Implementation of lifestyle recommendations in the Dutch medical specialists' guidelines: a mixed-methods cross-sectional survey study

INTRODUCTION: 

We recently showed that 65% of medical specialists' guidelines in the context of chronic disease management in the Netherlands contain recommendations on lifestyle. However, it remains unclear how these recommendations are perceived and implemented in clinical practice. 

OBJECTIVES: 

To analyse (1) the level of implementation of these recommendations and (2) the knowledge, attitudes and needs to further facilitate the implementation of lifestyle recommendations in chronic disease management within specialist care from both patient and healthcare professional perspectives. 

DESIGN: 

Mixed-methods cross-sectional study using two surveys. 

SETTING: 

Hospital care in the Netherlands. 

PARTICIPANTS: 

Medical specialists affiliated with the Dutch Association of Medical Specialists (n=193) and patients who had visited a medical specialist within the previous 6 months, recruited via the Dutch Patient Federation (n=1057).

EXPOSURE: 

Lifestyle recommendations embedded in clinical practice guidelines for chronic disease management. 

MAIN OUTCOME MEASURES: 

The level of implementation is assessed by the self-reported frequency of lifestyle discussions and familiarity with lifestyle recommendations in clinical practice guidelines. 

RESULTS:

Patients and medical specialists report different levels of implementation. While 72% of medical specialists reported discussing lifestyle topics during consultations, only 37% of patients recalled such discussions. Guideline familiarity among medical specialists was significantly associated with applying lifestyle advice in clinical practice (Fisher's exact test, p=0.02). Both groups expressed positive attitudes toward addressing lifestyle as part of medical specialist care consultations. Although medical specialists considered the lifestyle recommendations applicable, they identified key factors for successful implementation, including the framing of recommendations, patient motivation and capacity to make lifestyle changes and the organisational and societal contexts in which lifestyle recommendations are delivered. 

CONCLUSIONS: 

Although both medical specialists and patients recognise the importance of addressing lifestyle in healthcare, implementation in clinical practice can still be improved. Strengthening implementation requires institutions to allocate adequate resources to support these consultations, including protected time, targeted training and clearly defined referral pathways. Broader societal and political commitment, ensuring that prevention becomes a priority and shared responsibility across the healthcare ecosystem.