Adoption of positive health behaviour among primary care physicians: a cross-sectional pilot study from Lebanon

Discussion

This survey showed that PCPs in Lebanon follow the preventive practice guidelines of cardiovascular risk factors, but that there is variable adherence to the other components of positive health behaviour, such as immunisations and cancer screening.

The mean age of PCPs in this study was 41.3 years and 51.1% were males. These results are comparable to those reported in a previous study conducted among Lebanese family physicians, showing an average age of 40.7 years and 56% male participants.⁸

Academic physicians reported better health behaviour, which may be attributed to university hospitals’ policies (for example, a no smoking policy), easy access to screening services, and being 'role models' for residents and staff. Compared to the general Lebanese population, Lebanese PCPs smoked less (24.1% versus 38.5%), exercised more adequately (63.7% versus 54.2%), and were less overweight or obese (46.0% versus 65.4%).² With physicians having a healthier lifestyle than the wider community, they can be role models for their patients with regards adopting positive health behaviour.

There is limited data about this topic internationally and regionally, therefore comparing the Lebanese PCP’s health behaviour with that of other countries is limited. Regarding lifestyle behaviors, compared to the literature, 24.1% of Lebanese PCPs were current smokers, 63.7% exercised adequately, and 46.0% were overweight or obese, versus 1.8%, 58.1%, and 34.7% respectively in US physicians.³ On the other hand, PCPs in Lebanon were highly adherent to screening for cardiovascular risk factors, which was in keeping with Western studies with regards to BP and lipid profile measurements.^9,10 As for vaccination, Lebanese PCPs’ adherence to influenza and tetanus vaccines was similar to the rates reported in the literature.^6,9,11 However, adherence rate to pneumococcal vaccine was far less than that reported among Israeli PCPs in 2013 (44.5%).⁶

When it comes to cancer screening, the compliance for different types varied. The adherence to colon cancer screening was low in this survey (37.8%); this is slightly better than that reported among PCPs in Spain (24%),¹¹ but much worse than that reported among Israeli PCPs (60.9%)⁶ and US physicians (75%).³ As for breast cancer, more than two-thirds of the female physicians in Lebanon screen for it through mammograms, a result that correlates with the literature.^3,6,11 In the case of cervical cancer, the observed difference in screening between physicians in Lebanon (43.9%) and in Spain (73%)¹¹ may be due to some cultural concerns hindering unmarried Lebanese females from having a Pap smear.

There were several limitations in this pilot study. These include selection bias, since the sample was composed only of physicians attending the conference, who may have been more located in the city area, and who may be more academically affiliated; and the use of self-reported data, which cannot be externally confirmed.

Lower age and being affiliated to an academic institution are important predictors of the adherence level of PCPs to positive health behaviour. Improvement in physicians’ adoption of positive health behaviour and adherence to preventive services, particularly in immunisations and cancer screening, is recommended. This study sets grounds for future research to assess PCPs’ beliefs about, knowledge of, and adherence to the preventive recommendations guidelines in Lebanon and the international community. It opens doors for setting interventions to increase the physician’s adherence to different components of positive health behaviour through addressing the main barriers mentioned in this study.