Quality indicators for lifestyle or behavioural management for the primary prevention of cardiovascular disease in primary care: a systematic review

BACKGROUND:
Monitoring lifestyle or behavioural risk factors using quality indicators is critical for the primary prevention of cardiovascular disease (CVD).

AIM:
To summarise indicators for monitoring lifestyle risk factors for the primary prevention of CVD.

DESIGN & SETTING:
A systematic review of quality indicators in primary care.

METHOD:
Four research databases and grey literature were searched to identify articles (indicator sets) used to monitor lifestyle risk factors. Articles were assessed for methodological quality using the Appraisal of Indicators through Research and Evaluation instrument. Articles with strong methodological quality, scoring≥50% in each domain (ie, relevance, stakeholder involvement, scientific evidence, and usage) were included. Indicators were categorised into assessment of lifestyle risk factors or advice on healthy lifestyle.

RESULTS:
We identified 39/282 (14%) articles including indicators to monitor lifestyle risk factors from a full-text review. Of these,19/39 (49%) articles with strong methodological quality, comprising 90 unique indicators, were included. Most of the indicators were on assessing smoking status (21%), body weight (18%); advice on smoking cessation (13%), immunisation (9%), and advice on physical activity (8%). Assessment alcohol consumption (3%) and healthy eating (2%) were the least reported. When comparing assessment vs. advice indicators, we found gaps in monitoring smoking status (41% assessment vs. 27% advice) and body weight (35% vs.14%). Notably, there were more indicators for advice on (16%), than assessment of (4%) healthy eating.

CONCLUSION:
We identified several indicators for the monitoring of lifestyle risk factors. However, there is a need to ensure an appropriate mix of indicators on assessment vs. advice.