A number of pioneering studies on the prevention and treatment of chronic illness have been conducted in Finland in the past few decades. A study by Jallinoja and coworkers, for example, explored physicians' and nurses' views on patient and professional roles in the management of lifestyle-related diseases and their risk factors. A questionnaire with a focus on adult obesity, dyslipidemia, high blood pressure, type 2 diabetes, and smoking was given out in health centers in a district of Finland. Two hundred and twenty physicians and nurses completed the survey that looked at perceptions of barriers to treatment of lifestyle-related conditions, perceptions of patients' responsibilities in self-care, experiences of awkwardness in intervening in obesity and smoking, perceptions of rushed schedules, and perceptions of health professionals' roles and own competence in lifestyle counseling. A majority of those surveyed agreed that a major barrier to the treatment of lifestyle-related conditions was patients' unwillingness to change their habits. Patients' insufficient knowledge was considered as such a barrier less often. Self-care or self-management was actively encouraged. Although a majority of both physicians and nurses agreed that providing information, and motivating and supporting patients in lifestyle change are part of their tasks, only slightly more than one-half estimated that they have sufficient skills in lifestyle counseling. Among nurses, those with less professional experience more often reported having sufficient skills than those nurses with more experience. Two-thirds of the respondents reported that they had been able to help many patients to change their lifestyles into healthier ones.

VALUE OF STUDY TO READER: The primary care professionals showed a dilemma in patients' role in the treatment of lifestyle-related diseases: the patient was recognized as central in disease management but also, if reluctant to change, a major potential barrier to treatment. This is a major barrier in teaching self-management skills to patients. However, the factor that only about half of those surveyed said they lacked skills in lifestyle counseling is a second barrier. A glimmer of hope, however, concerned newer nurses surveyed. They seemed to have more awareness and skills in helping patients to make lifestyle changes. This could include teaching self-care skills to patients. It is likely that they and other newer nurses would be willing to help develop and evaluate self-management programs for patients with a chronic illness.

P Jallinoja et al. The dilemma of patient responsibility for lifestyle change: Perceptions among primary care physicians and nurses. Scandinavian Journal of Primary Health Care, October 12;1-6.