Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care

Assessment and management of lifestyle risk factors in rural and urban general practices in Australia

Megan Passey A D , Mahnaz Fanaian B , David Lyle C and Mark F. Harris B
+ Author Affliations
- Author Affliations

A Northern Rivers Department of Rural Health, School of Public Health, University of Sydney, Lismore, NSW 2480, Australia.

B Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of NSW, Sydney, NSW 2052, Australia.

C Broken Hill Department of Rural Health, School of Public Health, University of Sydney, Broken Hill, NSW 2880, Australia.

D Corresponding author. Email:

Australian Journal of Primary Health 16(1) 81-86
Published: 17 March 2010


Prevention of cardiovascular disease is a major public health challenge. Many chronic health problems are amenable to lifestyle interventions, which can ameliorate progression of disease and contribute to primary prevention. Prior to a large randomised controlled trial we assessed preventive care in trial practices. General practitioners and practice nurses completed a preventive care questionnaire covering frequency of assessing and managing behavioural and physiological risk factors, which was developed from previously validated instruments. Factor analysis confirmed 10 scales. Scores for rural and urban respondents were contrasted using univariate statistics. Sixty-three general practitioners and practice nurses completed the questionnaire (27 urban and 36 rural). The clinicians reported high levels of assessment and advice for cardiovascular risk factors but less frequent referral. There were no differences between urban and rural practitioners in relation to assessment of risk or stage of change, referral or barriers to referral or management of high blood pressure. Rural practitioners had lower scores for frequency of advice, and management of obesity/overweight, pre-diabetes and high lipids. Although clinicians report frequently advising high risk patients to exercise more, there remain significant gaps in provision of dietary advice and referral. Greater attention to addressing these issues is required to maximise the potential benefits for cardiovascular disease prevention in general practice.

Additional keywords: cardiovascular disease, prevention.


This paper was written on behalf of the Health Improvement and Prevention Study group and was supported by National Health and Medical Research Council Project Grant no. 455268. We would like to thank the participating practices and their staff, and the General Practice Networks of Northern Rivers, Dubbo, Central Sydney, South-Eastern Sydney and Eastern Sydney. We would also like to acknowledge the contribution of the other investigators (Associate Professor Gawaine Powell Davies, Dr Suzanne McKenzie, Dr Gaynor Heading, Professor Nick Zwar, Dr Upali Jayasinge, Dr Qing Wan, Rachel Laws, Cheryl Amoroso, Chris Tzarimas and Liz Devlin), and the research officers (Liz Rix and Emily Saurman).


Amoroso C, Hobbs C, Harris MF (2005) General practice capacity for behavioural risk factor management: a snap-shot of a needs assessment in Australia. Australian Journal of Primary Health 11, 120–127.
CrossRef | open url image1

Ampt AJ, Amoroso C, Harris MF, McKenzie S, Rose VK, Taggart JR (2009) Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Practice 10, 59.
CrossRef | PubMed | open url image1

Australian Institute of Health and Welfare (2006) ‘Chronic diseases and associated risk factors in Australia, 2006.’ Cat. No. PHE 81. (AIHW: Canberra)

Australian Institute of Health and Welfare (2008) ‘Rural, regional and remote health: indicators of health system performance.’ Cat. No. PHE 103. (AIHW: Canberra)

Begg SJ, Vos T, Barker B, Stanley L, Lopez AD (2008) Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. The Medical Journal of Australia 188, 36–40.
PubMed | open url image1

Britt H , Miller GC , Charles J , Henderson J , Bayram C , Harrison C , Valenti L , Fahridin S , Pan Y , O’Halloran J (2008) ‘General practice activity in Australia 2007–08. General Practice Series No. 22.’ Cat. No. GEP 22. (Australian Institute of Health and Welfare: Canberra)

Harris MF, Hobbs C, Powell Davies G, Simpson S, Bernard D, Stubbs A (2005) Implementation of a SNAP intervention in two divisions of general practice: a feasibility study. The Medical Journal of Australia 183, s54–s58.
PubMed | open url image1

Jacobsen ET, Rasmussen SR, Christensen M, Engberg M (2005) Perspectives on lifestyle intervention: the views of general practitioners who have taken part in a health promotion study. Scandinavian Journal of Public Health 33, 4–10.
CrossRef | PubMed |
open url image1

Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson K , et al. (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: the follow-up results of the Finnish diabetes prevention study. Lancet 368, 1673–1679.
CrossRef | PubMed | open url image1

Murphy KA, Yeazel M, Center BA (2000) Validity of residents’ self-reported cardiovascular disease prevention activities: the preventive medicine attitudes and activities questionnaire. Preventive Medicine 31(3), 241–248.
CrossRef | PubMed | CAS | open url image1

Productivity Commission (2005) Economic implications of an ageing Australia. Productivity Commission Research Report, Canberra.

Renehan AG, Howell A (2005) Preventing cancer, cardiovascular disease, and diabetes. Lancet 365(9469), 1449–1451.
CrossRef | PubMed | open url image1

Yeazel M, Lindstrom Bremer K, Center B (2006) A validated tool for gaining insight into clinicians’ preventive medicine behaviors and beliefs: the preventive medicine attitudes and activities questionnaire (PMAAQ). Preventive Medicine 43, 86–91.
CrossRef | PubMed | open url image1

Young J, Ward J (2001) Implementing guidelines of smoking cessation advice in Australian general practice: opinions, current practice, readiness to change and perceived barriers. Family Practice 18, 14–20.
CrossRef | PubMed | CAS | open url image1

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