Table 1 Summary of Emergent Themes

_Three distinct conceptions of prevention:

_Traditional model of prevention: primary (avoid disease), secondary (modify disease), and tertiary (ameliorate disease).

_Public health model: epidemiological-based prevention practiced largely outside of the clinic realm (e.g., sanitation, vaccination programs).

_Wellness model: state of high functioning of mind, body, and spirit across the health/disease spectrum.

Summary: Physicians acknowledge and strongly endorse the benefits of primary prevention. However, medical training emphasis on secondary prevention (treatment) resulted in physicians feeling unskilled to deal with issues of primary prevention and health promotion, regardless of their conceptualization of prevention.

Physicians' View of Patients' Perspectives of Preventive Care

_Patients typically entered the clinical arena seeking secondary prevention.

_The lay media (i.e., television, advertisement, print, Internet) often influenced and distorted patients' perceptions of their risks and health care needs and wants.

_Patients were predominantly interested in quick fixes to their health care needs.

_Patients expressed "ignorant bliss" (i.e., if they weren't experiencing or knowledgeable about disease symptoms, then their health was not in jeopardy).

Summary: Physicians had to overcome the barriers associated with patients' mindsets and notions of risk in order to provide preventive care.

Focusing on Behavioral Change

_Physicians wanted patients to accept more personal responsibility for their own health.

_Unwilling patients were difficult to motivate and unlikely to change, regardless of suggested change method.

_Physicians' lack of behavioral change training was a significant impediment to promoting patient behavioral change.

Summary: Behavioral change was perceived as an important base to the promotion of primary prevention and wellness. However, physician delivery of health behavioral counseling was hampered by physicians' lack of training in behavioral change concepts and techniques and perceived low self-efficacy.