Dietary and physical activity counselling on Type 2 diabetes and impaired glucose tolerance by physicians and nurses in primary healthcare in Finland

Objective. To investigate the initiation of dietary and physical activity counselling and the arguments used when discussing physical activity and the type and consumption of dietary fats, during nurse - patient and physician - patient diabetic lifestyle counselling. Design and subjects. This study is a part of a larger follow-up research project focusing on diabetes counselling. The data include 129 videotaped counselling sessions between 17 patients and their physicians and nurses. Content analysis was carried out by identifying the verbal comments and reactions of participants concerning both physical activity and the type and consumption of dietary fats. Results. The physicians and nurses spent little time on dietary and physical activity counselling. The counselling sessions consisted mainly of short questions with minimal feedback from either party. The beginning of the sessions concentrated on blood cholesterol levels and the extent of physical activity. The health professionals failed to emphasize the roles of reduced dietary fats and increased physical activity in substituting for or supplementing diabetes care. Although the patients communicated the factors that encouraged or discouraged physical activity the subject was generally not pursued by the health professionals. Conclusion. Within primary care there is a need for methods that would facilitate the discussion of health behaviour changes. In healthcare settings, education and training are required to develop the communication skills of health professionals in all aspects of preventive medicine.