Douladel Willie-Tyndale is a PhD Public Health candidate and faculty member at The University of the West Indies, Mona Campus in Kingston, Jamaica. Her research interests in the field of gerontology are in the areas of sexual and genitourinary health, social participation, and dementia.
What predicts receipt of physician advice regarding diet and physical activity among older adult patients in Jamaica?
Background: Doctors are generally viewed as a primary source of reliable health information and are expected to engage patients during one-on-one clinic consultations. In Jamaica, health visits are common in the older adult population providing frequent patient-provider interactions. Diet and physical activity are established as important factors in health and well-being, being influential in the development and management of chronic non-communicable diseases (CNCDs). The extent to which these are included in history-taking or are discussed as a part of the medical management of older patients during clinic visits is not known.
Objectives: This paper measures the proportion of older adults who reported being asked about diet and physical activity or having these topics discussed at their last doctor’s visit. Independently associated patient and facility characteristics are also investigated.
Method: This is a secondary analysis of data from a nationally-representative survey conducted in 2012. Data were analysed for 2,307 persons ≥60 years who reported visiting a doctor in the previous 12 months. The proportions of persons who reported being asked about diet and physical activity were determined. Chi-square analyses were used to identify associations with patient demographic, patient health, and health facility characteristics. Logistic regression models were developed to identify independently associated variables.
Results: Less than one-half (47.9%) of persons reported being asked about physical activity or having that topic discussed at their last clinic visit, while for diet the proportion was 53.1%. Controlling for sex, age, education, body mass index, location, lifestyle risk factors, facility type (public/private), and service at facility (wait time, ease of seeing doctor), persons who had ≥2 CNCDs were 2.6 times (1.2-5.9; p=0.016) more likely to have had diet discussed than those who had ≤1 CNCD. Persons who reported discussing physical activity at their last visit were astronomically more likely [69.3 (32.4-148.6; p<0.001)]to have also discussed diet. Using a similar regression model, independent predictors of having physical activity discussed at the last visit were: a history of smoking [61.8% (83.4%-11.8%)reduction in odds] and receiving dietary advice at last visit [33.9 (14.9-77.3) times higher odds].
Conclusion: Discussions about diet and physical activity need to be mainstreamed in consultation procedures as education, risk reduction, and disease management strategies. Further research is needed to elucidate physician characteristics influencing these low levels.