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Volume 45, Issue 5, May 2016

Patients’ acceptance of SNAP assessment: An exploration

Charlotte Hespe Chun Wah Michael Tam Nicholas Zwar
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We previously described in Australian Family Physician a survey experiment that demonstrated patients’ acceptance of alcohol enquiry from their general practitioners (GPs) varied markedly depending on the reason for the initial presentation.1 A further qualitative study identified that the acceptability of these discussions was influenced by their perceived relevance. For many patients, this ‘was determined by whether the presenting complaint was seen to be an issue affected by alcohol drinking’.2

Is this finding isolated to assessment of drinking, or does it apply to other SNAP (smoking, nutrition, alcohol, physical activity) risk factors?3

Methods

We re-analysed data from the 66 questionnaire respondents from the intervention arm of the original survey experiment.1 In brief, the participants were adult patients who attended a general practice in Sydney, Australia in 2014. Two-thirds of the participants were female and the mean age was 53.6 years. Full demographics are available in the original paper.1 These participants rated the acceptability of GP enquiry (‘unacceptable’, ‘ambivalent’ or ‘acceptable’) of each of the four SNAP factors to 20 clinical vignettes. The vignettes were simple, written to a fifth grade student reading level,1 and based on the most frequent reasons for encounter and problems managed in Australian general practice.4

We ranked the vignette acceptability data and reported them descriptively. We used Friedman’s two-way analysis of variance (ANOVA) by ranks to analyse the differences in SNAP factor acceptability within the vignettes, and Wilcoxon signed rank test between specific factors (IBM SPSS Statistics 23).

This study was approved by the University of New South Wales’s (UNSW’s) Human Research Ethics Committee (reference number HC14074).

Results

The variation in the acceptance of GP enquiry to all four SNAP factors was substantial, ranging from half of participants (least acceptable vignettes) to all (most acceptable; Table 1). There were variations in SNAP factor acceptability within the vignettes. The vignettes where these differences were statistically significant (P ≤ 0.05) were: cough, sore throat, back pain, skin rash, depression, diabetes, arthritis, high lipids, gastro-oesophageal reflux disease (GORD), bronchitis, asthma and urinary tract infection.

For example, while all participants reported smoking enquiry was acceptable in the asthma vignette, 85%, 81% and 92% did so for nutrition, alcohol and physical activity enquiry respectively (P < 0.0001).

Table 1. GP enquiry of SNAP risk factors – ranked by patient acceptability
Smoking(%)*ÌýNutrition(%)*ÌýAlcohol(%)*ÌýPhysical
activity		(%)*
Most acceptable vignettes 1 Asthma 100 Ìý GORD 100 Ìý GORD 99 Ìý Arthritis 99
2 Check-up 99 Ìý Diabetes 99 Ìý Diabetes 97 Ìý Hypertension 99
3 Hypertension 97 Ìý High lipids 99 Ìý Hypertension 97 Ìý Check-up 97
4 Bronchitis 96 Ìý Hypertension 97 Ìý Check-up 96 Ìý Diabetes 97
5 Cough 96 Ìý Check-up 96 Ìý Depression 96 Ìý High lipids 97
6 Diabetes 92 Ìý Depression 94 Ìý High lipids 96 Ìý Depression 92
7 Sore throat 92 Ìý Arthritis 88 Ìý Anxiety 86 Ìý Asthma 92
8 High lipids 91 Ìý Skin rash 88 Ìý Arthritis 83 Ìý Back pain 89
9 GORD 88 Ìý Anxiety 85 Ìý Blood test 82 Ìý GORD 89
10 Anxiety 83 Ìý Asthma 85 Ìý Skin rash 82 Ìý Anxiety 88
Least acceptable vignettes 11 Arthritis 82 Ìý Blood test 82 Ìý Asthma 81 Ìý Cough 83
12 Depression 82 Ìý Sore throat 82 Ìý UTI 79 Ìý Blood test 82
13 Blood test 82 Ìý Bronchitis 80 Ìý Bronchitis 77 Ìý Bronchitis 79
14 Prescription 73 Ìý UTI 79 Ìý Cough 74 Ìý Prescription 73
15 Skin rash 73 Ìý Cough 76 Ìý Sore throat 74 Ìý Sore throat 71
16 Test results 71 Ìý Prescription 73 Ìý Prescription 73 Ìý Test results 70
17 UTI 62 Ìý Test results 71 Ìý Test results 71 Ìý Skin rash 68
18 Immunisation 59 Ìý Back pain 62 Ìý Back pain 61 Ìý UTI 62
19 Back pain 58 Ìý Immunisation 59 Ìý Immunisation 59 Ìý Gov’t forms 59
20 Gov’t forms 56 Ìý Gov’t forms 55 Ìý Gov’t forms 58 Ìý Immunisation 58
*Proportion of participants who responded that enquiry of the specified lifestyle risk factor in the vignette was acceptable
GORD, gastro-oesophageal reflux disorder; UTI, urinary tract infection

Discussion

Patients’ acceptance of GP enquiry for all four SNAP factors seems to vary depending on the reason for presentation. Ensuring that patients understand why we are interested in these issues may be a useful strategy; for instance, explicitly linking SNAP assessment to the presenting complaint.1,2

Authors

CW Michael Tam BSc(Med), MBBS, MMH(GP), FRACGP, Staff Specialist in General Practice, Fairfield Hospital – General Practice Unit, Prairiewood, NSW; Conjoint Senior Lecturer, UNSW Australia − School of Public Health and Community Medicine, Sydney, NSW. m.tam@unsw.edu.au

Nicholas Zwar MBBS, MPH, PhD, FRACGP, Professor of General Practice, UNSW Australia – School of Public Health and Community Medicine, Sydney, NSW

Charlotte Hespe MBBS(Hons), DCH, GCUT, FRACGP, FAICD, Head, General Practice Research and conjoint Head, General Practice, University of Notre Dame Australia − School of Medicine, Darlinghurst, NSW

Acknowledgements

This project was funded by an RACGP Family Medical Care, ±«ÓãÊÓƵ and Research Grant and the authors gratefully acknowledge the RACGP Foundation for their support.

References
  1. Tam CWM, Leong LH, Zwar N, Hespe C. Consultation contexts and the acceptability of alcohol enquiry from general practitioners – A survey experiment. Aust Fam Physician 2015;44(7):490–96. Available at www.racgp.org.au/afp/2015/july/consultation-contexts-and-the-acceptability-of-alcohol-enquiry-from-general-practitioners-%E2%80%93-a-survey-experiment [Accessed 4 April 2016].
  2. Tam CWM, Leong L, Zwar N, Hespe C. Alcohol enquiry by GPs – Understanding patients’ perspectives: A qualitative study. Aust Fam Physician 2015;44(11):833–38. Available at www.racgp.org.au/afp/2015/november/alcohol-enquiry-by-gps-%E2%80%93-understanding-patients%E2%80%99-perspectives-a-qualitative-study [Accessed 4 April 2016].
  3. ±«ÓãÊÓƵ. Smoking, nutrition, alcohol and physical activity (SNAP): A population health guide to behavioural risk factors in general practice. 2nd edn. East Melbourne, Vic: RACGP, 2004. Available at www.racgp.org.au/your-practice/guidelines/snap [Accessed 4 April 2016].
  4. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2011–12. General practice series no. 31. Sydney: Sydney University Press, 2012.
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Australian Family Physician was the peer-reviewed, scholarly journal of ±«ÓãÊÓƵ (RACGP) from 1971 to 2017. From January 2018, it was superseded by

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