Nutritional guidance in general practice - a conceptual framework

Background and objective: The general practitioner is the personal doctor f or patients and families in the community. This paper explores the inclusio n of nutrition guidance in the overall methods of general practice care. Design: Three dominant factors of nutrition guidance have been identified: the disease or risk factor, the individual and the socio-cultural context. These factors were considered against the main features of general practice -the defined epidemiology, the focus on individual needs, family orientatio n and continuity of care. Results: General practice is particularly effective in individual counselli ng and addressing individual beliefs and values as many patients are consul ting more than once each year. Approximately 16% of all presented episodes of illness relate directly to nutritional guidance and provide 'critical' i ndividual incidents. For the large majority of situations nutrition guidanc e is promoting healthy food, on which individual needs require emphasis of specific aspects (salt, fat, fibre, starch). Conclusions: It is proposed to focus nutrition guidance in general practice primarily on individual needs, and use identified health problems as criti cal incidents to enhance nutritional changes. Coordination with public camp aigns can reinforce the effectiveness of this individual approach. Concepts like the Stages of Change provide a model for nutrition guidance that are based on continuity of care. From this a framework for individual nutrition guidance is presented, based on individual needs in the context of social values, Presented health problems over time an used as critical incidents t o motivate nutritional change, implement it and preserve new nutritional be haviour.