Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health



First Advisor

Dr. Nancy E. Schoenberg


The Nature and Perceived Influence of Lifestyle Discussions with Older Adults in Primary Care Rationale: A healthy diet and physical activity help with disease prevention and disease management and can promote quality of life regardless of the age at which an individual begins engaging in these behaviors. Despite the value of these health behaviors, many older adults do not follow lifestyle recommendations. Given that older adults frequently interact with the healthcare system, primary care providers are well situated to counsel older adults to improve their health behaviors. Unfortunately, we do not know how to most effectively engage in this counseling. The purpose of this dissertation is to better understand whether and how providers discuss diet and physical activity with their older patients and how patients perceive their providers’ communication regarding diet and physical activity.

Method: One hundred and four older adults, ranging in age from 65 to 95, consented to have their routine primary care visits recorded and immediately following their visits engaged in semi-structured interviews regarding current health behaviors and perceptions of their providers’ diet and physical activity recommendations. Clinical visits were selectively transcribed and analyzed using qualitative description. Interviews were transcribed verbatim, coded, and analyzed through a process of constant comparison.

Findings: Discussions of diet and physical activity occurred in over two thirds of visits; recommendations for diet and physical activity occurred in less than half of these discussions. The majority of patients correctly recalled whether or not discussions of diet or physical activity had taken place. Patients reported that the likelihood of engaging in healthy diet and physical activity related to personal motivation and perceived confidence in the ability to make effective changes, both of which could be influenced by providers’ recommendations. When providers did not discuss diet or physical activity, or mentioned these topics only briefly, patients often perceived the message that they should continue with their current behaviors.

Implications: These findings support an integrated theoretical framework, highlighting the role of autonomy and confidence, for understanding how providers can promote patients’ health behaviors. Implications for providers’ training and the healthcare system are discussed.