4051.0: Tuesday, November 14, 2000 - 9:30 AM

Abstract #16277

Physicians' beliefs and attitudes regarding factors that affect counseling in limited income and urban communities: A qualitative study on physician counseling about tobacco use and body weight control

Gillian R. Barclay, DDS, DrPH, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, 617-689-0250, barclay_dph99@post.harvard.edu, Graham A. Colditz, MD, DrPH, Channing Laboratory and Department of Epidemiology, Harvard Medical School, Harvard School of Public Health, 180 Longwood Avenue, Boston, MA 02115, Camara P. Jones, MD, MPH, PhD, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-30, Atlanta, GA 30341, and Lawren H. Daltroy, DrPH, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

CONTEXT: Physicians should counsel patients to modify health practices related to tobacco use and body weight as standard recommended practice. Factors that affect physician counseling can be assessed in a structured manner, to evaluate how they relate to the physician's counseling practices. OBJECTIVE: To evaluate factors that affect physician counseling of limited-income patients in urban communities, regarding tobacco use and body weight using the Theory of Planned Behavior. METHODS AND PARTICIPANTS: Physician counseling for tobacco use and body weight was obtained using structured elicitation interviews with twenty internists practicing in limited-income, urban communities. Interviews were audiotaped, transcribed and analyzed. RESULTS: Twenty physicians (13 male and 7 female) of varied race/ethnicity (12 White, 7 African American and 1 Latino) participated. Physician practices were 70 percent African American patients. Physicians interpreted tobacco use as smoking, and body weight control as overweight status. Key findings included African American physicians identifying race and racism as an issue affecting the likelihood and way in which they counseled, while White physicians did not. Physician personal health practices (smoking and overweight status) were identified as important to their counseling. Other factors cited by physicians included: patient's health status, psychosocial issues, inadequate physician training, poor financial reimbursement, and limited clinical time for counseling. CONCLUSIONS: A grounded theoretical approach identified factors that are important for patient counseling, some of which differed by physician race/ethnicity. This allows for prioritization of factors for more effective physician-based interventions for counseling regarding tobacco use and body weight.

Learning Objectives: At the conclusion of this presentation, the participant in this sesion will be able to 1. To recognize the importance of utilizing theoretical concepts in the design of physician-based interventions for tobacco use and body weight. 2.To discuss the impact of patient and physician race/ethnicity on physician counseling and the effect on the quality of health messages delivered to minority patients. 3. To assess the roles of the personal health practices of physicians in their counseling regarding these practices

Keywords: Physicians, Counseling

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA