Use of the Health Belief Model to Explain Participation in Lifestyle Medical Appointments Open Access

Abstract

Background: Lifestyle Medicine is a growing discipline that uses non-drug modalities to treat chronic conditions in the medical setting. Yet, little research exists on the utilization of lifestyle medical appointments by patients. In a primary care setting, two physicians embedded a lifestyle practice into their regular clinic schedule. After an initial lifestyle intake visit, patients were offered follow-up lifestyle appointments as individual medical appointments (IMAs) or shared medical appointments (SMAs). The Health Belief Model states that modifying factors and cues to action impact an individual's health behavior to counter a disease threat, and this paper investigates their role on participation in follow-up lifestyle appointments.

Methods: Using a medical record review, data from n = 100 patients who had been seen in the lifestyle clinic between September 2013 and November 2014 was abstracted. Descriptive analyses, bivariate analyses, and binomial and multinomial logistic regression were employed to investigate predictors of participation in lifestyle appointments by level and type of participation.

Results: Patients attending the intake appointment were middle-aged (M = 48.0 years), primarily female (81%) and Black (76%), and, on average, had a low Charlson Comorbidity Index (M = 2.0). 46% of patients attended only the intake visit, 36% attended only SMAs in follow-up, 7% attended only IMAs in follow-up, and 11% attended a combination of SMAs and IMAs in follow-up. Common predictors between the multinomial (No Follow-up, Low Follow-up (1 or 2 appointments), High Follow-up (3 or more appointments)) and binomial models (No Follow-up vs. Any Follow-up) were Charlson Comorbidity Index, family history, anxiety and depression. Important predictors for participation in IMAs were BMI, Charlson Comorbidity Index, and depression. For participation in SMAs, important predictors were race/ethnicity, family history, and anxiety.

Discussion: Among patients attending a lifestyle clinic set within a primary care clinic, participation in follow-up lifestyle appointments was found to be related to degree of illness, family history, anxiety, and depression. For type of participation, additional factors, such as race/ethnicity and BMI were important. Investigating real-world lifestyle practices with the application of theory is important to understanding expected future appointment utilization.

Table of Contents

Chapter I. Introduction................................................................................................1

Problem Definition......................................................................................................1

Problem Justification..................................................................................................11

Theoretical Framework...............................................................................................17

Formal Statement of Problem.....................................................................................20

Chapter II. Literature Review......................................................................................20

Chapter III. Methods...................................................................................................28

Chapter IV. Results.....................................................................................................34

Descriptive Statistics..................................................................................................34

Bivariate Analyses......................................................................................................35

Logistic Regression Models........................................................................................36

Chapter V. Discussion.................................................................................................37

Tables.........................................................................................................................45

References..................................................................................................................54

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Health Care Management
Keyword	lifestyle lifestyle medicine modifying factors appointment participation preventive medicine behavioral sciences health belief model lifestyle clinic shared medical appointments appointment utilization lifestyle intake lifestyle medical appointments cues to action individual medical appointments family medicine primary care
Committee Chair / Thesis Advisor	Levinson, Richard M, Emory University
Committee Members	Morgan, Toyosi O, Emory University Thompson, Nancy J, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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