Population Attitudes Towards Changing Dietary Habits and Reliance on General Practitioners in Spain

Population attitudes towards changing dietary habits and reliance on general practitioners in Spain

LL Serra-Majem1,2,3*, JR Calvo1, ML Male1, L Ribas3 and P Lainez1

1Community Nutrition Research Group, School of Health Sciences, University of Las Palmas de Gran Canaria, PO BOX 550, 35080 Las Palmas de Gran Canaria, Spain; 2University Hospital Materno Insular, Canary Islands Health Service, 85016, Las Palmas de Gran Canaria, Spain; and 3Community Nutrition Research Group, Scienti®c Park of Barcelona, University of Barcelona, 08028 Barcelona, Spain

Objective: To investigate the relationship between population attitudes towards modifying food behaviour and reliance on General Practitioners (GPs) as nutrition educators. Design: Personal interview in a random sample of the general population of the Canary Islands as part of the Canary Islands Nutrition Survey. Subjects: 1747 individuals aged 6 ± 74 y. Main outcome measures: Attitudes towards changing food behaviour and reliance on GPs. Results: Response rate was 67%. Physicians were the most reliable source of nutrition information with 79% of the population considering them as highly reliable. More than 60% of the population showed a favourable attitude towards increasing fruit and vegetables and towards decreasing alcohol, sugar and pastries. Reliance on GPs was associated with better attitudes towards increasing fruits, decreasing meat, pastries, sugar and losing weight. Conclusions: Population attitudes towards changing certain dietary behaviours were associated with having the greatest reliance on GPs. Sponsorship: Supported by a Grant from the Canary Islands Health Service, Autonomous Government of the Canary Islands, Spain. Descriptors: nutrition attitudes; general practitioner; nutrition counselling; nutrition survey; Spain

Introduction relationship between both population attitudes and reliance on GPs. Physicians are perceived as the most reliable and preferred source of nutrition information in many countries. In addition, General Practitioners (GPs) should play a decisive role as nutrition educators, as they may contribute to Methods increasing the nutrition knowledge of their patients and to From February 1997 to January 1998 a population-based modifying their attitudes and beliefs related to food and nutrition survey was carried out among a random sample of nutrition (Hiddink et al, 1997a; Levine et al, 1993; Serra- the Canarian population of 2600 people aged 6 y ± 74 y. The Majem & Salleras, 1995). interviews were done at home by 19 trained dietitians and Generally, GPs do not give enough nutrition information included a structured questionnaire as well as some anthro- to their patients. Whether or not GPs provide dietary pometric measurements. Dietary information included a 80- counselling to their patients will depend on their interest item semiquantitative food frequency questionnaire, two in the role of diet on health, their perception of their task 24 h dietary recalls and information on knowledge, beliefs, and their beliefs about the ability and willingness of opinions and attitudes related to food and nutrition. The patients to change their dietary habits (Hiddink et al, study also included an extensive biochemical evaluation of 1995). Also, an important issue in changing population the nutritional status which will not be described here dietary habits is related to the perceived level of reliance or (Serra-Majem 1997). trust in the source of dietary information or counselling In the present analysis only variables on attitudes and used (Buttriss, 1997). opinions of the general population were utilised. A question The objective of the present study was to describe measuring the level of reliance on 11 sources of nutrition population attitudes related to dietary modi®cations, to information was employed with a scale of: 1. none, 2. low, study the population's reliance on the different sources of 3. high and 4. very high. Another question measured the information on food and nutrition, and to analyse the positive attitude towards modifying 11 aspects of dietary habits in the near future. And ®nally, other questions investigated personal opinions on the need to modify their current diet and on the perceived adequacy of their nutrition knowledge. The questionnaire also *Correspondence: Professor L Serra-Majem, Department of Clinical Sciences, School of Health Sciences, University of Las Palmas de Gran included detailed information on socioeconomic status Canaria, PO BOX 550, 35080 Las Palmas de Gran Canaria, SPAIN. and educational level that was included in the present E-mail: [email protected] analysis. Is reliance on GPs linked to changing dietary habits? LL Serra-Majem et al S59 The analysis was carried out with SPSS-PC V8.0 (SPSS1 Inc. Chicago, Illinois). A descriptive analysis of the studied variables was performed. Answers regarding the reliance on the different sources of information were expressed in two categories (1. High ± high and very high, and 2. none) for descriptive purposes and in two other categories (1. High ± high and very high, and 2. Low ± low and none) for comparisons of the level of reliance on the GPs according to age, gender, social class, opinions on their diet, and positive attitudes towards modifying certain dietary habits. Statistical analysis included the Chi-square test to evaluate differences between proportions and trends. Figure 1 Level of reliance on different sources of nutrition information in the community. (Canary Islands (Spain) 1997 ± 98) Results Of 2600 people in the sample, 1747 responded (67.2%). Reasons for non response included: changes of residence sample were very willing to reduce meat, dairy products (11%), death (2%), refusal to participate (17%) and others and weight respectively (Figure 2). (2%). 79% of the population reported a high level of The level of reliance on GPs was slightly higher in reliance on GPs as a source of nutrition information. The young people and was not in¯uenced by social class (Table subsequent sources of information preferred were nurses ± 1). which also include dietitians (52%), pharmacists (50%) and Table 2 shows the population's perception regarding the TV Programmes (38%). The rest of the sources (radio, need to change their diet to improve health and about the press, government, industry and friends=neighbours) were perceived adequacy of their nutrition knowledge, in rela- ranked with a high level of reliance by only 23 to 29% of tion to age, social class and level of reliance on GPs by the population (Figure 1). gender. The percentage of the population with the intention 85% of the sample showed a positive attitude towards of changing their diet to improve health (43%) varied with increasing fruit consumption, and 80% towards increasing age (P-trend < 0.011), decreasing after the age of 50 y vegetables, but only 7% were willing to increase ®sh. 45% particularly in women, was lower in low social classes were favourable for taking vitamin and mineral supple- (P-trend < 0.01) particularly among men, and higher ments, and around 65% would be willing to decrease among females (P < 0.01) but was not related to reliance alcohol, sugar and pastries. 46%, 30% and 57% of the on GPs.

Figure 2 Percentage of population with positive attitudes towards modifying certain dietary habits. (Canary Islands (Spain) 1997 ± 98) Is reliance on GPs linked to changing dietary habits? LL Serra-Majem et al S60 Table 1 Reliance on general practitioner as a nutrition educator by age, dietary habits. Population groups with a higher reliance on social class and gender in the Canary Islands, Spain (1997 ± 98) GPs show better attitudes towards increasing fruits, Reliance on general practitioner decreasing meat, pastries, sugar and weight, and taking supplements. No differences were observed for reducing Gender Low (%) High (%) dairy products, potatoes and bread, vegetables and ®sh consumption, and reducing alcohol intake (Table 3). Age group < 18 y Total 14.9 85.1 n 381 Men 17.5 82.5 Women 12.0 88.0 Discussion 18 ± 50 y Total 24.2 75.8 n 878 Men 22.7 77.3 In the present study, physicians were found to be the most Women 25.5 74.5 reliable source of nutrition information in Spain as has been > 50 y Total 20.8 79.2 n 488 Men 21.8 78.1 described in other countries (Hiddink et al, 1997b; Buttriss, Women 19.8 80.2 1997). Eighty percent of the population considered physi- Social Class cians' level of reliance as high, compared with around 50% Upper Total 22.5 77.5 for nurses and pharmacists. However, the level of nutrition n 209 Men 21.0 79.1 Women 24.0 76.0 training in the medical undergraduate curriculum in Spain Middle Total 20.6 79.4 is very low as has also been described in other southern n 441 Men 20.2 79.8 Mediterranean countries (Lupo, 1997), and is considerably Women 21.1 78.9 lower than in the pharmacists' and nurses' curricula. Upon Lower Total 21.3 78.7 completing their studies, pharmacists and nurses have a n 872 Men 21.9 78.1 Women 20.7 79.3 greater level of nutrition, dietetics and food science knowledge than physicians. The pharmacists' curriculum places Chi-square test, signi®cant differences: between age groups (total more emphasis on food sciences and basic nutrition and the P 0.0015, men P < 0.048; women P 0.001). n 1747 (social class nurses' curriculum emphasizes dietetics, whereas the med- was missing in 225 cases). ical curriculum integrates some nutrition and metabolism concepts into the Internal Medicine courses, excluding any mention of concepts related to food sciences and dietetics (Marine, in press). Several universities in Spain such as the On the other hand, the percentage of the population that Universities Complutense of Madrid, Granada, Navarra, La considered their knowledge of nutrition as adequate (47%) Laguna, Barcelona and Las Palmas de Gran Canaria have increased with age (P-trend < 0.001), decreased in lower organised postgraduate studies directed at physicians to socioeconomic levels and was associated with reliance on address this important problem, and have been contributing GPs only among women: 41% of women with a low to close the gap between the GPs nutrition knowledge and reliance on GPs considered their knowledge of nutrition that of other health professionals in Spain. In addition, the adequate, and among those with a high reliance the per- lack of university trained dietitians in Spain until 1996 centage was 51%. makes more evident the need for health professionals Table 3 shows the relationships between the reliance on adequately prepared in nutrition and dietetics (Hiddink et GPs and the positive attitudes towards modifying certain al, 1997b).

Table 2 Percentage of population willing to change their diet to improve health and perceived adequacy of their nutrition knowledge by age group, social class and reliance on general practitioner

Age group (y) Social Class Reliance on general practitioner

Sex < 18 18 ± 50 > 50 P-trend Upper Middle Lower P-trend Low High P

Percentage of population Total 43.9 46.5 36.0 0.0106 50.2 44.3 40.6 0.0097 42.8 43.3 NS that want to change their Men 39.3 44.8 32.2 0.1138 51.9 41.0 36.1 0.0041 40.4 40.4 NS diet to improve health Women 48.6 47.9 39.1 0.0318 48.5 47.6 44.3 0.3328 45.0 45.8 NS

Percentage of population Total 41.7 42.7 57.5 0.0000 51.2 47.4 44.4 0.0612 43.3 48.0 NS that consider their knowledge Men 43.7 39.9 54.9 0.0173 53.8 42.5 43.1 0.1184 45.5 44.9 NS on nutrition adequate Women 39.7 45.0 59.7 0.0000 48.6 52.2 45.5 0.2456 41.4 50.6 0.0250

Chi-Square Test. n 1747.

Table 3 Positive attitudes towards modifying certain dietary habits according to the level of reliance on general practitioner

Percentage of population disposed to modify

Reliance on Dairy Potatoes Taking Pastries general practitioner % products Meat and bread Fruits Vegetables Fish Alcohol supplements and cakes Sugar Weight

Low 21.4 28.4 41.6 16.3 79.5 77.8 75.6 63.6 39.4 63.4 58.9 52.1 High 78.6 30.0 47.6 19.5 86.1 81.5 77.0 66.0 46.6 69.5 67.5 58.8 P NS 0.0432 NS 0.0021 NS NS NS 0.0165 0.027 0.0023 0.0238

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