Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. A study by Laws and colleagues aimed to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The study analyzed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept throughout the implementation of the project, and interviews with 48 participants comprised of 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analyzed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits and costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that the model extended previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Your perceptions that you can manage aspects of a particular chronic condition rests upon similar perceptions: the self-efficacy that you can successfully perform whatever skills you need to perform. This can only be acquired through repeated and successful use of self-management techniques.

RA Laws et al. An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management primary healthcare: a grounded theory study. Implementation Science, 2009;4:66.