Paper Title
Attitudes and Practices Among Physicians Regarding Lifestyle Interventions for Patients With Type 2 Diabetes

Abstract
BACKGROUND: Family physicians play a major role in diabetes management. Studies in Saudi Arabia on the attitudes and practices of family physicians regarding diabetes management, including lifestyle interventions, are very limited. OBJECTIVES: To examine family physician attitudes and practices regarding lifestyle interventions for patients with diabetes, and to determine the doctors’ perceived barriers to lifestyle interventions. METHODS: A cross-sectional design was used to study 196 family physicians between September and October 2016. Physicians taking care of patients with type 2 diabetes (T2D) were conveniently recruited from 3 primary care centres located in Eastern Province, Saudi Arabia. A structured, self-administered questionnaire was used to collect information. A ‘positive’ attitude was defined as having a score ≥ median. RESULTS: Out of 196 physicians, 115 (58.7%) were males and the mean age was 39.8±5.8 years. Positive responses to the 10 attitude questions ranged between 52.0% and 86.0%, with an average of 79.0%. Frequent referral (>10 times during the last 6 months) to dietitians was 63.8% and to other specialized services ranged between 0.0% and 4.6%. The overall ‘frequent referral’ mean of 60.0% ranged between 40.0% and 73.0%. Frequent referral to weight loss programs was significantly associated with positive attitudes towards lifestyle interventions for patients with diabetes (p=0.004) while frequent referral to endocrinologists or diabetologists was significantly associated with ‘negative’ attitudes (p=0.007). The majority of the physicians reported the following items as barriers for the initiation of lifestyle counseling among their patients: busy doctor’s schedule (97.4%), non-cooperative patients (97.4%), lack of resources such as educational materials to take away (96.9%), lack of multidisciplinary team communication (94.9%), poor patient adherence with scheduled visits (93.9%), and lack of referral pathways (93.4%). CONCLUSIONS: There is a generally positive attitude towards lifestyle interventions but relatively low referral practices among a sample of family physicians caring for patients with T2D in Saudi Arabia. Several system and patient barriers have been reported to limit both the initiation and effectiveness of lifestyle counseling. The current findings can be potentially helpful in identifying the components required for establishing a local improvement initiative to promote lifestyle counselling and referral practices.