Carel Fieren - Academia.edu (original) (raw)

Papers by Carel Fieren

Research paper thumbnail of Nutrition guidance by primary care physicians: models and circumstances

European Journal of Clinical Nutrition, 1999

Research paper thumbnail of Cross-sectional and longitudinal analysis of nutrition guidance by primary care physicians

Research paper thumbnail of Cross-sectional and longitudinal analysis of nutrition guidance by primary care physicians

Research paper thumbnail of Information sources and strategies of nutrition guidance used by primary care physicians

American Journal of Clinical Nutrition - AMER J CLIN NUTR, 1997

We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also ... more We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also are growing opportunities, challenges, and tools for PCPs to become more actively involved in nutrition guidance of patients. Am J Clin Nutr l997;65(suppl): l996S-2003S.

Research paper thumbnail of Driving Forces for and Barriers to Nutrition Guidance Practices of Dutch Primary Care Physicians

Journal of Nutrition Education, 1997

Determinants of the nutrition guidance practices of primary care physicians (PCPs) were studied u... more Determinants of the nutrition guidance practices of primary care physicians (PCPs) were studied using a mail questionnaire developed on the basis of focus group discussions, in-depth interviews, and literature review. The questionnaire was sent to a nationwide random sample of 1000 PCPs (in practice for between 5 and 15 years).The net response rate was 64%. Multiple regression analysis was used to identify determinants of nutrition guidance practices. The independent variables studied were the perceived barriers to nutrition guidance practices, characteristics of the respondents, and nutrition attitudes and beliefs of PCPs. As determinants of nutrition guidance practices, we identified both perceived barriers (which exert a negative influence) and driving forces (which exert a positive influence).The driving forces observed in PCPs were an active interest in the effect of nutrition on health and disease, a basic level of nutrition knowledge, and positive attitudes towards nutrition guidance practices. Although perceived barriers can be strong, negative determinants of being involved in nutrition guidance practices, in future, it may become more important to stress the driving forces that positively determine the involvement of PCPs in nutrition guidance practices.

Research paper thumbnail of Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians

European Journal of Clinical Nutrition, 1999

Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guida... more Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice (`noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a crosssectional and a longitudinal approach. Design: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992. Subjects: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20 y. Interventions: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997. Main outcome measure: To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable`noticing patients' overweight and guidance of treatment' with an adequate ®t of the empirical data, both in the cross-sectional and in the longitudinal approach. Results: The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time.

Research paper thumbnail of Nutrition guidance by primary care physicians: models and circumstances

European Journal of Clinical Nutrition, 1999

The perception of primary care physicians of the ability to influence the lifestyle and eating ha... more The perception of primary care physicians of the ability to influence the lifestyle and eating habits of patients is an important factor in nutrition guidance practices. This perception is based on assumptions about the kind of influencing process that is effective or not and on the capacity of primary care physicians to play an effective role in these processes. The first elements is dealt with in this article. Three models are distinguished. The first model is the prescription model, based on a medical optimum and on information transfer as a metaphor. The second model is the persuasion model, based on a medical optimum, but presupposing blockades that have to be cornered by persuasive communication. The third is the interaction model. It is not based upon a medical but on an efficacy optimum, and on sharing of information and continuous involvement of the client in the interaction. Behind these three models we can perceive different views on communication and knowledge. Moreover, these three models are more or less appropriate with regard to different circumstances. The current stress on the psychological, social and cultural meaning of food and the new information context in which clients live, asks for more attention to the interaction model.

Research paper thumbnail of Consumers' expectations about nutrition guidance: the importance of primary care physicians

… of clinical nutrition, 1997

To clarify the role of the primary care physician and reach to nearly all segments of the populat... more To clarify the role of the primary care physician and reach to nearly all segments of the population, PCPs are in a unique position compared with dietitians and the FNEB. Am J C/in Nutr l997;65(suppl): 1974S-9S. KEY WORDS Primary care physician, dietitian, nutrition information, referral score, perceived expertise, Netherlands, factor analysis Innovation Studies.

Research paper thumbnail of Information sources and strategies of nutrition guidance used by primary care physicians

Amer J Clin Nutr, 1997

We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also ... more We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also are growing opportunities, challenges, and tools for PCPs to become more actively involved in nutrition guidance of patients. Am J Clin Nutr l997;65(suppl): l996S-2003S.

Research paper thumbnail of Nutrition guidance by primary care physicians: models and circumstances

European Journal of Clinical Nutrition, 1999

Research paper thumbnail of Cross-sectional and longitudinal analysis of nutrition guidance by primary care physicians

Research paper thumbnail of Cross-sectional and longitudinal analysis of nutrition guidance by primary care physicians

Research paper thumbnail of Information sources and strategies of nutrition guidance used by primary care physicians

American Journal of Clinical Nutrition - AMER J CLIN NUTR, 1997

We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also ... more We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also are growing opportunities, challenges, and tools for PCPs to become more actively involved in nutrition guidance of patients. Am J Clin Nutr l997;65(suppl): l996S-2003S.

Research paper thumbnail of Driving Forces for and Barriers to Nutrition Guidance Practices of Dutch Primary Care Physicians

Journal of Nutrition Education, 1997

Determinants of the nutrition guidance practices of primary care physicians (PCPs) were studied u... more Determinants of the nutrition guidance practices of primary care physicians (PCPs) were studied using a mail questionnaire developed on the basis of focus group discussions, in-depth interviews, and literature review. The questionnaire was sent to a nationwide random sample of 1000 PCPs (in practice for between 5 and 15 years).The net response rate was 64%. Multiple regression analysis was used to identify determinants of nutrition guidance practices. The independent variables studied were the perceived barriers to nutrition guidance practices, characteristics of the respondents, and nutrition attitudes and beliefs of PCPs. As determinants of nutrition guidance practices, we identified both perceived barriers (which exert a negative influence) and driving forces (which exert a positive influence).The driving forces observed in PCPs were an active interest in the effect of nutrition on health and disease, a basic level of nutrition knowledge, and positive attitudes towards nutrition guidance practices. Although perceived barriers can be strong, negative determinants of being involved in nutrition guidance practices, in future, it may become more important to stress the driving forces that positively determine the involvement of PCPs in nutrition guidance practices.

Research paper thumbnail of Cross-sectional and longitudinal analyses of nutrition guidance by primary care physicians

European Journal of Clinical Nutrition, 1999

Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guida... more Objective: To investigate in primary care physicians (PCPs) the determinants of a nutrition guidance practice (`noticing patients' overweight and guidance of treatment'), as well as their mechanism of action, in a crosssectional and a longitudinal approach. Design: Mixed longitudinal design. Five years follow up study of a previous cross-sectional study in October 1992. Subjects: A representative sample of 675 Dutch PCPs, in practice for 5 up to 20 y. Interventions: A shortened version of the Wageningen PCPs Nutritional Practices Questionnaire was mailed to the subjects in August 1997. Main outcome measure: To obtain with the LISREL-program a model of the mechanism of action of determinants of the dependent variable`noticing patients' overweight and guidance of treatment' with an adequate ®t of the empirical data, both in the cross-sectional and in the longitudinal approach. Results: The same set of predisposing factors and intermediary factors explains the dependent variable both in two different representative cross-sectional study populations of PCPs, and in a cohort cross-sectional study at two points in time.

Research paper thumbnail of Nutrition guidance by primary care physicians: models and circumstances

European Journal of Clinical Nutrition, 1999

The perception of primary care physicians of the ability to influence the lifestyle and eating ha... more The perception of primary care physicians of the ability to influence the lifestyle and eating habits of patients is an important factor in nutrition guidance practices. This perception is based on assumptions about the kind of influencing process that is effective or not and on the capacity of primary care physicians to play an effective role in these processes. The first elements is dealt with in this article. Three models are distinguished. The first model is the prescription model, based on a medical optimum and on information transfer as a metaphor. The second model is the persuasion model, based on a medical optimum, but presupposing blockades that have to be cornered by persuasive communication. The third is the interaction model. It is not based upon a medical but on an efficacy optimum, and on sharing of information and continuous involvement of the client in the interaction. Behind these three models we can perceive different views on communication and knowledge. Moreover, these three models are more or less appropriate with regard to different circumstances. The current stress on the psychological, social and cultural meaning of food and the new information context in which clients live, asks for more attention to the interaction model.

Research paper thumbnail of Consumers' expectations about nutrition guidance: the importance of primary care physicians

… of clinical nutrition, 1997

To clarify the role of the primary care physician and reach to nearly all segments of the populat... more To clarify the role of the primary care physician and reach to nearly all segments of the population, PCPs are in a unique position compared with dietitians and the FNEB. Am J C/in Nutr l997;65(suppl): 1974S-9S. KEY WORDS Primary care physician, dietitian, nutrition information, referral score, perceived expertise, Netherlands, factor analysis Innovation Studies.

Research paper thumbnail of Information sources and strategies of nutrition guidance used by primary care physicians

Amer J Clin Nutr, 1997

We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also ... more We studied the nutrition information seeking behavior of primary care physicians (PCPs) and also are growing opportunities, challenges, and tools for PCPs to become more actively involved in nutrition guidance of patients. Am J Clin Nutr l997;65(suppl): l996S-2003S.