tal rubella syndrome. It could be that signif- ... port more frequent use of seat belts and less smoking. ... probably include Ontario seat belt legisla- tion and ...
Physicians' and Nurses' Own 0
Health Practices We sent an anonymous self-report questionnaire on personal health practices to 141 nurses, 72 family physicians, and 171 specialists in the greater Hamilton area. All groups had similar lifestyle behaviors; differences between groups and between men and women were found for disease detection and prevention and health care use. Health professionals could significantly improve personal health practices, benefiting both themselves and their patients. Nous avons poste un questionnaire anonyme touchant les habitudes personnelles de sante a 141 infirmieres, 72 medecins de famille et a 171 specialistes de la region metropolitaine de Hamilton. Tous les groupes ont exprime des comportements semblables quant a leur mode de vie; on a constate des differences entre les groupes et entre les hommes et les femmes dans les domaines du depistage, de la prevention et de l'utilisation des ressources de sante. Les professionnels de la sante pourraient ameliorer significativement leurs habitudes sanitaires personnelles, ce qui serait benefique tant pour eux-memes que pour leurs patients. Can Fhm Physkian 1992;38:277-283.
A survg RONALD D. JANES, MD DOUGLAS M.C. W\ILSON, MID, CCFP JOEI, SINGER, PHD
EALH MiAI.NTrEN.ANCEL AND DIS-
prevention are being increasingly promoted among ease
the public,' physicians,2'and national and international organizations.6 A majority of physicians who have been surveyed believe they should play a significant role in counseling their patients to adopt a healthier lifestyle.7 10 It has been observed that physicians with good personal health practices appear to counsel their patients significantly more about health maintenance than do physicians with poorer health practices.89 Do physicians, with their superior health knowledge and daily exposure to the deleterious effects of poor health practices, look after themselves? On the whole, studies examining the health maintenance practices of American9 14 and British" physicians suggest that they are not much better or worse than their patients at most health maintenance activities. We wondered how health professionals in Canada - where access to health *
.-5 0 0 0 0 9 v v - v v v v v v v v v
*0 0 0 0 0 0
* 0 0 - 0 0 0 * 0 0 *
Dr Janes wXas, at the time the research zwas conducted, a Resident in the Depar2tment of Family Medicine, Alcfasrter (Tniversity, Hamilton, Ont, he is now in pirvate pratice in AN'w Zealand. Dr Wilson, a Fellowz of the College, is a Pmfessor and Dr Singer is an Assistant Clinicrl TNfessor at the Department of
Family Afedicine, AlcAfla(V tr (nizersiX.
care is not limited by personal ability to pay - compared with Canadians in general and with health professionals from other countries. A literature search of Index Medicus and Family Medicine Literature Index revealcd no articles examining the health maintenance practices of nurses or of Canadian physicians. To get some preliminary answers, we decided to conduct a questionnaire survey of a convenience sample of family physicians, nurses, and specialists in the greater Hamilton area.
METHODS A self-reporting questionnaire was developed to examine personal health maintenance activitics of health professionals: specifically, eight lifestyle, four disease prevention, and seven disease detection activities, as well as health care system use and treatment of self, spouse, and dependents with prescription drugs. The questionnaire was to be completed anonymously. Because we believed that busy professionals would not take the time to complete a long, detailed survey, we kept the questionnaire short: one double-sided sheet of paper, containing yes or no questions, with some questions asking for additional information in a checklist format. Completion took from 2 to 5 minutes.
Canadian Family Physician VOL 38: Februasy 1992 277
Table 1. DEMOGRAPHIC DATA (PERCENTAGES)
L.
MARRIED CHILDREN (64 NA
RN BSCN NA
73
100 70
95 58
100
96
57
58
29 47 20 2 0 2
10 50
9
0 71
0 29 32 37 2
74
17
Sob 40 Group 60
9
NA 0
20 20 0 0
26 30 30 5 0
67 26 7
0 0
Surgery 14 Mediane 43 NA 43
0
42 51 7
NA -.no answer The questions were chosen to permit comparisons to studies of physicians in other countries and to the Canada's Health Promotion Survey.'" While some questions were drawn from Canada's Health Promotion Survey,") that questionnaire was inappropriate for the purposes of this study because it was designed for a lay population, to be conducted in person over the telephone, and to assess attitudes and opinions as well as behaviors. It also did not address areas such as immunization, self-treatment, and having a family physician. The final draft of the questionnaire was assessed by staff physicians within the Department of Family Medicine, MlcMaster University, as having face validity. All the questions in the questionnaire used in this study wvere demonstrated to have retest reliability (kappa > 0.6), except for the question regarding alcohol consumption (kappa = 0.54; 95% confidence interval = 0.08 to 1.00). In mid-April 1989, the questionnaire was distributed once to the study populations in the greater Hamilton area, with no reminders. With the permission of the director of the Department of Nursing of an urban teaching hospital, 141 questionnaires (in-
278
0 29
Canadian Famill, IlIasician
\VO1 38: Februarl
1992
cluding self-addressed return hospital mail envelopes) were distributed to all full-time nurses along with their paycheques. WVith the permission of the head of the Department of Family NMedicine of a community hospital, all 72 family physicians attending a departmental meeting were individually handed a questionnaire on arrival and asked to complete it during the meeting and to either return it when they were leaving or mail it back later using an enclosed self-addressed, unstamped envelope. A community hospital was used because members of the Department of Family Medicine had been involved with the development of the questionnaire.
With the permissions of the heads of the Departments of MIedicine and Surgery of NIcNIaster University, questionnaires including self-addressed return hospital mail envelopes were sent vlia hospital mail to 103 medical and 68 surgical full-time specialists within the respective departments practising at various hospitals within the greater Hamilton area. The distribution technique was not uniform because of cost limitations and restrictions on how various heads of departments allowed the questionnaire to be distributed.
. . . . . . . . . . . . . . _.
Table 2. LIFESTYLE BEHAVIORS
FEMALE
NURSES (N = 112)
BEHAVIOR
%
PHYSICALLY ACTIVE
89
IDEAL BODY WEIGHT (±9 kg)
75
SMOKE TOBACCO
13
USE ILUEGAL DRUGS
7
Na
111
111
PHYSICIA.NS (N
=
27)
MALE PHYSICIANS (N = 136)
MALE FAIILY PHYSICIANS (N a 43)
Na
MALE SPECIALISTS (N - 93) °% Na
%
Na
%
81
93
135
91
93
85
86
134
86
86
11
8
7
9
%
4
Na
26
2
133
5
41
1
91
92
ap4Mm N is given, respondents who did not answer the question have been excluded. p < 0.05
_-~~~~~~~~~~~~~~~~~~~~~
RESULTS Statistical comparisons using the X2 statistic made between female nurses and female physicians, female physicians and male physicians, and male family physicians and male specialists. Age and sex were controlled for in the analysis. Nominal P values are reported, but significant differences with P values greater than .01 should be interpreted with caution because of the number of comparisons made. Response rates for the groups, as expected because of different formats, were significantly different (P < 0.001). Eighty-one percent of nurses (n = 1 4; 2 men, 1 2 women), 88% of family physicians (n = 63; 43 men, 20 women), and only 58% of specialists (n = 100; 93 men, 7 women) returned completed questionnaires. As only two of 114 responding nurses were male, their questionnaires were excluded from data analysis. Table I summarizes the demographic data. As anticipated, age and sex differences existed between the groups. Nurses were younger, less likely to be married, and had fewer children. Because we excluded the two were
male nurses, the study group was all female. Physicians were predominantly male; almost all were married; and more than 50% in each group had young children. Lifestyle behaviors Table 2 summarizes the results of reported lifestyle behaviors for female nurses, female physicians, male physicians, male family physicians, and male specialists. The groups compared were quite similar for all of eight lifestyle behaviors. However, more male physicians than female physicians reported exercising three times a week for 20 minutes (60% versus 46%), and more male family physicians than male specialists reported avoiding foods for health reasons (81 % versus 6 1 %). Two hundred thirty-eight of 275 health professionals responded yes to the statement "I drink alcoholic beverages" (36 responded no; 1 gave no answer). Of those consuming alcohol, two nurses and three male physicians reported consuming 14 or more drinks each week on average. More than half of all health professionals responded yes to the statement "I avoid certain foods for health reasons" (Table 2), Canadian Family Physician VOI, 38: February 1992
279
Table 3. DISEASE PREVENTION AND DETECTION ACTIVITIES
ACTIVITY TETANUS (
