Hiddink G J, Hautvast J G, van Woerkum C M, van't Hof M A, Fieren C J
Dairy Foundation on Nutrition and Health, Maarssen, The Netherlands.
Eur J Clin Nutr. 1999 May;53 Suppl 2:S35-43. doi: 10.1038/sj.ejcn.1600800.
To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice ('noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a cross-sectional and a longitudinal approach.
Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992.
A representative sample of 675 Dutch PCPs, in practice for 5 up to 20y.
A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997.
To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable 'noticing patients' overweight and guidance of treatment' with an adequate fit of the empirical data, both in the cross-sectional and in the longitudinal approach.
The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time. Two dynamic LISREL-models were developed (the 'determinant-longitudinal approach' and the 'early behaviour longitudinal approach') which explain the dependent variable. The latter model has, as added value, a gain in explained variance. In 5 y time, the dependent variable decreased significantly (P < 0.001).
This study reconfirms that PCPs' nutritional guidance practices are determined partly directly by predisposing factors, and indirectly via driving forces and barriers. However this study also reveals that an important nutrition guidance practice of PCPs, 'noticing patients' overweight and guidance of treatment', shows a significant decrease over the last 5 y. At the same time, two of the four predisposing factors and two of the three driving factors also decreased significantly. As research findings indicate that the role of diet in health and disease becomes of greater influence PCPs need to be activated to apply their responsibility in this field within a multi-faceted approach.
采用横断面研究和纵向研究方法，调查基层医疗医生（PCP）营养指导实践（“注意到患者超重并指导治疗”）的决定因素及其作用机制。
混合纵向设计。对1992年10月之前的横断面研究进行为期五年的随访研究。
675名荷兰基层医疗医生的代表性样本，从业5至20年。
1997年8月向研究对象邮寄了一份简化版的瓦赫宁根基层医疗医生营养实践调查问卷。
使用LISREL程序获得一个关于因变量“注意到患者超重并指导治疗”决定因素作用机制的模型，该模型要能很好地拟合横断面研究和纵向研究中的实证数据。
同一组易患因素和中介因素在两个不同的基层医疗医生代表性横断面研究人群中，以及在同一队列的两个时间点的横断面研究中，均能解释因变量。开发了两个动态LISREL模型（“决定因素纵向研究方法”和“早期行为纵向研究方法”）来解释因变量。后一个模型的附加值在于解释方差有所增加。在5年时间里，因变量显著下降（P<0.001）。
本研究再次证实，基层医疗医生的营养指导实践部分直接由易患因素决定，部分通过驱动力和障碍间接决定。然而，本研究还揭示，基层医疗医生一项重要的营养指导实践“注意到患者超重并指导治疗”在过去5年中显著下降。同时，四个易患因素中的两个以及三个驱动因素中的两个也显著下降。由于研究结果表明饮食在健康和疾病中的作用变得越来越重要，因此需要激励基层医疗医生在多方面的方法中履行其在该领域的责任。
