Abstract
Nurses in primary health care (PHC) provide an increasing proportion of chronic disease management and preventive lifestyle advice. The databases MEDLINE, CINAHL, EMBASE and PsychINFO were searched and the articles were systematically reviewed for articles describing controlled adult lifestyle intervention studies delivered by a PHC nurse, in a PHC setting. Thirty-one articles describing 28 studies were analysed by comparison group which revealed: (i) no difference of effect when the same intervention was delivered by a PHC nurse compared to other health professionals in PHC (n = 2); (ii) the provision of counselling delivered by a PHC nurse was more effective than health screening (n = 10); (iii) counselling based on behaviour change theory was more effective than the same dose of non-behavioural counselling when at least three counselling sessions were delivered (n = 3). The evidence supports the effectiveness of lifestyle interventions delivered by nurses in PHC to affect positive changes on outcomes associated with the prevention of chronic disease including: weight, blood pressure, cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for change and quality of life. The strength of recommendations is limited by the small number of studies within each comparison group and the high risk of bias of the majority of studies.
Highlights
The international rise in obesity rates over the last three decades has been accompanied by an increase in preventable chronic diseases, such as type 2 diabetes, cardiovascular disease, stroke, arthritis and some cancers [1]
The aims of this research were to: (i) review the evidence of intervention effectiveness to change lifestyle risk factors when delivered by primary health care (PHC) nurses in a PHC setting; and (ii) inform the direction of future research to evaluate PHC nursing interventions to reduce lifestyle risk factors associated with overweight, obesity and preventable chronic diseases in adults
The key question informing this systematic review was: What does the published literature report on the effectiveness of interventions for adults which aim to affect change in lifestyle risk factors for chronic diseases that are associated with overweight and obesity, when these are delivered by a PHC nurse in a PHC setting?
Summary
The international rise in obesity rates over the last three decades has been accompanied by an increase in preventable chronic diseases, such as type 2 diabetes, cardiovascular disease, stroke, arthritis and some cancers [1]. Nurses in PHC are assuming an increasing proportion of the chronic disease management and preventive health advice [6]. Gemson 1990 [38] RCT in a large financial services firm over several sites, United States n = 295 (58% at 6-month FU), average age 40 years, 43% female ✕✕. Both groups received the same 30-min health check for cardiovascular RF and dietary advice by PNs. A blood sample was taken and cholesterol was measured using POC equipment. Ammerman 2003 [44] RCT in a variety of primary care settings, United States n = 468 (87% at 3-month FU and 75% at 12-month FU), average age 55 years, 71% female ✕✕.
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