Physicians' perceptions of their role in cardiovascular risk reduction

Fifty randomly selected family physicians were interviewed to evaluate the role of primary care physicians in the reduction and control of cardiovascular risk in their patients. The interview schedule, developed from the PRECEDE framework, incorporated three categories of factors modifying behavior: predisposing, reinforcing, and enabling. In relation to high blood pressure, elevated serum cholesterol, and smoking, physicians were questioned regarding (a) knowledge and beliefs of desirable practice, (b) perceptions of personal ability, (c) factors that affect their preventive performance, and (d) perceptions of their own role and those of other resources. Physicians believed all three risk factors to be modifiable, and that reduced cardiovascular risk could prolong life and improve quality of life. Participants perceived themselves most effective in reducing high blood pressure, followed by serum cholesterol reduction and smoking cessation. Relationships with patients, patient compliance, personal committment, and belief in the efficacy of risk reduction were most frequently perceived to contribute to effectiveness. Physicians perceived themselves least skilled in enhancing patient compliance and achieving behavior change. Most physicians were committed to cardiovascular disease prevention and saw their own role as central. Contributions of other resources were not well understood. The effect of these complex and interacting perceptions has implications for attempts to enhance physicians' preventive activities.