Influence of GPs’ unhealthy lifestyle on patients’ adherence to lifestyle recommendations: a cross-sectional study in Belgian primary care

Summary

In this study, we examined the influence of a GP’s unhealthy lifestyle on patient adherence to lifestyle advice. Most responders are less adherent to advice on smoking cessation and alcohol use if their GP respectively smokes or drinks more than average. However, approximately one-third of responders indicated that the GP’s lifestyle does not influence their adherence to these recommendations. The majority, on the other hand, experience no influence when it comes to advice on physical activity, sleep hygiene and rest, and stress and relaxation. Yet, approximately one-third of responders are less adherent when their GP does not apply these recommendations themselves. There is no clear trend regarding vaccination and healthy eating habits. Approximately half of the responders are less likely to follow these recommendations if their GP is not vaccinated or is overweight, respectively.

Strengths and limitations

This research has some limitations. The hypothetical thinking and formulation of the questions proved to be a challenge. At the same time, working with statements was a strength because it was not necessary to recruit patients from specific physicians with certain unhealthy habits, allowing for a larger population to be surveyed. The major limitation is the limited sample size and the use of a convenience sampling method. We distributed the survey via accessible social media channels, user-group newsletters, and primary care practices. Consequently, we lack insights into response rates and responders’ intentions. However, our study is among the first, to our knowledge, to examine the impact of unhealthy habits of GPs on patient adherence to lifestyle advice.

Comparison with existing literature

These findings partly contradict previous studies on advice about physical activity and eating habits. Patients have more trust and motivation when a seemingly healthy physician, with a normal BMI, gives advice on physical activity and eating habits compared with an unhealthy physician.^15,16 On the other hand, some patients with an increased BMI express more trust in an overweight physician’s advice.¹⁷

The article by O’Brien suggests that some patients prefer a GP without a healthy lifestyle because they feel more understood and less intimidated. Conversely, others prefer a role model as they derive motivation from seeing the end result.¹⁴ However, we observe that this pattern is not uniform across all themes. It is noteworthy that most responders are less adherent when a GP smokes or drinks more than average. The increasing patient awareness of the harmful effects of smoking and alcohol on health might explain this result.²² Most responders experience no influence on the feeling of being judged, while a large portion feel less judged when receiving advice from a GP without a healthy lifestyle. These findings do not align with the research by Bleich et al, which found that patients with a BMI >25 feel more judged by an overweight GP.¹⁷ Moreover, a clear majority are less adherent when they feel judged. This aligns with existing literature. A feeling of being judged harms the physician–patient relationship and consequently adherence to therapy.^18–20

Age weakly predicts the feeling of being judged and adherence. This is only true for adherence when feeling judged and advice on smoking cessation, alcohol use, and vaccination from a GP who violates these domains. Older responders experience less influence from an unhealthy lifestyle of GPs when compared with younger responders. This may stem from their upbringing in a time of medical paternalism when physicians were seen as infallible authorities and their advice was often blindly followed.²³ Moreover, the general social acceptance of smoking and alcohol use in the past could explain why this mainly applies to these specific behaviour patterns.²⁴ Vaccination programmes also played a less prominent role in health care at the time.²⁵

Finally, several themes emerged in the free comments. Various opinions were expressed regarding expectations about the lifestyle of GPs. A common opinion is that GPs should serve as role models, with some responders even considering changing their GP if this is not the case. Conversely, responders indicate that they hold themselves responsible for their health but appreciate any medical advice, especially if given in an understanding manner. They respect the privacy and professional boundaries of GPs. Responders also feel that during consultations, limited time and attention is often devoted to lifestyle and they express doubts about the competence and expertise of GPs in lifestyle medicine. According to the literature, many physicians also acknowledge the lack of time and training as significant barriers.^6,7,26 Overall, it is crucial to promote a healthy lifestyle among physicians themselves, for both their own wellbeing and that of their patients.^14,15

Implications for research and practice

By focusing on a diverse sample from Flanders and Brussels, the findings underscore the importance of GPs modeling healthy behaviours to enhance patient trust and adherence. These insights are crucial for developing strategies to improve patient outcomes in lifestyle-related chronic disease prevention and management. The study’s results emphasise the need for targeted interventions to support GPs in maintaining healthy lifestyles.

In the future, it would be beneficial to further explore ways to promote and emphasise the exemplary role of medical doctors in enhancing patients’ adherence to lifestyle advice.

In conclusion, this research shows that the influence of a GP’s unhealthy lifestyle on patient adherence to lifestyle advice is not unequivocal. Most responders indicate that they are less adherent to advice on smoking cessation and alcohol use when their GP respectively smokes or drinks more than average, while the majority report no influence of the GP’s lifestyle on other types of lifestyle advice. Nevertheless, approximately one-third of the responders are less adherent when their GP does not follow these recommendations themselves. Therefore, it remains essential to promote a healthy lifestyle among GPs. Furthermore, responders are less adherent when they feel judged by their GP. Therefore, it is important that advice is given in an empathetic and non-judgemental manner.