nurses, and 14%(n = 7) of occupational therapists. Practitioners reportedthat they sourced information on weight management froma variety of places, including pharmaceutical companies(31.8%) and textbooks (19.2%) (Table 2).

Beliefs about their capability to provide healthlifestyle advice to clients

The respondents reported on their current knowledge abouthealthy lifestyles and how this was translated into serviceprovision (n = 233). Dieticians were the most confident pro-fession in all aspects of healthy lifestyle advice, with 92%reporting they had a high or very high level of knowledge ofthis topic. Those respondents from other professions had lessconfidence in their capabilities to provide healthy lifestyleadvice (Table 3).

Table 1. Characteristics of healthcare practitioners

DietitianPhysiotherapist &

exercise physiologistOccupational

therapist Nurse Psychologist TotalN = 36 N = 72 N = 51 N = 79 N = 21 N = 259†

Sex Male 2 (5.6%) 30 (41.7%) 5 (9.8%) 7 (8.9%) 4 (19%) 48 (18.5%)Female 34 (94.4%) 42 (58.3%) 46 (90.2%) 72 (91.1%) 17 (81%) 211 (81.5%)

Qualification Entry level 21 (58.3%) 47 (65.3%) 42 (82.4%) 16 (20.5%) 4 (19%) 130 (51%)Postgraduate 15 (41.7%) 25 (34.7%) 9 (17.6%) 62 (79.5%) 17 (81%) 128 (50%)

Area ofpractice

Aged/community 15 (41.7%) 2 (2.8%) 16 (31.4%) 35 (44.3%) 13 (61.9%) 81 (31.3%)Rehabilitation centre 0 4 (5.6%) 7 (13.7%) 1 (1.3%) 1 (4.8%) 13 (5%)Public hospital 10 (27.8%) 27 (37.5%) 18 (35.3%) 32 (40.5%) 3 (14.3%) 90 (34.7%)Private hospital 11 (30.6%) 37 (51.4%) 5 (9.8%) 3 (3.8%) 2 (9.5%) 58 (22.4%)Industry/mental

health/other0 2 (2.8%) 5 (9.8%) 8 (10.1%) 2 (9.5%) 17 (6.6%)

Remotenesscategory

Major city 10 (27.8%) 37 (51.4%) 22 (43.1%) 16 (20.3%) 13 (61.9%) 98 (37.8%)Inner regional 7 (19.4%) 6 (8.3%) 11 (21.6%) 15 (19%) 3 (14.3%) 42 (16.2%)Outer regional 16 (44.4%) 23 (31.9%) 15 (29.4%) 38 (48.1%) 5 (23.8%) 97 (37.5%)Remote 3 (8.3%) 3 (4.2%) 2 (3.9%) 9 (11.4%) 0 17 (6.6%)

†Not all questions were answered by the health professional respondents.

Provision of healthy lifestyle advice 3


Intention to provide healthy lifestyle advice

Seventy-one percent of respondents considered the provisionof healthy lifestyle advice to be within their professionalroles. The acknowledgment of this role ranged across theprofessions, from 95% (n = 34) of dietitians, 83% (n = 60) ofphysiotherapists, 61% (n = 53) of nurses, 60% (n = 12) of psy-chologists, to 47% (n = 23) of occupational therapists. Never-theless, only 62% of respondents indicated that they hadtranslated this acceptance into their practice by providinghealthy lifestyle advice to clients. The motivation to provide

healthy lifestyle advice varied across professional groups.Those most motivated were dietitians, 89% (n = 32), followedby 76% (n = 50) of nurses, 70% (n = 48) of physiotherapists,65% (n = 11) of psychologists, and 45% (n = 20) of occupa-tional therapists.

Engaging in the provision of healthy lifestyle advice

The translation of existing knowledge of healthy lifestyleadvice into practical actions (behavior) included, in order ofpreference, the provision of advice on diet, energy balance,

Table 2. Current behaviors – where do healthcare practitioners source weight management information?


exercise physiologistOccupational


Magazines 0 2 (4.5%) 0 1 (5.9%) 2 (28.6%) 5 (4.7%)Diet books 0 1 (2.3%) 1 (4.2%) 1 (5.9%) 0 3 (2.9%)Colleagues 0 0 1 (4.2%) 2 (11.1%) 0 3 (2.9%)Internet 1 (6.3%) 4 (8.7%) 3 (11.5%) 7 (30.4%) 1 (16.7%) 16 (13.7%)Intranet 1 (6.3%) 4 (8.7%) 6 (20.7%) 9 (36%) 2 (28.6%) 22 (17.9%)Professional journals 0 1 (2.3%) 1 (4.2%) 6 (27.3%) 0 8 (7.3%)Textbooks 4 (21.1%) 7 (14.3%) 4 (14.8%) 7 (30.4%) 2 (28.6%) 24 (19.2%)Seminars/conferences 1 (6.3%) 1 (2.3%) 0 2 (11.1%) 1 (16.7%) 5 (4.7%)Pharmaceutical companies 13 (46.4%) 7 (14.3%) 8 (25.8%) 16 (50%) 3 (37.5%) 47 (31.8%)Healthcare professionals as

recipients of care0 0 0 2 (11.1%) 1 (16.7%) 3 (2.9%)

Other 1 (6.3%) 3 (6.7%) 4 (14.8%) 10 (38.5%) 4 (44.4%) 22 (17.9%)


Table 3. Practitioners’ beliefs about capabilities in providing weight management advice

Dietitian

Physiotherapist& exercise

physiologistOccupational


Knowledge level No/low 3 (8.3%) 50 (73.5%) 42 (95.5%) 48 (70.5%) 13 (76.5%) 156 (66.9%)High/very high 33 (91.7%) 18 (26.5%) 2 (4.5%) 20 (29.4%) 4 (23.5%) 77 (33.1%)

Importance of dietaryadvice

Not/somewhat important 0 10 (14.7%) 13 (31.7%) 38 (56.4%) 7 (43.8%) 68 (30%)Confident/very important 35 (100%) 58 (85.3%) 28 (68.3%) 29 (43.3%) 9 (56.3%) 159 (70%)

Confidence in discussingweight

Not/somewhat confident 2 (5.7%) 21 (30.9%) 27 (62.8%) 32 (47.7%) 8 (47.1%) 90 (39.2%)Confident/very confident 33 (94.3%) 47 (69.2%) 16 (37.2%) 35 (52.2%) 9 (53%) 140 (60.8%)

Confidence in settingweight loss goals

Not/somewhat confident 3 (8.6%) 44 (64.7%) 37 (88%) 51 (76.1%) 14 (82.4%) 149 (65%)Confident/very confident 33 (91.4%) 24 (35.3%) 5 (11.9%) 16 (23.9%) 3 (17.7%) 81 (34.9%)

Confidence in assessingdietary intake

Not/somewhat confident 0 59 (89.4%) 41 (97.6%) 52 (77.6%) 15 (88.2%) 167 (73.6%)Confident/very confident 35 (100%) 7 (10.6%) 1 (2.4%) 15 (22.4%) 2 (11.8%) 60 (26.4%)

Confidence inmaking dietaryrecommendations

Not/somewhat confident 0 51 (77.3%) 41 (95.4%) 51 (76.1%) 16 (94.1%) 159 (69.8%)

Confident/very confident 35 (100%) 15 (22.7%) 2 (4.7%) 16 (23.9%) 1 (5.9%) 69 (30.3%)

Confidence in assessingphysical activityparticipation

Not/somewhat confident 11 (32.4%) 7 (10.3%) 29 (69.1%) 47 (70.1%) 14 (82.4%) 108 (47.4%)

Confident/very confident 23 (67.7%) 61 (89.8%) 13 (31%) 20 (29.9%) 3 (17.6%) 120 (52.6%)

Confidence in makingphysical activityrecommendations

Not/somewhat confident 16 (45.7%) 7 (10.3%) 33 (78.6%) 45 (67.1%) 12 (70.6%) 113 (49.3%)

Confident/very confident 19 (54.3%) 61 (89.8%) 9 (21.4%) 22 (32.9%) 5 (29.4%) 116 (50.6%)


4 S. Ashby et al.


portion control, exercise, and alcohol (Tables 4,5). A limitednumber of respondents used evidence-based, specific nutri-tion messages (9%, n = 23), dietary guidelines (5%, n = 13),or food guide messages (3%, n = 8) to provide advice toclients who were overweight or obese. Only 8% of respon-dents identified that they used group or individual sessions toprovide relevant advice. Rather than implementing serviceswithin their role, 20% of practitioners referred to otherappropriate weight management services.

DISCUSSION

The findings from this cross-sectional survey of Australianpractitioners identified the connection between knowledgetranslation of healthy lifestyle advice and three factors: (i) apractitioner’s education and confidence in the currency oftheir knowledge; (ii) personal characteristics – whether theyaccepted that providing this advice was within their domainof practice; and (iii) the existence of organizational support

Table 4. Practitioners’ self-reported behaviors in relation to weight management advice provided


exercise physiologistsOccupational


Referral to appropriateservice

1 (3.3%) 10 (18.9%) 7 (31.8%) 15 (30%) 1 (8.3%) 34 (20.4%)

Individual/group sessions 4 (13.3%) 0 2 (9.1%) 4 (8%) 3 (25%) 13 (7.8%)Provide dietary advice 32 (100%) 32 (46%) 10 (21%) 55 (73%) 8 (42%) 141 (57%)Use dietary guidelines 5 (14%) 2 (3%) 1 (2%) 4 (5%) 1 (5%) 13 (5%)Provide advice on

appropriate exercise5 (14%) 8 (11%) 3 (6%) 8 (10%) 1 (5%) 25 (10%)

Provide advice on reducingalcohol

2 (6%) 1 (1.5%) 0 2 (2.5%) 0 5 (2%)

Provide advice on energybalance/portion control

14 (39%) 11 (15%) 3 (6%) 9 (11%) 1 (5%) 38 (15%)

Use of food pyramidmessages

0 4 (6%) 2 (4%) 1 (1%) 1 (5%) 8 (3%)

Specific nutrition message(e.g. low salt, low fat)

5 (14%) 4 (6%) 1 (2%) 12 (15%) 1 (5%) 23 (9%)


Table 5. Healthcare professionals’ practice settings and behaviors

Agedcommunity/home

Rehabilitationcentre

Publichospital

Privatehospital

Industry/mentalhealth/other Total c2

N = 76 N = 12 N = 88 N = 57 N = 15 N = 248 P-value

Referral to appropriate service 5 (6.2%) 2 (15.4%) 5 (5.6%) 7 (12.1%) 1 (5.9%) 20 (7.7%) 25.43P = 0.18

Provide dietary advice 46 (60.5%) 7 (58%) 43 (49%) 35 (61%) 10 (67%) 141 (57%) 3.78P = 0.43

Tailored to suit the individual 1 (1.2%) 0 5 (5.6%) 4 (6.9%) 0 10 (3.9%) 4.85P = 0.3

Use dietary guidelines 6 (7.4%) 0 4 (4.4%) 3 (5.2%) 0 13 (5%) 2.62P = 0.62

Provide advice on appropriateexercise

10 (12.3%) 2 (15.4%) 4 (4.4%) 8 (13.8%) 1 (5.9%) 25 (9.7%) 5.38P = 0.25

Provide advice on reducingalcohol

1 (1.2%) 0 1 (1.1%) 3 (5.2%) 0 5 (1.9%) 4.34P = 0.36

Provide advice on energybalance/portion control

12 (14.8%) 3 (23.1%) 9 (10%) 13 (22.4%) 1 (5.9%) 38 (14.7%) 6.13P = 0.19

Use of food pyramid messages 0 0 5 (5.6%) 1 (1.7%) 2 (11.8%) 8 (3.1%) 9.46P = 0.05

Specific nutrition message (e.g.low salt, low fat)

11 (13.6%) 1 (7.7%) 7 (7.8%) 2 (3.4%) 2 (11.8%) 23 (8.9%) 4.66P = 0.32



structures, such as access to education, and best practiceguidelines. These factors are discussed with reference to thecore constructs of the modified TPB framework Godin et al.(2008): intent and behavior.

Factors relating to the health practitioner’spersonal characteristics

The present study found that knowledge translation ofhealthy lifestyle advice into practice was affected by a prac-titioner’s personal characteristics (Godin et al., 2008). It con-firms that professional identity and scope of practice aredeterminants in clinical behaviors (Zwarenstein & Reeves,2006), with behavior determined by the perception of profes-sional “social norms”. The results indicated that it was apractitioner’s belief and acceptance that this role was withintheir professional boundary and domain (Skjørshammer,2002) that influenced their decision to provide advice toclients. This decision was not affected by their geographiclocation, sex, education level, or practice setting. Conversely,those who did not consider interprofessional health promo-tion to be within their role, and scope of practice, wereunlikely to provide this information. Yet within each of theseven professions, there were individual practitioners whoconsidered healthy lifestyle advice to be within their scope ofpractice, but did not translate their intent into practicalactions.

Strong perceptions of other practitioners’ roles appearedto result in demarcations or divisions of roles and dutiesamong these Australian practitioners, with advice on healthylifestyle considered to be mostly in the professional domainsof dietitians and GP services. These demarcations are oftenreferred to as professional silos, and are known to createbarriers to seamless services for clients (Conway, 1997;Margalit et al., 2009). The present study identified that per-ceptions of professional silos are a factor in whether existingknowledge is translated into a practitioner’s practical actions,with each profession reporting a specific interest, such asphysiotherapists focus on the need to exercise, and occupa-tional therapists focus on the need to engage in activitywithin daily routines.

While discipline-specific roles are important within healthorganizations, clarity of roles and expectations on practitio-ners to provide healthy lifestyle advice, guided by organiza-tional policy, might reduce the risk of role blurring or a lackof interventions, due to the belief that it falls within another’sdomain (Conway, 1997).

Beliefs about their capability to provide healthlifestyle advice to clients

The practitioners’ belief in their capability to provide healthylifestyle advice was a factor in their practical actions. Itappears that more targeted education programs to providepractitioners with current knowledge on this subject couldlead to a change in their behavior. As noted in the results,members of all the professional disciplines surveyed consid-ered healthy lifestyle advice to be within their scope of prac-

tice; however, dietitians, nurses, and psychologists were theprofessions most likely to report that they provided healthylifestyle advice to clients, and regard this as their role (Tse &Benzie, 2004). This was despite psychologists reporting noentry-level education or continuing professional develop-ment training in healthy lifestyle advice.

For dietitians, their role and professional identity led toconfidence that the provision of weight management advicewas within their professional domain. In addition, our studyreinforces that they were confident in their knowledge base;the information and skill development was included in theirentry-level programs, and the majority had sought furthertraining in weight management (Cochrane et al., 2007). Forthis professional group, further education appeared toenhance their clinical repertoire (Collins, 2003). Given thatdietitians have evidence-based guidelines for weight manage-ment in adults (National Health & Medical ResearchCouncil, 2003), they are likely to have integrated evidence-based practice into their clinical interventions as a matter ofcourse (Cornelissen et al., 2011). For the other disciplineswith practitioners unwilling to engage in health lifestyleadvice, further education might assist in improving beliefsabout their capability (Dressendorfer et al., 2005). This edu-cation might need to be within the remit of healthcare orga-nizations, as the majority of practitioners reported that theyhad not received entry-level (71%) or continuing pro-fessional development (74%) in the provision of healthylifestyle advice.

When a lack of education in weight management advice iscombined with a lack of role identification, it appears toreduce the clinical behavior in this area, as indicated by thelow engagement in healthy lifestyle advice by the practitio-ners in our survey. It also leads to the finding that a commonstrategy, for 20% of the respondents, was the referral ofclients to other services. This places the onus of providinghealthy lifestyle advice predominantly on the nutrition anddietetics professions and GP services, and inevitably createsdelays for clients who want advice; a problem compoundedby the limited services and growing numbers of people whoare overweight.The expansion of healthy lifestyle advice intointerprofessional domains, through targeted education withinhealthcare organizations, might overcome these limitationsand delays. Education programs about healthy lifestyles mustconsider that connecting this information to a practitioner’srole within their organization might assist in its implementa-tion into clinical practice.

Intention to provide healthy lifestyle advice

The ongoing access to education about healthy lifestyles andadditional organizational support appeared to be importantcomponents in changing practitioners’ behaviors. While it isacknowledged that it is difficult to change practitioners’habituated practices (Godin et al., 2008), organizations canimpact on professional practice behaviors through clearpolicies that guide practice by providing clear expectationsthat providing health lifestyle advice is an interprofessionalrole (Jay et al., 2010). This can improve the effectiveness ofhealth promotion education and its application into practice,

6 S. Ashby et al.


by outlining who is responsible for its delivery (Grimshawet al., 2002; Eccles et al., 2007). This is particularly importantwhen the roles of individual practitioners are blurred orexcluded (Jay et al., 2010).

Engaging in the provision of healthy lifestyle advice

The findings from this study indicated that most healthcarepractitioners (62%) were willing to provide healthy lifestyleadvice to clients. Thus, healthcare organizations must con-sider how to translate this willingness to provide healthylifestyle advice into practical actions that are accepted as ashared interprofessional role (Dressendorfer et al., 2005).One potential organizational initiative that encourages thetranslation of this willingness into practical actions is theincreased access to written educational materials outlininglocal best practice guidelines, such as Australian Best PracticeGuidelines and other sources of evidence-based weight man-agement interventions (National Health & Medical ResearchCouncil, 2003; Gibbs et al., 2004; Morris et al., 2009). Thisaccess would ensure that the main source of practitioners’knowledge about healthy lifestyle advice was evidence based,rather than using sources from pharmaceutical companies,textbooks, and the intranet, as was identified in our study. Ifhealthcare organizations supported initiatives that extendedpractitioners’ access to these guidelines, it could improveclient outcomes across a range of services (Farmer et al.,2009).

Conclusion

The present study is the first to investigate Australian prac-titioners’ current provision of healthy lifestyle advice. It iden-tified factors that can act as barriers to engagement in thisaspect of professional practice, and identified methods tofacilitate its translation into practice. These methods canpotentially increase the role all practitioners play in provid-ing healthy lifestyle advice to the growing numbers of clientswho are overweight or obese. While all practitioners were ina position to provide evidence-based healthy lifestyle adviceto overweight and obese clients, their actions were affectedby factors, such as education, personal characteristics, andavailable organizational support. Thus, a key initiative is toimprove the preparedness of healthcare organizations toimplement education and policies that ensure that this adviceis regarded as an interprofessional role.

Professional demarcations were found to act as barriers topractitioners providing healthy lifestyle advice for clientswho are obese or overweight. An important strategy forbreaking down this barrier is the implementation of educa-tion and policies by healthcare organizations. Through tar-geted education, practitioners feel more prepared to providehealthy lifestyle advice and to regard it as an interprofes-sional role (Dressendorfer et al., 2005). This has the potentialto impact on health services. It is clear from this study thatthere is a need to overcome professional demarcations thatinhibit the provision of healthy lifestyle advice, and the bestmethods to achieve this require further research.

While this research provided a unique insight into whatimpacts on Australian health practitioners’ translation ofknowledge into practice for obese clients, the generalizabilityof the findings are limited because of the low response rateand subsequent small sample from only one geographic loca-tion in Australia. This low response rate might have been theresult of the sampling strategy used, and future research inthis area needs to consider how to improve on this.The use ofother healthcare organizational systems to access practitio-ners directly, rather than using the method of distributingsurveys through each discipline leader, might have increasedthe response rate, and should be investigated for futureresearch. The findings from this study indicate that there is aneed for further research to investigate how health practitio-ners can implement healthy lifestyle advice into practice, andthe role they can play in reducing the impact of obesity onclients. The extension of this role has the potential to impacton the quality of health service provision for the growingnumbers of clients who are overweight or obese.

ACKNOWLEDGMENTS

The authors would like to thank all the practitioners whogave their time to participate in this study. This study wasmade possible with the support of a research grant from theSchool of Health Sciences at the University of Newcastle.

CONTRIBUTIONS

Study Design: SA, CJ, RP, CC, MG, AK, SS.Data Collection and Analysis: SA, CJ, RP, CC, MG, AK, SS.Manuscript Writing: SA, CJ, RP, CC, MG, AK, SS.

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Documents

Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese