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Am J Lifestyle Med. 2017 Mar 1;13(3):301-311. doi: 10.1177/1559827617694594. eCollection 2019 May-Jun.

A Cross-sectional Analysis of Motivation and Decision Making in Referrals to Lifestyle Interventions by Primary Care General Practitioners: A Call for Guidance.

Bouma AJ1,2,3,4,5,6, van Wilgen P1,2,3,4,5,6, Baarveld F1,2,3,4,5,6, Lemmink KAPM1,2,3,4,5,6, Diercks RL1,2,3,4,5,6, Dijkstra A1,2,3,4,5,6.

Author information

Institute of Sports Studies, Hanze University of Applied Sciences Groningen, Netherlands (AJB).
Department of Physiotherapy and Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels; and Pain in Motion Study Group and Transcare, Transdisciplinary Pain Management Center, Groningen, Netherlands (PvW).
Training Institution for Family Practice, Utrecht, Netherlands (FB).
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Netherlands (KAPML).
Department of Sports Medicine and Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Netherlands (RLD).
Social Psychology, Faculty of Behavioral and Society Sciences, University of Groningen, Netherlands (AD).



To explore (1) general practitioners' (GPs') motivations to refer to lifestyle interventions and to investigate the association between GPs' own lifestyle behaviors and their referral behavior and (2) patient indicators in the decision-making process of the GPs' referral to lifestyle interventions.


A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs' referral behaviors were assessed-considering referral and self-reported actual referral-as well as their own lifestyle behaviors (physical activity, dieting, being overweight). Decision making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and case-based referring (vignettes).


A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs' referral behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important, patient indicators in referral to lifestyle interventions were somatic indicators and patients' motivation for lifestyle interventions.


GPs' motivation and referral behavior might be improved by providing them with tailored resources about evidence-based lifestyle interventions, with support from allied health professionals and with official guidelines for a more objective and systematic screening of patients.


decision making; general practitioners; lifestyle interventions; motivation; refer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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