Legitimacy, trust and readiness for implementing lifestyle medicine in England: a cross-sectional study

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A secondary objective was to assess how professional training and system factors relate to the provision and intended use of lifestyle medicine services within the NHS. Design Cross-sectional, self-administered online survey. Setting United Kingdom; online survey administered in January 2026. Participants Adults aged ≥ 18 years living in the UK, recruited via a closed online panel using quota sampling to approximate national distributions by age, gender and ethnicity. A subgroup of respondents self-identified as healthcare professionals. Main outcome measures Primary outcomes were perceived legitimacy of lifestyle medicine as a healthcare approach and intention to use an NHS lifestyle medicine service if available. Secondary outcomes included awareness and familiarity with the term “lifestyle medicine,” trust in different providers of lifestyle advice, perceived self-efficacy across lifestyle domains and - among HCPs - training, confidence, barriers and current provision of lifestyle-related advice. Results A total of 733 participants completed the survey, including 58 HCPs. Awareness of the term “lifestyle medicine” was limited in the general population (26.3%) but substantially higher among HCPs (62.1%). Despite this, there was broad agreement across groups regarding core lifestyle medicine domains; particularly nutrition, physical activity, sleep and stress management. Higher perceived legitimacy of lifestyle medicine was strongly associated with stated intention to use an NHS service. Trust in lifestyle advice was highest when delivered by clinicians with formal lifestyle medicine training and lower for non-medical professionals, even when formally trained. Among HCPs, formal training and greater confidence were strongly associated with provision of lifestyle-related advice, whereas perceptions of NHS support for lifestyle-based approaches were consistently low regardless of training status. Conclusions Lifestyle medicine is widely viewed as legitimate and potentially valuable when anchored within professional training and NHS delivery but its implementation is constrained by limited public familiarity, variable workforce capability and low perceived system readiness. Strengthening training pathways, clarifying professional standards and enhancing institutional support may be critical to embedding lifestyle medicine within NHS prevention and long-term condition strategies Lifestyle medicine Prevention Health behaviour Healthcare professionals Trust and legitimacy Health services implementation Primary care National Health Service Cross-sectional survey United Kingdom Figures Figure 1 Figure 2 Figure 3 Background Non-communicable diseases (NCDs) remain the dominant cause of preventable morbidity and mortality worldwide, accounting for most deaths and a substantial share of premature mortality. The World Health Organization (WHO) estimates that NCDs caused at least 43 million deaths in 2021, with a high proportion occurring prematurely and disproportionately affecting low- and middle-income countries ( 1 ). Although health systems continue to invest heavily in downstream diagnosis and treatment, the upstream drivers of NCD incidence and progression remain strongly patterned by modifiable behavioural and social exposures raising persistent questions about how health services can deliver prevention at scale, equitably and with public legitimacy. The contemporary epidemiology of avoidable illness highlights the centrality of self-care, behavioural and lifestyle-related risk factors. Global comparative risk assessment analyses consistently identify diet-related risks, high body-mass index, tobacco exposure and insufficient physical activity among the most important contributors to mortality and disability ( 2 ). In parallel, the rapid growth of high BMI as a risk factor has outpaced improvements in physical activity and diet quality in many settings, suggesting that prevention requires more than information provision and individual willpower alone ( 3 ). This body of evidence has strengthened interest in approaches that integrate behaviour change support into routine care and address the everyday determinants of health in ways that are clinically credible, acceptable to the public and feasible within health-system constraints. “Lifestyle medicine” has emerged as a label for a structured, clinical approach to using evidence-based behavioural interventions as primary therapeutic modalities to prevent, treat and, where evidence supports, modify the course of chronic disease. In the UK context, the Royal College of General Practitioners has articulated lifestyle medicine within general practice as evidence-based clinical care using person-centred behaviour change techniques across core domains including healthy eating, physical activity, restorative sleep, mental wellbeing/stress, relationships/social connection and minimising harmful substances ( 4 ). Internationally, the American College of Lifestyle Medicine and aligned programmes commonly describe “six pillars” that closely map to these domains, offering a pragmatic taxonomy for education, service design and clinical quality improvement. Reflecting the maturation of the field, the European Lifestyle Medicine Organisation has recently expanded its lifestyle medicine framework to include two additional pillars (vi) sexual health and fertility, and (vii) environmental exposure, signalling a shift towards a more comprehensive, life-course and planetary-health–aligned conception of prevention ( 5 ). The increasing formalisation of the field has also been reflected in professional development initiatives, including the UK’s competency-framed pathway for GPs with extended roles, developed in collaboration with the British Society of Lifestyle Medicine ( 6 ). The preventive and therapeutic potential of structured lifestyle intervention is supported by landmark trial evidence in specific disease areas. In high-risk populations, intensive lifestyle programmes have demonstrated large relative reductions in incident type 2 diabetes compared with usual care, notably in the Diabetes Prevention Program and the Finnish Diabetes Prevention Study ( 7 ). These trials are often cited as proof-of-concept that behavioural interventions can be delivered with clinical rigour and measurable outcomes. However, the translation of such evidence into practice raises distinct questions: who trusts lifestyle-focused advice, under what conditions does it appear legitimate (as opposed to “wellness”) and how do system constraints shape delivery in real-world practice? In England, the policy environment has increasingly favoured prevention, self-management and community-oriented models of care. The NHS England Long Term Plan emphasised major strategic shifts including a stronger focus on prevention and better support for people to manage health outside hospital settings ( 8 ). Prevention-oriented service models are now well established in certain pathways, including the Healthier You NHS Diabetes Prevention Programme (NHS DPP), which offers a structured lifestyle change programme (including digital options) for people identified as at elevated risk ( 9 ). National evaluation work has also examined effectiveness and cost-effectiveness of the NHS DPP, highlighting both promise and the importance of implementation factors such as uptake, retention and delivery fidelity ( 10 ). These developments suggest that “lifestyle” is no longer peripheral to the NHS but is rather increasingly institutionalised within prevention and long-term condition strategies. Yet implementation at scale depends on more than the availability of services. Behaviour change practice in routine care requires workforce skills, time, training and evidence-informed design. National guidance from the National Institute for Health and Care Excellence sets out principles for individual-level behaviour change interventions (including goal setting, feedback, monitoring and social support), reflecting a longstanding recognition that effective behaviour change is structured and requires competencies that are not automatically acquired through clinical training ( 11 ). Updated NICE guidance on overweight and obesity further illustrates how prevention and management are framed as system responsibilities requiring coordinated interventions rather than isolated patient advice ( 12 ). In this context, lifestyle medicine can be seen as an attempt to assemble clinical behaviour change, prevention science and whole-person care into a coherent practice model, but its adoption will be shaped by whether clinicians feel prepared and supported and whether patients interpret the approach as credible, relevant and fair. Public legitimacy and trust are particularly salient given the contemporary information environment. Health knowledge and risk perception are increasingly mediated by digital platforms where misinformation can spread rapidly and erode confidence in authoritative institutions ( 13 ). The WHO has explicitly framed “infodemics” as a public health threat because information overload and false or misleading content can drive confusion, harmful behaviours and mistrust ( 14 ). Lifestyle medicine is especially exposed to these dynamics because it sits at the intersection of everyday habits, commercial wellness markets and contested online health narratives. As a result, the acceptability of lifestyle medicine services may depend not only on perceived effectiveness but also on who delivers advice, what credentials are valued and how people distinguish evidence-based care from generic wellness messaging. There are also practical questions about how “lifestyle support” is operationalised across NHS and community settings. Social prescribing has been positioned as one mechanism to connect people to non-clinical supports that address wider determinants of health, with link workers embedded in primary care and a focus on “what matters to me?” care planning ( 15 ). However, evidence syntheses have highlighted gaps in robust outcomes evidence for social prescribing link workers and variability in implementation, prompting calls for stronger evaluation and clearer expectations about impacts ( 16 ). This matters because, in practice, lifestyle medicine pathways may draw on a mixed ecology of NHS-delivered services, commissioned prevention programmes and community assets; the public’s and professionals’ confidence in these pathways may therefore reflect perceived coherence, governance and quality assurance. The primary aim of this study was to characterise how lifestyle medicine is understood and regarded as a credible healthcare approach among community-dwelling adults and healthcare professionals, with particular attention to perceived legitimacy, trust and acceptability within an NHS context. We also sought to (i) quantify awareness and familiarity with the term “lifestyle medicine” and identify sociodemographic and professional predictors of familiarity; (ii) examine how perceived legitimacy relates to stated intention to use an NHS lifestyle medicine service; (iii) describe preferences for service delivery and trusted providers for lifestyle support; (iv) assess perceived control/self-efficacy across lifestyle domains relevant to behaviour change; and (v) among healthcare professionals, examine the relationships between training, confidence, perceived barriers and current provision of lifestyle-related advice, alongside perceptions of NHS readiness to support lifestyle-based care. Methods Design and reporting standard We conducted a cross-sectional, self-administered online survey of adults living in the UK. Reporting complied with the Checklist for Reporting Results of Internet ESurveys (CHERRIES); Supplementary file 1 . Setting, dates and eligibility The online survey was open from 9 to 23 January 2026. Eligibility required age ≥ 18 years and the ability to read English. Participants accessed an anonymous web link and completed the instrument on desktop or mobile devices. Sampling frame, openness and recruitment Participants were recruited exclusively via the Prolific Academic panel using quota sampling to approximate the UK adult population by age, gender and ethnicity. The survey was implemented as a closed panel study, with access restricted to Prolific participants via unique panel identifiers. No targeted incentives beyond standard panel compensation were used. Because recruitment was conducted through a closed panel, CHERRIES view and participation rates are defined by the panel provider rather than site visitor counts; completion among eligible respondents is reported below. This sampling approach prioritised internal validity and comparability across respondents over maximising reach. Platform and delivery The instrument was implemented in the Qualtrics XM Platform (Qualtrics International Inc., Provo, UT). The platform captured timestamps, device metadata, IP address and coarse geolocation if permitted by the browser. These variables were used solely for data quality checks and are not reported in identifiable form. The instrument used concise items, varied stems and mandatory responses with neutral options where appropriate. Device type and completion time distributions were inspected to flag implausible submissions; no thresholds triggered exclusion. Instrument development and pretesting The survey was developed to assess public knowledge, attitudes, experiences and perceived role of lifestyle medicine in health and healthcare settings. Drawing on established lifestyle medicine frameworks and prior population health surveys, the questionnaire comprised six main sections assessing: (i) sociodemographic characteristics; (ii) awareness and familiarity with the concept of lifestyle medicine; (iii) perceptions, legitimacy and trust in lifestyle-based approaches within healthcare; (iv) self-reported lifestyle behaviours across core lifestyle medicine domains (nutrition, physical activity, sleep, stress management, substance use and social connection); (v) perceived control and confidence over lifestyle-related behaviours and change; and (vi) preferences for service delivery, training and system-level support for lifestyle medicine, including perspectives from health and care professionals. Awareness of lifestyle medicine was measured by prior exposure to the term, sources of exposure and self-rated familiarity on a five-point scale. Perceptions and attitudes were assessed using Likert-type agreement scales capturing perceived legitimacy, distinction from general wellness advice, trust in trained professionals, perceived effectiveness for prevention and long-term condition management, and appropriateness for inclusion within NHS care pathways. Self-reported lifestyle behaviours were measured using brief frequency-based items covering physical activity, fruit and vegetable intake, sleep duration, alcohol consumption, nicotine use, stress-management strategies, loneliness and social connection. Perceived control over lifestyle domains (e.g. diet, exercise, sleep, stress, substance use, social habits) was assessed using five-point scales ranging from “no control at all” to “complete control,” with “not applicable” options where relevant. Among participants identifying as health or care professionals, additional items assessed provision of lifestyle-related advice, confidence, training exposure, perceived barriers to delivery and views on current system support. Preferences for future service models and training needs were assessed across the full sample. The questionnaire underwent internal piloting to refine wording and routing logic before launch. A copy of the survey is included in Supplementary file 2 . Page design, adaptive questioning, completeness checks and timing The online survey was administered across multiple pages with a visible progress indicator to support completion. Adaptive questioning was applied using limited branching logic: questions relating to professional roles, delivery of lifestyle advice and training needs were displayed only to participants who identified as working in health or care roles; similarly, questions on sources of awareness were displayed only to those reporting prior exposure to the term “lifestyle medicine.” Most attitudinal, behavioural and outcome items were set as required to minimise missing data, with “prefer not to say” options provided for sensitive demographic variables. The survey platform enforced completeness checks before respondents could advance between pages. Average completion time was under 10 minutes. In line with CHERRIES guidance, post-hoc checks were conducted to identify potential duplicate entries; IP addresses were inspected for repetition, and no duplicate responses were retained in the final dataset. Outcomes and measures The primary outcomes were (i) perceived legitimacy and acceptability of lifestyle medicine within healthcare, assessed using agreement ratings on five-point Likert scales, and (ii) self-reported perceived control and confidence over key lifestyle domains relevant to lifestyle medicine practice. Secondary outcomes included awareness and familiarity with lifestyle medicine, trust in different providers of lifestyle-related advice (e.g. clinicians, allied health professionals, dietitians, trained non-medical professionals), self-reported lifestyle behaviours, perceived barriers and facilitators to lifestyle change, and preferences for service delivery models within the health system. Among health and care professionals, secondary outcomes additionally included frequency of delivering lifestyle-related advice, confidence in doing so, exposure to formal training, perceived system-level barriers (e.g. time, resources, pathways) and perceived adequacy of current NHS support for lifestyle-based approaches. All items, response options and coding rules are provided in the Supplementary Materials and the statistical analysis plan. Statistical analysis Descriptive statistics were used to summarise participant sociodemographic characteristics, awareness and familiarity with lifestyle medicine, self-reported lifestyle behaviours, perceived control over lifestyle domains, attitudes towards lifestyle medicine, trust in providers of lifestyle-related advice and preferences for service delivery. Categorical variables were summarised using frequencies and percentages, while continuous variables were summarised using means, standard deviations, minimum and maximum. Multivariable analyses employed ordinal logistic regression to estimate unadjusted and adjusted odds ratios (ORs and aORs) with 95% confidence intervals (CIs) for familiarity with the term "lifestyle medicine." Candidate predictors included age, sex, educational attainment, ethnicity, employment status, and current status as a health or care professional. The fully adjusted model included all sociodemographic and professional covariates simultaneously to identify independent predictors of familiarity. Bivariate associations between categorical variables were examined using Fisher's exact test, with effect sizes estimated using Cramér's V and contingency coefficients where appropriate. These analyses explored relationships between: (i) perceived legitimacy of lifestyle medicine and intention to use NHS lifestyle medicine services; (ii) professional characteristics (training status, confidence levels, and perceived barriers) and provision of lifestyle-related advice among healthcare professionals; and (iii) formal training status and perception of NHS support for lifestyle-based approaches. For the contingency table analysis examining perceived legitimacy and service use intention, Monte Carlo simulation methods were employed to compute Fisher's exact test p-values. Effect sizes were interpreted using conventional thresholds (Cramér's V: 0.30 strong). Among healthcare professionals, Fisher's exact tests examined associations between training, confidence, perceived barriers (time constraints and patient readiness), and frequency of providing lifestyle advice. Statistical significance was set at p < 0.05. All analyses were performed using STATA, version 18 (StataCorp LP, College Station, TX, USA). Ethics, consent and data protection The study was approved by the Imperial College Research Ethics Committee (ICREC #7696202) and complied with UK GDPR. Participants viewed an information sheet and provided electronic informed consent before answering any items; consent pages described purpose, voluntary nature, data handling and contact details. No direct personal identifiers were collected. IP addresses and coarse location, captured by the platform, were accessible only to the core research team for fraud and duplication checks and were not used to reidentify participants. Data were stored on secure institutional servers and analysed in deidentified form. Patient and public involvement The survey was developed by the research team and after several iterations, the instrument was passed on to three lay members for comments. The survey was iterated again among the research team partners to arrive at the final version. Results Participant characteristics A total of 733 participants were included in the analysis (Table 1 ). The mean age of the study population was 45.6 years (SD = 14.8; range 18–84). The sample was gender-balanced, consisting of 51.2% women and 48.0% men. Most participants identified as White (83.1%), followed by Asian or Asian British (8.6%). Educational attainment was generally high, with 62.6% of the total cohort holding a university or postgraduate degree. Regarding employment status, nearly half of the participants were employed full-time (46.9%), while 13.2% worked part-time and 12.4% were retired. A subgroup of 58 participants (7.9%) were healthcare professionals (HCPs). Compared to the total sample, the HCP subgroup had a slightly lower mean age of 43.6 years (SD = 12.9) and a higher proportion of women (63.8%); Table 1 . The HCP subgroup also demonstrated higher educational qualifications, with 48.3% holding a postgraduate degree, greater ethnic diversity, particularly regarding Asian or Asian British background (22.4%) and a higher prevalence of full-time employment (63.8%). The findings of the full survey are presented in Supplementary Table 1. Table 1 Participants’ characteristics Variable Frequency (Percentage) All participants (N = 733) HCPs (N = 58) Age, Mean (SD) [min – max] 45.6 (14.8) [18–84] 43.6 (12.9) [18–75] What is your gender? Man 352 (48.0%) 21 (36.2%) Woman 375 (51.2%) 37 (63.8%) Non-Binary 1 (0.1%) 0 (0%) Prefer not to say 5 (0.7%) 0 (0%) Which of the following best describes your background? White 609 (83.1%) 37 (63.8%) Asian or Asian British 63 (8.6%) 13 (22.4%) Black, African, Caribbean or Black British 29 (4.0%) 3 (5.2%) Mixed or Multiple ethnic groups 16 (2.2%) 2 (3.4%) Other ethnic group 10 (1.4%) 2 (3.4%) Prefer not to say 6 (0.8%) 1 (1.7%) What is your highest level of education? Secondary school or equivalent 79 (10.8%) 5 (8.6%) A-levels/college or equivalent 191 (26.1%) 5 (8.6%) University degree 282 (38.5%) 19 (32.8%) Postgraduate degree 177 (24.1%) 28 (48.3%) Prefer not to say 4 (0.5%) 1 (1.7%) What is your current employment status? Employed full-time 344 (46.9%) 37 (63.8%) Employed part-time 97 (13.2%) 11 (19.0%) Homemaker / unpaid carer 24 (3.3%) 0 (0%) Retired 91 (12.4%) 0 (0%) Self-employed 80 (10.9%) 7 (12.1%) Student 31 (4.2%) 1 (1.7%) Unable to work due to long-term illness or disability 20 (2.7%) 0 (0%) Unemployed / looking for work 43 (5.9%) 2 (3.4%) Other 3 (0.4%) 0 (0%) Awareness and Understanding of Lifestyle Medicine Awareness of the term 'lifestyle medicine' varied significantly between the total cohort and the HCP subgroup ( Supplementary Table 1 ). While only 26.3% of the total sample had heard of the term prior to the survey, this figure rose to 62.1% among HCPs. The distribution of familiarity scores differed markedly by professional status, with the general cohort skewed heavily towards lower awareness (mode = 1; 38.7%). In contrast, HCPs demonstrated a clear shift towards greater familiarity, with nearly half (46.5%) reporting high confidence scores of 4 or 5 compared to only 12.6% of the total sample (Fig. 1 ). The sources of information also differed; the general population primarily encountered the term via social media (13.6%), whereas HCPs were more likely to hear about it through Online health information websites (24.1%) then workplace or university settings (22.4%). Despite low familiarity with the specific terminology, there was a high consensus across all participants regarding the core components of lifestyle medicine frameworks, with nutrition (91.5%), physical activity (82.8%), sleep (86.6%) and stress management (78.3%) universally recognised as key elements. Attitudes and Perceived Legitimacy Attitudes toward lifestyle medicine were generally positive, though stronger among clinical professionals. While 43.8% of the total cohort agreed that lifestyle medicine is a legitimate healthcare approach, HCPs demonstrated stronger conviction, with 48.3% strongly agreeing. There was widespread agreement regarding the need for education; 72.4% of all participants and 86.2% of HCPs agreed or strongly agreed that medical professionals should receive formal training in lifestyle-based approaches. Trust in advice was heavily influenced by the provider's professional status; participants expressed high trust (73.4%) in advice from clinicians with formal lifestyle training, but trust dropped notably for non-medical professionals (42.4%), even if they held lifestyle medicine qualifications (Fig. 2 ). Personal Lifestyle Behaviours and Self-Efficacy Regarding personal health behaviours, perceived control varied by domain ( Supplementary Table 1 ). Participants reported high levels of control (combined "A lot" and "Complete") over substance use (71.4%) and diet (76.8%), but lower perceived control over stress (23.3%) and environmental exposures (30.5%). When asked about hypothetical changes in the next three months, HCPs generally reported higher self-efficacy regarding sleep (41.4%) and stress management (27.6%) compared to the general population. Service Delivery Preferences and NHS Implementation There was substantial support for integrating lifestyle medicine into public health services. Nearly half of the total participants (46.9%) and two-thirds of HCPs (67.2%) stated they would use a lifestyle medicine service if available via the NHS. When asked about resource allocation, 81.0% of HCPs believed the NHS should increase investment in these services, compared to 62.2% of the general cohort. In terms of delivery format, there was a clear preference for one-to-one consultations (56.2%) and app-based guidance (51.0%) over group (16.0%) and peer support (17.6%). Healthcare Professional Perspectives and Barriers Among the subgroup of HCPs (n = 58), 48.3% reported currently providing lifestyle-related advice to patients, yet only 20.7% had received formal training in the discipline ( Supplementary Table 1 ). Interest in further education was high, with 62.1% expressing a desire for training or resources. HCPs identified systemic and practical hurdles to implementation; the most frequently cited barriers to delivering lifestyle advice included patient readiness or interest (55.2%), time constraints (50.0%) and a lack of training (41.4%). Furthermore, only 3.4% of HCPs felt the NHS currently supports lifestyle-based approaches "very well". Sociodemographic and Familiarity with Lifestyle Medicine Ordinal logistic regression analyses were conducted to examine the association between educational attainment and familiarity with the term "lifestyle medicine," adjusting for potential confounders (Table 2 ; Fig. 3 ). Contrary to the primary hypothesis, educational attainment was not a statistically significant predictor of familiarity with lifestyle medicine. In both unadjusted and adjusted models, higher levels of education did not correspond to higher odds of familiarity compared to the reference group (secondary school education). Even among those with a postgraduate degree, the increased odds observed in the unadjusted analysis (OR 1.54) were attenuated in the adjusted model and remained non-significant (aOR = 1.31; 95% CI 0.79 to 2.20; p=.297). Table 2 Association between sociodemographic characteristics and familiarity with the term "lifestyle medicine" (unadjusted and multivariable adjusted ordinal logistic regression analyses) Predictor Unadjusted Adjusted Odds ratio 95% Confidence Interval p Odds ratio 95% Confidence Interval p Lower Upper Lower Upper Highest level of education? Secondary school or equivalent Ref. Ref. A-levels/college or equivalent 1.07 0.66 1.74 0.785 1.12 0.68 1.87 0.658 University degree 1.16 0.73 1.84 0.531 1.08 0.66 1.75 0.766 Postgraduate degree 1.54 0.95 2.53 0.082 1.31 0.79 2.20 0.297 Age (years) 1.00 0.99 1.01 0.933 1.00 0.99 1.01 0.689 Gender Man Ref. Ref. Woman 0.96 0.74 1.25 0.776 0.91 0.68 1.20 0.494 Current employment status Employed full-time Ref. Ref. Employed part-time 1.12 0.75 1.67 0.587 1.08 0.70 1.66 0.739 Homemaker / unpaid carer 0.57 0.26 1.17 0.129 0.70 0.31 1.50 0.365 Retired 0.99 0.65 1.51 0.978 1.18 0.70 1.99 0.544 Self-employed 1.34 0.83 2.14 0.228 1.37 0.84 2.21 0.204 Unemployed / looking for work 0.55 0.30 0.98 0.047 0.61 0.33 1.11 0.110 Student 1.50 0.80 2.79 0.204 1.82 0.90 3.67 0.094 Unable to work due to long-term illness or disability 0.50 0.20 1.17 0.118 0.58 0.23 1.37 0.226 Other (please specify) 1.41 0.15 12.52 0.755 1.78 0.17 16.87 0.610 Ethnic background White Ref. Ref. Asian or Asian British 1.53 0.93 2.52 0.093 1.33 0.80 2.22 0.269 Black, African, Caribbean or Black British 2.01 1.03 3.89 0.039 2.07 1.04 4.10 0.036 Mixed or Multiple ethnic groups 0.38 0.13 0.99 0.057 0.24 0.06 0.75 0.022 Other ethnic group 0.95 0.29 2.90 0.923 0.62 0.18 1.97 0.426 Currently, a health or care professional No Ref. Ref. Yes 7.65 4.54 13.02 < .001 6.96 4.05 12.11 < .001 The strongest independent predictor identified was professional status, with health or care professionals having nearly seven times the odds of reporting greater familiarity compared to non-professionals (adjusted OR = 6.96; 95% CI 4.05 to 12.11; p < 0.001). Significant associations were also observed regarding ethnicity: participants identifying as Black, African, Caribbean, or Black British had significantly higher odds of familiarity (adjusted OR = 2.07; 95% CI 1.04 to 4.10; p = 0.036) compared to White participants, whereas those from Mixed or Multiple ethnic groups showed significantly lower odds (adjusted OR = 0.24; 95% CI 0.06 to 0.75; p = 0.022). While unemployment appeared associated with lower familiarity in the unadjusted analysis (p=.047), this association was no longer significant after adjusting for covariates (p=.110). No significant associations were found for age, gender, or other employment categories. Perceived Legitimacy and Intention to Use Services A contingency table analysis examined the association between perceived legitimacy of lifestyle medicine (five response levels from strongly disagree to strongly agree) and intention to use an NHS lifestyle medicine service if available (yes/maybe/no) (Table 3 ). There was strong evidence of an association between the two variables (Fisher’s exact test, Monte Carlo simulated p < 0.001; N = 651). The pattern showed a clear gradient, such that higher perceived legitimacy corresponded to higher stated intention to use the service: among participants who strongly agreed that lifestyle medicine is legitimate, 73% indicated “Yes” (and 23% “Maybe”), while among those who agreed, 51% indicated “Yes” (and 42% “Maybe”); in contrast, those who neither agreed nor disagreed were most likely to respond “Maybe” (61%) and less likely to respond “Yes” (25%). Effect size estimates indicated a moderate association (Cramér’s V = 0.25), consistent with a meaningful but not determinative relationship and the contingency coefficient (0.33) similarly suggested a moderate degree of association. Table 3 Association between perceived legitimacy of lifestyle medicine and intention to use an NHS lifestyle medicine service (Fisher’s exact test; N = 651). I consider lifestyle medicine to be a legitimate approach within healthcare If a lifestyle medicine service were available through the national health service, would you consider using it? P-value Cramer's V Yes No Maybe Total < .001 0.25 Strongly disagree Observed 3 1 0 4 % within row 75% 25% 0% 100% Disagree Observed 4 4 9 17 % within row 24% 24% 53% 100% Neither agree nor disagree Observed 32 17 78 127 % within row 25% 13% 61% 100% Agree Observed 163 22 136 321 % within row 51% 7% 42% 100% Strongly agree Observed 132 9 41 182 % within row 73% 5% 23% 100% Total Observed 334 53 264 651 % within row 51% 8% 41% 100% Lifestyle Advice Provision Among Healthcare Professionals Bivariate associations between professional characteristics and the provision of lifestyle advice were examined using Fisher’s exact tests (Table 4 ). Formal training was significantly associated with advice provision (p = 0.003; Cramér’s V = 0.35); professionals who had completed training were highly likely to provide advice (83% "Yes" vs. 17% "No") compared to those with no training (32% "Yes" vs. 39% "No"). Similarly, confidence levels showed a strong, statistically significant gradient with advice provision (p < 0.001; Cramér’s V = 0.50). No participants in the "Not confident at all" category actively provided advice (0.0%), whereas 83% of those who were "Extremely confident" provided advice. Perceived barriers showed mixed associations: patient readiness was significantly associated with provision (p=.006; Cramér’s V = 0.42), with professionals identifying this barrier being more likely to provide advice (56% "Yes") compared to those who did not (38% "Yes"). In contrast, time constraints were not statistically associated with the frequency of advice provision (p = 0.624). Table 4 Association between training, confidence and barriers with the provision of lifestyle-related advice among healthcare professionals (Fisher’s exact test; N = 58). Variable Do you provide lifestyle-related advice to patients/clients as part of your role? Total P-value Cramer's V Yes Sometimes No Have you had formal training relevant to lifestyle medicine (e.g., accredited course, diploma, certification, structured CPD)? 0.003 0.35 Yes Observed 10 0 2 12 % within row 83% 0% 17% 100% Currently undertaking training Observed 6 2 0 8 % within row 75% 25% 0% 100% No Observed 12 11 15 38 % within row 32% 29% 39% 100% How confident are you in delivering lifestyle-related advice? < .001 0.50 Not confident at all Observed 0 1 7 8 % within row 0% 13% 88% 100% Slightly confident Observed 3 2 6 11 % within row 27% 18% 55% 100% Moderately confident Observed 11 8 2 21 % within row 52% 38% 10% 100% Very confident Observed 9 2 1 12 % within row 75% 17% 8% 100% Extremely confident Observed 5 0 1 6 % within row 83% 0% 17% 100% What are the main barriers to delivering lifestyle advice in your setting? - Time constraints 0.624 0.14 Yes Observed 16 6 7 29 % within row 55% 21% 24% 100% No Observed 12 7 10 29 % within row 41% 24% 34% 100% Patient/client readiness or interest 0.006 0.42 Yes Observed 18 10 4 32 % within row 56% 31% 13% 100% No Observed 10 3 13 26 % within row 38% 12% 50% 100% Training and Perceived NHS Support Fisher’s exact test revealed no statistically significant association between formal training status and the perception of NHS support for lifestyle-based approaches (p=.50; Cramér’s V = 0.34); Table 5 . Overall, perceptions of NHS support were low across all groups, with most participants (67%) rating support as either "Not at all well" or only "Slightly well." While a higher proportion of professionals with formal training rated support as "Moderately well" (55%) compared to those without training (23%), this difference did not reach statistical significance. Consequently, possession of formal training does not appear to significantly alter healthcare professionals' perception of the structural support available for lifestyle interventions within the current NHS framework. Table 5 Association between formal lifestyle medicine training and healthcare professionals' perception of NHS support for lifestyle-based approaches (Fisher’s exact test; N = 48) Have you had formal training relevant to lifestyle medicine)? Overall, how well do you think the NHS currently supports lifestyle-based approaches to health & prevention? Total P-Value Cramer's V Not at all well Slightly well Moderately well Very well Yes Observed 4 1 6 0 11 0.50 0.34 % within row 36% 9% 55% 0% 100% Currently undertaking training Observed 1 3 1 1 6 % within row 17% 50% 17% 17% 100% No Observed 6 17 7 1 31 % within row 19% 55% 23% 3% 100% Total Observed 11 21 14 2 48 % within row 23% 44% 29% 4% 100% Discussion Summary of principal findings This cross-sectional study provides novel empirical evidence on how lifestyle medicine is understood, trusted and perceived as legitimate among community-dwelling adults and health and care professionals (HCPs) in England and on the readiness of the NHS to support its implementation. Three principal findings emerge. First, while awareness of the term “lifestyle medicine” remains limited in the general population, recognition is substantially higher among healthcare professionals and there is broad intuitive alignment across groups regarding its core components, particularly nutrition, physical activity, sleep and stress management. Second, perceived legitimacy of lifestyle medicine is strongly associated with intention to use an NHS-delivered service, indicating that public trust and conceptual clarity are likely to be key determinants of uptake. Third, among healthcare professionals, formal training and confidence are strongly associated with the provision of lifestyle-related advice, whereas perceptions of NHS readiness to support such approaches remain consistently low, irrespective of training status. Importantly, the findings suggest that the primary barriers to implementation are not public resistance or scepticism about prevention per se, but rather issues of professional credibility, workforce capability and system-level support. Lifestyle medicine is largely viewed as distinct from generic “wellness” advice, particularly when delivered by trained clinicians, yet remains vulnerable to misclassification alongside complementary or alternative therapies in the absence of clear institutional anchoring. Taken together, these results indicate that lifestyle medicine occupies an emergent but fragile position within contemporary NHS prevention discourse - one that is contingent on governance, training and legitimacy rather than on public appetite alone. Comparison with existing literature The limited public familiarity with the term “lifestyle medicine” observed in this study is consistent with prior UK and international work suggesting that while individuals recognise behavioural determinants of health, they do not necessarily conceptualise these within formal clinical frameworks ( 17 , 18 ). By contrast, the substantially higher awareness among HCPs aligns with evidence of growing professionalisation of the field, particularly through organisations such as the American College of Lifestyle Medicine and the British Society of Lifestyle Medicine ( 19 ). The strong association between perceived legitimacy and stated intention to use NHS services mirrors findings from implementation research demonstrating that trust in preventive interventions is shaped not only by perceived effectiveness but also by institutional endorsement and professional accountability ( 20 ). This is particularly relevant for lifestyle-focused interventions, which historically have been delivered across heterogeneous settings ranging from rigorously evaluated clinical programmes to loosely regulated commercial wellness markets. The observed preference for advice delivered by medically trained professionals with formal lifestyle training reinforces earlier work showing that credibility, rather than message content alone, is a key driver of engagement in behaviour change interventions ( 21 ). Our findings also resonate with the extensive trial literature demonstrating the effectiveness of structured lifestyle interventions in specific disease contexts. Landmark studies such as the Diabetes Prevention Program and the Finnish Diabetes Prevention Study showed that intensive lifestyle interventions can reduce incident T2D by approximately 50–60% in high-risk populations ( 7 , 22 ). However, these trials were delivered under controlled conditions with dedicated resources, raising persistent questions about scalability and real-world implementation. Subsequent evaluations of the NHS Diabetes Prevention Programme highlight similar challenges, including variable uptake, retention and fidelity across delivery models ( 23 , 24 ). The present study extends this literature by demonstrating that perceived legitimacy may be a missing intermediary between evidence generation and population-level uptake. Among HCPs, the strong association between training, confidence and advice provision is consistent with behaviour change theory and prior empirical studies. NICE guidance has long emphasised that effective behaviour change requires specific competencies, including goal setting, feedback and motivational techniques, which are not automatically acquired through standard clinical training ( 11 ). Surveys of UK clinicians repeatedly identify lack of training and confidence as major barriers to delivering preventive advice, even where motivation is high ( 25 ). Our findings reinforce the conclusion that workforce capability is a necessary - though not sufficient- condition for embedding lifestyle medicine into routine care. Finally, the consistently low perception of NHS support for lifestyle-based approaches echoes broader critiques of prevention policy in England. While strategic documents such as the NHS Long Term Plan emphasise prevention and self-management, implementation has often been constrained by short-term funding cycles, performance metrics oriented toward acute care and limited integration across sectors ( 8 , 26 ). The gap identified here between individual professional readiness and perceived system readiness mirrors findings from evaluations of social prescribing and community-based prevention initiatives, where frontline enthusiasm frequently outpaces structural support ( 27 ). Implications for policy and practice These findings carry several important implications for policy, commissioning and clinical practice. First, they suggest that efforts to expand lifestyle medicine within the NHS should prioritise legitimacy-building alongside service development. Clear articulation of what distinguishes evidence-based lifestyle medicine from generic wellness or alternative therapies is essential, particularly in a digital information environment characterised by misinformation and commercialisation ( 28 ). National bodies could play a stronger role in defining standards, competencies and governance frameworks to protect both patients and professionals. Second, workforce development emerges as a critical lever. The strong association between formal training and advice provision indicates that investment in accredited education pathways may yield immediate practice-level benefits. This aligns with existing NICE guidance and with emerging GP extended role frameworks but requires sustained funding and integration into continuing professional development rather than reliance on optional or privately funded courses. Third, the association between perceived legitimacy and intention to use services highlights the importance of public-facing communication strategies. If lifestyle medicine services are to achieve equitable uptake, they must be clearly positioned as NHS-endorsed, professionally delivered and accessible irrespective of ability to pay. This has relevance for addressing concerns that lifestyle medicine is primarily for those who can afford private care - a perception that, while not dominant, remains present among a substantial minority of respondents. Finally, the findings highlight the need for system-level alignment. Training clinicians without addressing time constraints, referral pathways and commissioning incentives risks perpetuating the current disconnect between policy rhetoric and frontline reality. Embedding lifestyle medicine into existing prevention pathways such as long-term condition management, social prescribing and digital health platforms, may offer a pragmatic route forward, provided that accountability and evaluation are maintained. Strengths and limitations This study draws on a large, demographically diverse sample recruited via a structured online panel, achieving high completion rates and enabling comparison between community members and healthcare professionals within a single analytic framework. The use of validated analytical approaches and transparent reporting in line with CHERRIES strengthens internal validity. Importantly, the study also moves beyond attitudes alone to examine associations between legitimacy, intention to use services and professional practice. The principal limitation of this study is concerned with its cross-sectional design which precludes causal inference and stated intentions may not translate into actual behaviour. HCPs constituted a relatively small subgroup, limiting statistical power for some analyses and precluding profession-specific conclusions. All measures were self-reported and may be subject to social desirability or recall bias. Finally, while quota sampling improves representativeness, online panels may under-represent individuals with limited digital access, who may also face greater barriers to lifestyle intervention uptake. Summary and conclusion Lifestyle medicine is seen as credible and valuable when delivered by trained professionals within the NHS. However, its wider implementation is constrained by limited public familiarity with the term, uneven workforce capability and consistently low perceptions of system readiness. Although the public recognises the core domains of lifestyle medicine and expresses willingness to use NHS-delivered services, legitimacy is the key determinant linking awareness, trust and service-use intention. Among healthcare professionals, formal training and confidence are closely tied to the provision of lifestyle-related advice, yet such training remains rare and unsupported by existing organisational structures. Advancing lifestyle medicine in England will require coordinated action. Strengthening accredited training pathways, embedding behaviour-change competencies within professional education and clarifying standards of practice would directly address workforce variability. Clearer institutional endorsement, improved commissioning mechanisms and integration of lifestyle medicine within existing prevention and long-term condition pathways would help translate professional interest into routine care. Public-facing communication strategies will help to differentiate evidence-based lifestyle medicine from unregulated wellness messaging and to build trust in new models of preventive care. As the NHS continues to shift towards prevention and person-centred long-term condition management, lifestyle medicine is an underused but strategically important intervention. Addressing the legitimacy, capability and system-readiness gaps identified in this study are essential to realise its full potential and secure equitable, population-level benefits. Abbreviations aOR – Adjusted odds ratio BMI – Body mass index CI – Confidence interval CHERRIES – Checklist for Reporting Results of Internet E-Surveys COM-B – Capability, Opportunity, Motivation–Behaviour model CPD – Continuing professional development DPP – Diabetes Prevention Programme GDPR – General Data Protection Regulation GP – General practitioner HCP – Healthcare professional ICS – Integrated Care System IP – Internet Protocol KPI – Key performance indicator LM – Lifestyle medicine NCD – Non-communicable disease NHS – National Health Service NICE – National Institute for Health and Care Excellence NIHR – National Institute for Health and Care Research OR – Odds ratio OT – Occupational therapist PH – Public health (NICE guidance prefix) RCGP – Royal College of General Practitioners SD – Standard deviation STATA – Statistical software (StataCorp) UK – United Kingdom WHO – World Health Organization Declarations Conflicts of interest The authors declare they have no other competing interests. Ethical Approval The study received a favourable opinion and was approved by the Imperial College Research Ethics Committee (ICREC #7696202) and complied with UK GDPR. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all subjects. Consent for publication is not applicable. Availability of data and materials All relevant data is provided within the manuscript. Funding The study received no funding. Austen El-Osta and Azeem Majeed are supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest London. The views expressed are those of the authors and not necessarily those of the NHS or the NIHR or the Department of Health and Social Care. Author Contributors All authors provided substantial contributions to the conception (AEO, SK), design (AEO, SA, AA), acquisition (AA, AEO) and interpretation (SA, SK, AA, SK, AM, AEO) of study data and approved the final version of the paper. AEO took the lead in planning the study with support from co-authors. SA carried out the data analysis with support from AEO. AEO is the guarantor. Twitter: @austenelosta @ImperialSCARU References WHO Noncommunicable diseases 2025 [Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases Brauer M, Roth GA, Aravkin AY, Zheng P, Abate KH, Abate YH, et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. 2024;403(10440):2162 – 203 Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al.Global burden of 87 risk factors in 204 countries and territories, 1990–2019:a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1223-49 RCGP Lifestyle medicine in general practice 2024 [Available from: https://www.rcgp.org.uk/your-career/gp-extended-roles/lifestyle-medicine-framework-practice European Lifestyle Medicine Organizarion What is lifestyle medicine? 2026 [Available from: https://www.eulm.org/what-is-lifestyle-medicine/ RCGP Introduction and overview of GPwER in lifestyle medicine 2024 [Available from: https://www.rcgp.org.uk/your-career/gp-extended-roles/lifestyle-medicine-framework-introduction The New England Journal of Medicine (2002) Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 346(6):393–403 NHS (2019) The NHS Long Term Plan NHS. NHS Diabetes Prevention Programme (NHS DPP) (2025) [Available from: https://www.england.nhs.uk/diabetes/diabetes-prevention/ Bower P, Soiland-Reyes C, Bennett C, Brunton L, Burch P, Cameron E et al (2025) The effectiveness and cost-effectiveness of the NHS Diabetes Prevention Programme (NHS-DPP): the DIPLOMA long-term multimethod assessment. Health Social Care Delivery Res. (19):1–47 NICE Behaviour change: individual approaches 2014 [Available from: https://www.nice.org.uk/guidance/ph49?utm_source=chatgpt.com NICE Overweight and obesity management 2026 [Available from: https://www.nice.org.uk/guidance/ng246/chapter/Behavioural-overweight-and-obesity-management-interventions Denniss E, Lindberg R (2025) Social media and the spread of misinformation: infectious and a threat to public health. Health Promot Int. ;40(2) WHO, Infodemic (2025) [Available from: https://www.who.int/health-topics/infodemic#tab=tab_1 NHS Social prescribing 2026 [Available from: https://www.england.nhs.uk/personalisedcare/social-prescribing/ Kiely B, Croke A, Shea M, Boland F, Shea E, Connolly D, Smith SM (2022) Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. BMJ Open 12(10):e062951 Kelly MP, Barker M (2016) Why is changing health-related behaviour so difficult? Public Health 136:109–116 Marteau TM, Hollands GJ, Fletcher PC (2012) Changing Human Behavior to Prevent Disease: The Importance of Targeting Automatic Processes. Science 337(6101):1492–1495 Sagner M, Egger G, Binns A, Rossner S (2017) Lifestyle medicine: lifestyle, the environment and preventive medicine in health and disease. Academic Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C et al (2017) Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 19(11):e367 Michie S, Van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6(1):1–12 Tuomilehto J, Lindström J, Eriksson Johan G, Valle Timo T, Hämäläinen H, Ilanne-Parikka P et al Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. N Engl J Med. 344(18):1343–1350 Hall JM, Fowler CF, Barrett F, Humphry RW, MacRury SM et al (2020) Reply to Verougstraete. Comment on HbA1c determination from HemaSpot blood collection devices: comparison of home-prepared dried blood spots with standard venous blood analysis. Diabetic Medicine. ;37(9):1614-5 Barron E, Clark R, Hewings R, Smith J, Valabhji J (2018) Progress of the Healthier You: NHS Diabetes Prevention Programme: referrals, uptake and participant characteristics. Diabet Med 35(4):513–518 Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ (2020) Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews. Prev Sci 21(3):319–331 Buck D, Baylis A, Dougall D, Robertson R (2018) A vision for population health: towards a healthier future Drinkwater C, Wildman J, Moffatt S (2019) Social prescribing. BMJ 364:l1285 Organization WH (2020) WHO package of essential noncommunicable (PEN) disease interventions for primary health care Additional Declarations The authors declare no competing interests. Supplementary Files SupplementaryFile1survye.docx Supplementary File 1 SupplementaryFile2CHERRIESChecklist.docx Supplementry File 2 Supplementary.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8833633","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588510915,"identity":"9e42f0f6-4041-42fd-9714-91caedac6959","order_by":0,"name":"Austen El-Osta","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie2RwUoDMRCGJwS2l0iuU5TuK2QRBFHwVeLJa8HLHmSJFHPqA9THEF9gyoB72QeoLIgieO6xIIqJFi+S1mMP+S6TDHzM/AlAJrObCPoug2sXi4LBT9tscqKCoOZrRf5bQbu+blO0k0RQN42+fb25H9dPB3oCYrkCPkwpSIUl6BixP/f9rLtUyCCHU+Cj9FbK8IcnhKjseauAAfYB+DRllKSXJHyD5eM8KJ9WlWHK+ybFkIKgSDQLERRnw1Ao4pTkYhUXJmYZ3nUxy4NVFQt/PDUXyfijdvLyHF5Mj9r2rR9f2bPQ4cWqPqlcypF/z8Jt+ciEnslkMplfvgAtBVO5eaETNQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-8772-4938","institution":"Imperial College London","correspondingAuthor":true,"prefix":"","firstName":"Austen","middleName":"","lastName":"El-Osta","suffix":""},{"id":588510916,"identity":"d7fd45f9-95a5-43b3-9955-a730df6c89db","order_by":1,"name":"Sunil Kumar","email":"","orcid":"https://orcid.org/0009-0006-8322-0114","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Sunil","middleName":"","lastName":"Kumar","suffix":""},{"id":588510917,"identity":"d4126c10-e18a-4ccb-87b2-09dec39b525c","order_by":2,"name":"Sami Altalib","email":"","orcid":"https://orcid.org/0000-0001-7404-8486","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Sami","middleName":"","lastName":"Altalib","suffix":""},{"id":588510918,"identity":"04bf20e4-8f0c-48e4-90d8-0ad144095da2","order_by":3,"name":"Aos Alaa","email":"","orcid":"https://orcid.org/0000-0001-6130-5092","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Aos","middleName":"","lastName":"Alaa","suffix":""},{"id":588510919,"identity":"0f3e62b6-65ee-4df3-a676-bfeb530ff031","order_by":4,"name":"Azeem Majeed","email":"","orcid":"https://orcid.org/0000-0002-2357-9858","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Azeem","middleName":"","lastName":"Majeed","suffix":""}],"badges":[],"createdAt":"2026-02-09 18:42:06","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8833633/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8833633/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102311703,"identity":"423753ce-a2c6-4e5e-aed8-14291fd13647","added_by":"auto","created_at":"2026-02-10 11:58:39","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154426,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA bar chart showing the distribution of self-reported familiarity with the term \"lifestyle medicine\" among all study participants (N=733) and the healthcare professional subgroup (N=58). Ratings were measured on a 5-point scale ranging from 1 (not familiar at all) to 5 (extremely familiar).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/072a184d04cab8dbdd290c41.jpg"},{"id":102311988,"identity":"2ca61f1a-7021-415b-85a2-fdbaf8b7bbda","added_by":"auto","created_at":"2026-02-10 11:59:40","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":256491,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiverging bar chart illustrating attitudes toward lifestyle medicine among all participants (N=733) and healthcare professionals (N=58). \u003c/strong\u003eThe chart displays agreement (\"Agree\" and \"Strongly Agree\") versus disagreement (\"Disagree\" and \"Strongly Disagree\") across four key domains: perceived legitimacy of the discipline, the necessity of professional training, and trust in advice provided by trained clinicians versus non-medical professionals. Responses indicating \"Neither agree nor disagree\" and \"Don't know\" have been excluded to highlight the directionality of opinion.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/f17fb02780f2360603462663.jpg"},{"id":102311975,"identity":"44cfbc68-a8a3-4bee-b266-70a7e64918b7","added_by":"auto","created_at":"2026-02-10 11:59:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":149862,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOrdinal logistic regression analysis examining predictors of higher familiarity with the term \"lifestyle medicine\" (ordinal outcome measured on a 1–5 scale). Forest plots display unadjusted and adjusted odds ratios (95% CI) for (A) sociodemographic characteristics and (B) employment and professional status. Reference categories are listed in parentheses.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/769ea4632ded5d4ac7bcd861.png"},{"id":102312319,"identity":"c471ee1c-56b9-48bf-8f54-b36aef987663","added_by":"auto","created_at":"2026-02-10 12:01:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2700473,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/996f12be-3dbc-469d-ab81-01d976ae2e7b.pdf"},{"id":102311610,"identity":"2e4a27af-ea7b-4b5c-9c47-8cb1af4026cc","added_by":"auto","created_at":"2026-02-10 11:58:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18842,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary File 1\u003c/p\u003e","description":"","filename":"SupplementaryFile1survye.docx","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/e7ac8629dcb44451ccbc0926.docx"},{"id":102311500,"identity":"6d10fd59-1db7-4fb0-b9b4-0c1c6f0dfc57","added_by":"auto","created_at":"2026-02-10 11:58:17","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20649,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementry File 2\u003c/p\u003e","description":"","filename":"SupplementaryFile2CHERRIESChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/fb0ad09192a131eb5c7cc3a8.docx"},{"id":102311976,"identity":"9965226d-5902-4817-8b27-93bae2eaf002","added_by":"auto","created_at":"2026-02-10 11:59:34","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":39223,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-8833633/v1/e0f412c7b18249087101984f.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eLegitimacy, trust and readiness for implementing lifestyle medicine in England: a cross-sectional study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eNon-communicable diseases (NCDs) remain the dominant cause of preventable morbidity and mortality worldwide, accounting for most deaths and a substantial share of premature mortality. The World Health Organization (WHO) estimates that NCDs caused at least 43\u0026nbsp;million deaths in 2021, with a high proportion occurring prematurely and disproportionately affecting low- and middle-income countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although health systems continue to invest heavily in downstream diagnosis and treatment, the upstream drivers of NCD incidence and progression remain strongly patterned by modifiable behavioural and social exposures raising persistent questions about how health services can deliver prevention at scale, equitably and with public legitimacy.\u003c/p\u003e \u003cp\u003eThe contemporary epidemiology of avoidable illness highlights the centrality of self-care, behavioural and lifestyle-related risk factors. Global comparative risk assessment analyses consistently identify diet-related risks, high body-mass index, tobacco exposure and insufficient physical activity among the most important contributors to mortality and disability (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In parallel, the rapid growth of high BMI as a risk factor has outpaced improvements in physical activity and diet quality in many settings, suggesting that prevention requires more than information provision and individual willpower alone (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This body of evidence has strengthened interest in approaches that integrate behaviour change support into routine care and address the everyday determinants of health in ways that are clinically credible, acceptable to the public and feasible within health-system constraints.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Lifestyle medicine\u0026rdquo; has emerged as a label for a structured, clinical approach to using evidence-based behavioural interventions as primary therapeutic modalities to prevent, treat and, where evidence supports, modify the course of chronic disease. In the UK context, the Royal College of General Practitioners has articulated lifestyle medicine within general practice as evidence-based clinical care using person-centred behaviour change techniques across core domains including healthy eating, physical activity, restorative sleep, mental wellbeing/stress, relationships/social connection and minimising harmful substances (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Internationally, the American College of Lifestyle Medicine and aligned programmes commonly describe \u0026ldquo;six pillars\u0026rdquo; that closely map to these domains, offering a pragmatic taxonomy for education, service design and clinical quality improvement. Reflecting the maturation of the field, the European Lifestyle Medicine Organisation has recently expanded its lifestyle medicine framework to include two additional pillars (vi) sexual health and fertility, and (vii) environmental exposure, signalling a shift towards a more comprehensive, life-course and planetary-health\u0026ndash;aligned conception of prevention (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The increasing formalisation of the field has also been reflected in professional development initiatives, including the UK\u0026rsquo;s competency-framed pathway for GPs with extended roles, developed in collaboration with the British Society of Lifestyle Medicine (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe preventive and therapeutic potential of structured lifestyle intervention is supported by landmark trial evidence in specific disease areas. In high-risk populations, intensive lifestyle programmes have demonstrated large relative reductions in incident type 2 diabetes compared with usual care, notably in the Diabetes Prevention Program and the Finnish Diabetes Prevention Study (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These trials are often cited as proof-of-concept that behavioural interventions can be delivered with clinical rigour and measurable outcomes. However, the translation of such evidence into practice raises distinct questions: who trusts lifestyle-focused advice, under what conditions does it appear legitimate (as opposed to \u0026ldquo;wellness\u0026rdquo;) and how do system constraints shape delivery in real-world practice?\u003c/p\u003e \u003cp\u003eIn England, the policy environment has increasingly favoured prevention, self-management and community-oriented models of care. The NHS England Long Term Plan emphasised major strategic shifts including a stronger focus on prevention and better support for people to manage health outside hospital settings (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Prevention-oriented service models are now well established in certain pathways, including the Healthier You NHS Diabetes Prevention Programme (NHS DPP), which offers a structured lifestyle change programme (including digital options) for people identified as at elevated risk (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). National evaluation work has also examined effectiveness and cost-effectiveness of the NHS DPP, highlighting both promise and the importance of implementation factors such as uptake, retention and delivery fidelity (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These developments suggest that \u0026ldquo;lifestyle\u0026rdquo; is no longer peripheral to the NHS but is rather increasingly institutionalised within prevention and long-term condition strategies.\u003c/p\u003e \u003cp\u003eYet implementation at scale depends on more than the availability of services. Behaviour change practice in routine care requires workforce skills, time, training and evidence-informed design. National guidance from the National Institute for Health and Care Excellence sets out principles for individual-level behaviour change interventions (including goal setting, feedback, monitoring and social support), reflecting a longstanding recognition that effective behaviour change is structured and requires competencies that are not automatically acquired through clinical training (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Updated NICE guidance on overweight and obesity further illustrates how prevention and management are framed as system responsibilities requiring coordinated interventions rather than isolated patient advice (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In this context, lifestyle medicine can be seen as an attempt to assemble clinical behaviour change, prevention science and whole-person care into a coherent practice model, but its adoption will be shaped by whether clinicians feel prepared and supported and whether patients interpret the approach as credible, relevant and fair.\u003c/p\u003e \u003cp\u003ePublic legitimacy and trust are particularly salient given the contemporary information environment. Health knowledge and risk perception are increasingly mediated by digital platforms where misinformation can spread rapidly and erode confidence in authoritative institutions (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The WHO has explicitly framed \u0026ldquo;infodemics\u0026rdquo; as a public health threat because information overload and false or misleading content can drive confusion, harmful behaviours and mistrust (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Lifestyle medicine is especially exposed to these dynamics because it sits at the intersection of everyday habits, commercial wellness markets and contested online health narratives. As a result, the acceptability of lifestyle medicine services may depend not only on perceived effectiveness but also on who delivers advice, what credentials are valued and how people distinguish evidence-based care from generic wellness messaging.\u003c/p\u003e \u003cp\u003eThere are also practical questions about how \u0026ldquo;lifestyle support\u0026rdquo; is operationalised across NHS and community settings. Social prescribing has been positioned as one mechanism to connect people to non-clinical supports that address wider determinants of health, with link workers embedded in primary care and a focus on \u0026ldquo;what matters to me?\u0026rdquo; care planning (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, evidence syntheses have highlighted gaps in robust outcomes evidence for social prescribing link workers and variability in implementation, prompting calls for stronger evaluation and clearer expectations about impacts (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This matters because, in practice, lifestyle medicine pathways may draw on a mixed ecology of NHS-delivered services, commissioned prevention programmes and community assets; the public\u0026rsquo;s and professionals\u0026rsquo; confidence in these pathways may therefore reflect perceived coherence, governance and quality assurance.\u003c/p\u003e \u003cp\u003eThe primary aim of this study was to characterise how lifestyle medicine is understood and regarded as a credible healthcare approach among community-dwelling adults and healthcare professionals, with particular attention to perceived legitimacy, trust and acceptability within an NHS context. We also sought to (i) quantify awareness and familiarity with the term \u0026ldquo;lifestyle medicine\u0026rdquo; and identify sociodemographic and professional predictors of familiarity; (ii) examine how perceived legitimacy relates to stated intention to use an NHS lifestyle medicine service; (iii) describe preferences for service delivery and trusted providers for lifestyle support; (iv) assess perceived control/self-efficacy across lifestyle domains relevant to behaviour change; and (v) among healthcare professionals, examine the relationships between training, confidence, perceived barriers and current provision of lifestyle-related advice, alongside perceptions of NHS readiness to support lifestyle-based care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and reporting standard\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional, self-administered online survey of adults living in the UK. Reporting complied with the Checklist for Reporting Results of Internet ESurveys (CHERRIES); \u003cb\u003eSupplementary file 1\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting, dates and eligibility\u003c/h3\u003e\n\u003cp\u003eThe online survey was open from 9 to 23 January 2026. Eligibility required age\u0026thinsp;\u0026ge;\u0026thinsp;18 years and the ability to read English. Participants accessed an anonymous web link and completed the instrument on desktop or mobile devices.\u003c/p\u003e\n\u003ch3\u003eSampling frame, openness and recruitment\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited exclusively via the Prolific Academic panel using quota sampling to approximate the UK adult population by age, gender and ethnicity. The survey was implemented as a closed panel study, with access restricted to Prolific participants via unique panel identifiers. No targeted incentives beyond standard panel compensation were used. Because recruitment was conducted through a closed panel, CHERRIES view and participation rates are defined by the panel provider rather than site visitor counts; completion among eligible respondents is reported below. This sampling approach prioritised internal validity and comparability across respondents over maximising reach.\u003c/p\u003e\n\u003ch3\u003ePlatform and delivery\u003c/h3\u003e\n\u003cp\u003eThe instrument was implemented in the Qualtrics XM Platform (Qualtrics International Inc., Provo, UT). The platform captured timestamps, device metadata, IP address and coarse geolocation if permitted by the browser. These variables were used solely for data quality checks and are not reported in identifiable form. The instrument used concise items, varied stems and mandatory responses with neutral options where appropriate. Device type and completion time distributions were inspected to flag implausible submissions; no thresholds triggered exclusion.\u003c/p\u003e\n\u003ch3\u003eInstrument development and pretesting\u003c/h3\u003e\n\u003cp\u003eThe survey was developed to assess public knowledge, attitudes, experiences and perceived role of lifestyle medicine in health and healthcare settings. Drawing on established lifestyle medicine frameworks and prior population health surveys, the questionnaire comprised six main sections assessing: (i) sociodemographic characteristics; (ii) awareness and familiarity with the concept of lifestyle medicine; (iii) perceptions, legitimacy and trust in lifestyle-based approaches within healthcare; (iv) self-reported lifestyle behaviours across core lifestyle medicine domains (nutrition, physical activity, sleep, stress management, substance use and social connection); (v) perceived control and confidence over lifestyle-related behaviours and change; and (vi) preferences for service delivery, training and system-level support for lifestyle medicine, including perspectives from health and care professionals.\u003c/p\u003e \u003cp\u003eAwareness of lifestyle medicine was measured by prior exposure to the term, sources of exposure and self-rated familiarity on a five-point scale. Perceptions and attitudes were assessed using Likert-type agreement scales capturing perceived legitimacy, distinction from general wellness advice, trust in trained professionals, perceived effectiveness for prevention and long-term condition management, and appropriateness for inclusion within NHS care pathways. Self-reported lifestyle behaviours were measured using brief frequency-based items covering physical activity, fruit and vegetable intake, sleep duration, alcohol consumption, nicotine use, stress-management strategies, loneliness and social connection. Perceived control over lifestyle domains (e.g. diet, exercise, sleep, stress, substance use, social habits) was assessed using five-point scales ranging from \u0026ldquo;no control at all\u0026rdquo; to \u0026ldquo;complete control,\u0026rdquo; with \u0026ldquo;not applicable\u0026rdquo; options where relevant. Among participants identifying as health or care professionals, additional items assessed provision of lifestyle-related advice, confidence, training exposure, perceived barriers to delivery and views on current system support. Preferences for future service models and training needs were assessed across the full sample. The questionnaire underwent internal piloting to refine wording and routing logic before launch. A copy of the survey is included in \u003cb\u003eSupplementary file 2\u003c/b\u003e.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePage design, adaptive questioning, completeness checks and timing\u003c/h2\u003e \u003cp\u003eThe online survey was administered across multiple pages with a visible progress indicator to support completion. Adaptive questioning was applied using limited branching logic: questions relating to professional roles, delivery of lifestyle advice and training needs were displayed only to participants who identified as working in health or care roles; similarly, questions on sources of awareness were displayed only to those reporting prior exposure to the term \u0026ldquo;lifestyle medicine.\u0026rdquo; Most attitudinal, behavioural and outcome items were set as required to minimise missing data, with \u0026ldquo;prefer not to say\u0026rdquo; options provided for sensitive demographic variables.\u003c/p\u003e \u003cp\u003eThe survey platform enforced completeness checks before respondents could advance between pages. Average completion time was under 10 minutes. In line with CHERRIES guidance, post-hoc checks were conducted to identify potential duplicate entries; IP addresses were inspected for repetition, and no duplicate responses were retained in the final dataset.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcomes and measures\u003c/h3\u003e\n\u003cp\u003eThe primary outcomes were (i) perceived legitimacy and acceptability of lifestyle medicine within healthcare, assessed using agreement ratings on five-point Likert scales, and (ii) self-reported perceived control and confidence over key lifestyle domains relevant to lifestyle medicine practice. Secondary outcomes included awareness and familiarity with lifestyle medicine, trust in different providers of lifestyle-related advice (e.g. clinicians, allied health professionals, dietitians, trained non-medical professionals), self-reported lifestyle behaviours, perceived barriers and facilitators to lifestyle change, and preferences for service delivery models within the health system.\u003c/p\u003e \u003cp\u003eAmong health and care professionals, secondary outcomes additionally included frequency of delivering lifestyle-related advice, confidence in doing so, exposure to formal training, perceived system-level barriers (e.g. time, resources, pathways) and perceived adequacy of current NHS support for lifestyle-based approaches. All items, response options and coding rules are provided in the Supplementary Materials and the statistical analysis plan.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarise participant sociodemographic characteristics, awareness and familiarity with lifestyle medicine, self-reported lifestyle behaviours, perceived control over lifestyle domains, attitudes towards lifestyle medicine, trust in providers of lifestyle-related advice and preferences for service delivery. Categorical variables were summarised using frequencies and percentages, while continuous variables were summarised using means, standard deviations, minimum and maximum.\u003c/p\u003e \u003cp\u003eMultivariable analyses employed ordinal logistic regression to estimate unadjusted and adjusted odds ratios (ORs and aORs) with 95% confidence intervals (CIs) for familiarity with the term \"lifestyle medicine.\" Candidate predictors included age, sex, educational attainment, ethnicity, employment status, and current status as a health or care professional. The fully adjusted model included all sociodemographic and professional covariates simultaneously to identify independent predictors of familiarity.\u003c/p\u003e \u003cp\u003eBivariate associations between categorical variables were examined using Fisher's exact test, with effect sizes estimated using Cram\u0026eacute;r's V and contingency coefficients where appropriate. These analyses explored relationships between: (i) perceived legitimacy of lifestyle medicine and intention to use NHS lifestyle medicine services; (ii) professional characteristics (training status, confidence levels, and perceived barriers) and provision of lifestyle-related advice among healthcare professionals; and (iii) formal training status and perception of NHS support for lifestyle-based approaches.\u003c/p\u003e \u003cp\u003eFor the contingency table analysis examining perceived legitimacy and service use intention, Monte Carlo simulation methods were employed to compute Fisher's exact test p-values. Effect sizes were interpreted using conventional thresholds (Cram\u0026eacute;r's V: \u0026lt;0.10 weak, 0.10\u0026ndash;0.30 moderate, \u0026gt;\u0026thinsp;0.30 strong). Among healthcare professionals, Fisher's exact tests examined associations between training, confidence, perceived barriers (time constraints and patient readiness), and frequency of providing lifestyle advice. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were performed using STATA, version 18 (StataCorp LP, College Station, TX, USA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthics, consent and data protection\u003c/h2\u003e \u003cp\u003e The study was approved by the Imperial College Research Ethics Committee (ICREC #7696202) and complied with UK GDPR. Participants viewed an information sheet and provided electronic informed consent before answering any items; consent pages described purpose, voluntary nature, data handling and contact details. No direct personal identifiers were collected. IP addresses and coarse location, captured by the platform, were accessible only to the core research team for fraud and duplication checks and were not used to reidentify participants. Data were stored on secure institutional servers and analysed in deidentified form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePatient and public involvement\u003c/h2\u003e \u003cp\u003eThe survey was developed by the research team and after several iterations, the instrument was passed on to three lay members for comments. The survey was iterated again among the research team partners to arrive at the final version.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eA total of 733 participants were included in the analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age of the study population was 45.6 years (SD\u0026thinsp;=\u0026thinsp;14.8; range 18\u0026ndash;84). The sample was gender-balanced, consisting of 51.2% women and 48.0% men. Most participants identified as White (83.1%), followed by Asian or Asian British (8.6%). Educational attainment was generally high, with 62.6% of the total cohort holding a university or postgraduate degree. Regarding employment status, nearly half of the participants were employed full-time (46.9%), while 13.2% worked part-time and 12.4% were retired.\u003c/p\u003e \u003cp\u003eA subgroup of 58 participants (7.9%) were healthcare professionals (HCPs). Compared to the total sample, the HCP subgroup had a slightly lower mean age of 43.6 years (SD\u0026thinsp;=\u0026thinsp;12.9) and a higher proportion of women (63.8%); Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The HCP subgroup also demonstrated higher educational qualifications, with 48.3% holding a postgraduate degree, greater ethnic diversity, particularly regarding Asian or Asian British background (22.4%) and a higher prevalence of full-time employment (63.8%). The findings of the full survey are presented in \u003cb\u003eSupplementary Table\u0026nbsp;1.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency (Percentage)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll participants (N\u0026thinsp;=\u0026thinsp;733)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHCPs (N\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, Mean (SD) [min \u0026ndash; max]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.6 (14.8) [18\u0026ndash;84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.6 (12.9) [18\u0026ndash;75]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is your gender?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e352 (48.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e375 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Binary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich of the following best describes your background?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e609 (83.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian or Asian British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack, African, Caribbean or Black British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed or Multiple ethnic groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther ethnic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is your highest level of education?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school or equivalent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA-levels/college or equivalent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e191 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e282 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is your current employment status?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed full-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e344 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed part-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHomemaker / unpaid carer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnable to work due to long-term illness or disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed / looking for work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAwareness and Understanding of Lifestyle Medicine\u003c/h2\u003e \u003cp\u003eAwareness of the term 'lifestyle medicine' varied significantly between the total cohort and the HCP subgroup (\u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e). While only 26.3% of the total sample had heard of the term prior to the survey, this figure rose to 62.1% among HCPs. The distribution of familiarity scores differed markedly by professional status, with the general cohort skewed heavily towards lower awareness (mode\u0026thinsp;=\u0026thinsp;1; 38.7%). In contrast, HCPs demonstrated a clear shift towards greater familiarity, with nearly half (46.5%) reporting high confidence scores of 4 or 5 compared to only 12.6% of the total sample (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The sources of information also differed; the general population primarily encountered the term via social media (13.6%), whereas HCPs were more likely to hear about it through Online health information websites (24.1%) then workplace or university settings (22.4%). Despite low familiarity with the specific terminology, there was a high consensus across all participants regarding the core components of lifestyle medicine frameworks, with nutrition (91.5%), physical activity (82.8%), sleep (86.6%) and stress management (78.3%) universally recognised as key elements.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes and Perceived Legitimacy\u003c/h2\u003e \u003cp\u003eAttitudes toward lifestyle medicine were generally positive, though stronger among clinical professionals. While 43.8% of the total cohort agreed that lifestyle medicine is a legitimate healthcare approach, HCPs demonstrated stronger conviction, with 48.3% strongly agreeing.\u003c/p\u003e \u003cp\u003eThere was widespread agreement regarding the need for education; 72.4% of all participants and 86.2% of HCPs agreed or strongly agreed that medical professionals should receive formal training in lifestyle-based approaches. Trust in advice was heavily influenced by the provider's professional status; participants expressed high trust (73.4%) in advice from clinicians with formal lifestyle training, but trust dropped notably for non-medical professionals (42.4%), even if they held lifestyle medicine qualifications (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePersonal Lifestyle Behaviours and Self-Efficacy\u003c/h2\u003e \u003cp\u003eRegarding personal health behaviours, perceived control varied by domain (\u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e). Participants reported high levels of control (combined \"A lot\" and \"Complete\") over substance use (71.4%) and diet (76.8%), but lower perceived control over stress (23.3%) and environmental exposures (30.5%). When asked about hypothetical changes in the next three months, HCPs generally reported higher self-efficacy regarding sleep (41.4%) and stress management (27.6%) compared to the general population.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eService Delivery Preferences and NHS Implementation\u003c/h2\u003e \u003cp\u003eThere was substantial support for integrating lifestyle medicine into public health services. Nearly half of the total participants (46.9%) and two-thirds of HCPs (67.2%) stated they would use a lifestyle medicine service if available via the NHS. When asked about resource allocation, 81.0% of HCPs believed the NHS should increase investment in these services, compared to 62.2% of the general cohort. In terms of delivery format, there was a clear preference for one-to-one consultations (56.2%) and app-based guidance (51.0%) over group (16.0%) and peer support (17.6%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare Professional Perspectives and Barriers\u003c/h2\u003e \u003cp\u003eAmong the subgroup of HCPs (n\u0026thinsp;=\u0026thinsp;58), 48.3% reported currently providing lifestyle-related advice to patients, yet only 20.7% had received formal training in the discipline (\u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e). Interest in further education was high, with 62.1% expressing a desire for training or resources. HCPs identified systemic and practical hurdles to implementation; the most frequently cited barriers to delivering lifestyle advice included patient readiness or interest (55.2%), time constraints (50.0%) and a lack of training (41.4%). Furthermore, only 3.4% of HCPs felt the NHS currently supports lifestyle-based approaches \"very well\".\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic and Familiarity with Lifestyle Medicine\u003c/h2\u003e \u003cp\u003eOrdinal logistic regression analyses were conducted to examine the association between educational attainment and familiarity with the term \"lifestyle medicine,\" adjusting for potential confounders (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Contrary to the primary hypothesis, educational attainment was not a statistically significant predictor of familiarity with lifestyle medicine. In both unadjusted and adjusted models, higher levels of education did not correspond to higher odds of familiarity compared to the reference group (secondary school education). Even among those with a postgraduate degree, the increased odds observed in the unadjusted analysis (OR 1.54) were attenuated in the adjusted model and remained non-significant (aOR\u0026thinsp;=\u0026thinsp;1.31; 95% CI 0.79 to 2.20; p=.297).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between sociodemographic characteristics and familiarity with the term \"lifestyle medicine\" (unadjusted and multivariable adjusted ordinal logistic regression analyses)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school or equivalent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA-levels/college or equivalent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent employment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed full-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed part-time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHomemaker / unpaid carer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed / looking for work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnable to work due to long-term illness or disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther (please specify)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnic background\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian or Asian British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack, African, Caribbean or Black British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed or Multiple ethnic groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther ethnic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrently, a health or care professional\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe strongest independent predictor identified was professional status, with health or care professionals having nearly seven times the odds of reporting greater familiarity compared to non-professionals (adjusted OR\u0026thinsp;=\u0026thinsp;6.96; 95% CI 4.05 to 12.11; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eSignificant associations were also observed regarding ethnicity: participants identifying as Black, African, Caribbean, or Black British had significantly higher odds of familiarity (adjusted OR\u0026thinsp;=\u0026thinsp;2.07; 95% CI 1.04 to 4.10; p\u0026thinsp;=\u0026thinsp;0.036) compared to White participants, whereas those from Mixed or Multiple ethnic groups showed significantly lower odds (adjusted OR\u0026thinsp;=\u0026thinsp;0.24; 95% CI 0.06 to 0.75; p\u0026thinsp;=\u0026thinsp;0.022).\u003c/p\u003e \u003cp\u003eWhile unemployment appeared associated with lower familiarity in the unadjusted analysis (p=.047), this association was no longer significant after adjusting for covariates (p=.110). No significant associations were found for age, gender, or other employment categories.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePerceived Legitimacy and Intention to Use Services\u003c/h2\u003e \u003cp\u003eA contingency table analysis examined the association between perceived legitimacy of lifestyle medicine (five response levels from strongly disagree to strongly agree) and intention to use an NHS lifestyle medicine service if available (yes/maybe/no) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There was strong evidence of an association between the two variables (Fisher\u0026rsquo;s exact test, Monte Carlo simulated p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; N\u0026thinsp;=\u0026thinsp;651). The pattern showed a clear gradient, such that higher perceived legitimacy corresponded to higher stated intention to use the service: among participants who strongly agreed that lifestyle medicine is legitimate, 73% indicated \u0026ldquo;Yes\u0026rdquo; (and 23% \u0026ldquo;Maybe\u0026rdquo;), while among those who agreed, 51% indicated \u0026ldquo;Yes\u0026rdquo; (and 42% \u0026ldquo;Maybe\u0026rdquo;); in contrast, those who neither agreed nor disagreed were most likely to respond \u0026ldquo;Maybe\u0026rdquo; (61%) and less likely to respond \u0026ldquo;Yes\u0026rdquo; (25%). Effect size estimates indicated a moderate association (Cram\u0026eacute;r\u0026rsquo;s V\u0026thinsp;=\u0026thinsp;0.25), consistent with a meaningful but not determinative relationship and the contingency coefficient (0.33) similarly suggested a moderate degree of association.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between perceived legitimacy of lifestyle medicine and intention to use an NHS lifestyle medicine service (Fisher\u0026rsquo;s exact test; N\u0026thinsp;=\u0026thinsp;651).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eI consider lifestyle medicine to be a legitimate approach within healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eIf a lifestyle medicine service were available through the national health service, would you consider using it?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCramer's V\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMaybe\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStrongly disagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNeither agree nor disagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStrongly agree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLifestyle Advice Provision Among Healthcare Professionals\u003c/h2\u003e \u003cp\u003eBivariate associations between professional characteristics and the provision of lifestyle advice were examined using Fisher\u0026rsquo;s exact tests (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Formal training was significantly associated with advice provision (p\u0026thinsp;=\u0026thinsp;0.003; Cram\u0026eacute;r\u0026rsquo;s V\u0026thinsp;=\u0026thinsp;0.35); professionals who had completed training were highly likely to provide advice (83% \"Yes\" vs. 17% \"No\") compared to those with no training (32% \"Yes\" vs. 39% \"No\"). Similarly, confidence levels showed a strong, statistically significant gradient with advice provision (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Cram\u0026eacute;r\u0026rsquo;s V\u0026thinsp;=\u0026thinsp;0.50). No participants in the \"Not confident at all\" category actively provided advice (0.0%), whereas 83% of those who were \"Extremely confident\" provided advice. Perceived barriers showed mixed associations: patient readiness was significantly associated with provision (p=.006; Cram\u0026eacute;r\u0026rsquo;s V\u0026thinsp;=\u0026thinsp;0.42), with professionals identifying this barrier being more likely to provide advice (56% \"Yes\") compared to those who did not (38% \"Yes\"). In contrast, time constraints were not statistically associated with the frequency of advice provision (p\u0026thinsp;=\u0026thinsp;0.624).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between training, confidence and barriers with the provision of lifestyle-related advice among healthcare professionals (Fisher\u0026rsquo;s exact test; N\u0026thinsp;=\u0026thinsp;58).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eDo you provide lifestyle-related advice to patients/clients as part of your role?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCramer's V\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave you had formal training relevant to lifestyle medicine (e.g., accredited course, diploma, certification, structured CPD)?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCurrently undertaking training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow confident are you in delivering lifestyle-related advice?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNot confident at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSlightly confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModerately confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVery confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExtremely confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat are the main barriers to delivering lifestyle advice in your setting?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e- Time constraints\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient/client readiness or interest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eTraining and Perceived NHS Support\u003c/h2\u003e \u003cp\u003eFisher\u0026rsquo;s exact test revealed no statistically significant association between formal training status and the perception of NHS support for lifestyle-based approaches (p=.50; Cram\u0026eacute;r\u0026rsquo;s V\u0026thinsp;=\u0026thinsp;0.34); Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Overall, perceptions of NHS support were low across all groups, with most participants (67%) rating support as either \"Not at all well\" or only \"Slightly well.\" While a higher proportion of professionals with formal training rated support as \"Moderately well\" (55%) compared to those without training (23%), this difference did not reach statistical significance. Consequently, possession of formal training does not appear to significantly alter healthcare professionals' perception of the structural support available for lifestyle interventions within the current NHS framework.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between formal lifestyle medicine training and healthcare professionals' perception of NHS support for lifestyle-based approaches (Fisher\u0026rsquo;s exact test; N\u0026thinsp;=\u0026thinsp;48)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave you had formal training relevant to lifestyle medicine)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eOverall, how well do you think the NHS currently supports lifestyle-based approaches to health \u0026amp; prevention?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCramer's V\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot at all well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSlightly well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerately well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVery well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCurrently undertaking training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% within row\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e\u003c/h2\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eSummary of principal findings\u003c/h2\u003e \u003cp\u003eThis cross-sectional study provides novel empirical evidence on how lifestyle medicine is understood, trusted and perceived as legitimate among community-dwelling adults and health and care professionals (HCPs) in England and on the readiness of the NHS to support its implementation. Three principal findings emerge. First, while awareness of the term \u0026ldquo;lifestyle medicine\u0026rdquo; remains limited in the general population, recognition is substantially higher among healthcare professionals and there is broad intuitive alignment across groups regarding its core components, particularly nutrition, physical activity, sleep and stress management. Second, perceived legitimacy of lifestyle medicine is strongly associated with intention to use an NHS-delivered service, indicating that public trust and conceptual clarity are likely to be key determinants of uptake. Third, among healthcare professionals, formal training and confidence are strongly associated with the provision of lifestyle-related advice, whereas perceptions of NHS readiness to support such approaches remain consistently low, irrespective of training status.\u003c/p\u003e \u003cp\u003eImportantly, the findings suggest that the primary barriers to implementation are not public resistance or scepticism about prevention per se, but rather issues of professional credibility, workforce capability and system-level support. Lifestyle medicine is largely viewed as distinct from generic \u0026ldquo;wellness\u0026rdquo; advice, particularly when delivered by trained clinicians, yet remains vulnerable to misclassification alongside complementary or alternative therapies in the absence of clear institutional anchoring. Taken together, these results indicate that lifestyle medicine occupies an emergent but fragile position within contemporary NHS prevention discourse - one that is contingent on governance, training and legitimacy rather than on public appetite alone.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eComparison with existing literature\u003c/h2\u003e \u003cp\u003eThe limited public familiarity with the term \u0026ldquo;lifestyle medicine\u0026rdquo; observed in this study is consistent with prior UK and international work suggesting that while individuals recognise behavioural determinants of health, they do not necessarily conceptualise these within formal clinical frameworks (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). By contrast, the substantially higher awareness among HCPs aligns with evidence of growing professionalisation of the field, particularly through organisations such as the American College of Lifestyle Medicine and the British Society of Lifestyle Medicine (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe strong association between perceived legitimacy and stated intention to use NHS services mirrors findings from implementation research demonstrating that trust in preventive interventions is shaped not only by perceived effectiveness but also by institutional endorsement and professional accountability (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This is particularly relevant for lifestyle-focused interventions, which historically have been delivered across heterogeneous settings ranging from rigorously evaluated clinical programmes to loosely regulated commercial wellness markets. The observed preference for advice delivered by medically trained professionals with formal lifestyle training reinforces earlier work showing that credibility, rather than message content alone, is a key driver of engagement in behaviour change interventions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings also resonate with the extensive trial literature demonstrating the effectiveness of structured lifestyle interventions in specific disease contexts. Landmark studies such as the Diabetes Prevention Program and the Finnish Diabetes Prevention Study showed that intensive lifestyle interventions can reduce incident T2D by approximately 50\u0026ndash;60% in high-risk populations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, these trials were delivered under controlled conditions with dedicated resources, raising persistent questions about scalability and real-world implementation. Subsequent evaluations of the NHS Diabetes Prevention Programme highlight similar challenges, including variable uptake, retention and fidelity across delivery models (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The present study extends this literature by demonstrating that perceived legitimacy may be a missing intermediary between evidence generation and population-level uptake.\u003c/p\u003e \u003cp\u003eAmong HCPs, the strong association between training, confidence and advice provision is consistent with behaviour change theory and prior empirical studies. NICE guidance has long emphasised that effective behaviour change requires specific competencies, including goal setting, feedback and motivational techniques, which are not automatically acquired through standard clinical training (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Surveys of UK clinicians repeatedly identify lack of training and confidence as major barriers to delivering preventive advice, even where motivation is high (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Our findings reinforce the conclusion that workforce capability is a necessary - though not sufficient- condition for embedding lifestyle medicine into routine care.\u003c/p\u003e \u003cp\u003eFinally, the consistently low perception of NHS support for lifestyle-based approaches echoes broader critiques of prevention policy in England. While strategic documents such as the NHS Long Term Plan emphasise prevention and self-management, implementation has often been constrained by short-term funding cycles, performance metrics oriented toward acute care and limited integration across sectors (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The gap identified here between individual professional readiness and perceived system readiness mirrors findings from evaluations of social prescribing and community-based prevention initiatives, where frontline enthusiasm frequently outpaces structural support (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eImplications for policy and practice\u003c/h2\u003e \u003cp\u003eThese findings carry several important implications for policy, commissioning and clinical practice. First, they suggest that efforts to expand lifestyle medicine within the NHS should prioritise legitimacy-building alongside service development. Clear articulation of what distinguishes evidence-based lifestyle medicine from generic wellness or alternative therapies is essential, particularly in a digital information environment characterised by misinformation and commercialisation (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). National bodies could play a stronger role in defining standards, competencies and governance frameworks to protect both patients and professionals.\u003c/p\u003e \u003cp\u003eSecond, workforce development emerges as a critical lever. The strong association between formal training and advice provision indicates that investment in accredited education pathways may yield immediate practice-level benefits. This aligns with existing NICE guidance and with emerging GP extended role frameworks but requires sustained funding and integration into continuing professional development rather than reliance on optional or privately funded courses.\u003c/p\u003e \u003cp\u003eThird, the association between perceived legitimacy and intention to use services highlights the importance of public-facing communication strategies. If lifestyle medicine services are to achieve equitable uptake, they must be clearly positioned as NHS-endorsed, professionally delivered and accessible irrespective of ability to pay. This has relevance for addressing concerns that lifestyle medicine is primarily for those who can afford private care - a perception that, while not dominant, remains present among a substantial minority of respondents.\u003c/p\u003e \u003cp\u003eFinally, the findings highlight the need for system-level alignment. Training clinicians without addressing time constraints, referral pathways and commissioning incentives risks perpetuating the current disconnect between policy rhetoric and frontline reality. Embedding lifestyle medicine into existing prevention pathways such as long-term condition management, social prescribing and digital health platforms, may offer a pragmatic route forward, provided that accountability and evaluation are maintained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThis study draws on a large, demographically diverse sample recruited via a structured online panel, achieving high completion rates and enabling comparison between community members and healthcare professionals within a single analytic framework. The use of validated analytical approaches and transparent reporting in line with CHERRIES strengthens internal validity. Importantly, the study also moves beyond attitudes alone to examine associations between legitimacy, intention to use services and professional practice.\u003c/p\u003e \u003cp\u003eThe principal limitation of this study is concerned with its cross-sectional design which precludes causal inference and stated intentions may not translate into actual behaviour. HCPs constituted a relatively small subgroup, limiting statistical power for some analyses and precluding profession-specific conclusions. All measures were self-reported and may be subject to social desirability or recall bias. Finally, while quota sampling improves representativeness, online panels may under-represent individuals with limited digital access, who may also face greater barriers to lifestyle intervention uptake.\u003c/p\u003e \u003c/div\u003e"},{"header":"Summary and conclusion","content":"\u003cp\u003eLifestyle medicine is seen as credible and valuable when delivered by trained professionals within the NHS. However, its wider implementation is constrained by limited public familiarity with the term, uneven workforce capability and consistently low perceptions of system readiness. Although the public recognises the core domains of lifestyle medicine and expresses willingness to use NHS-delivered services, legitimacy is the key determinant linking awareness, trust and service-use intention. Among healthcare professionals, formal training and confidence are closely tied to the provision of lifestyle-related advice, yet such training remains rare and unsupported by existing organisational structures.\u003c/p\u003e \u003cp\u003eAdvancing lifestyle medicine in England will require coordinated action. Strengthening accredited training pathways, embedding behaviour-change competencies within professional education and clarifying standards of practice would directly address workforce variability. Clearer institutional endorsement, improved commissioning mechanisms and integration of lifestyle medicine within existing prevention and long-term condition pathways would help translate professional interest into routine care. Public-facing communication strategies will help to differentiate evidence-based lifestyle medicine from unregulated wellness messaging and to build trust in new models of preventive care.\u003c/p\u003e \u003cp\u003eAs the NHS continues to shift towards prevention and person-centred long-term condition management, lifestyle medicine is an underused but strategically important intervention. Addressing the legitimacy, capability and system-readiness gaps identified in this study are essential to realise its full potential and secure equitable, population-level benefits.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eaOR \u0026ndash; Adjusted odds ratio\u003cbr\u003e\u0026nbsp;BMI \u0026ndash; Body mass index\u003cbr\u003e\u0026nbsp;CI \u0026ndash; Confidence interval\u003cbr\u003e\u0026nbsp;CHERRIES \u0026ndash; Checklist for Reporting Results of Internet E-Surveys\u003cbr\u003e\u0026nbsp;COM-B \u0026ndash; Capability, Opportunity, Motivation\u0026ndash;Behaviour model\u003cbr\u003e\u0026nbsp;CPD \u0026ndash; Continuing professional development\u003cbr\u003e\u0026nbsp;DPP \u0026ndash; Diabetes Prevention Programme\u003cbr\u003e\u0026nbsp;GDPR \u0026ndash; General Data Protection Regulation\u003cbr\u003e\u0026nbsp;GP \u0026ndash; General practitioner\u003cbr\u003e\u0026nbsp;HCP \u0026ndash; Healthcare professional\u003cbr\u003e\u0026nbsp;ICS \u0026ndash; Integrated Care System\u003cbr\u003e\u0026nbsp;IP \u0026ndash; Internet Protocol\u003cbr\u003e\u0026nbsp;KPI \u0026ndash; Key performance indicator\u003cbr\u003e\u0026nbsp;LM \u0026ndash; Lifestyle medicine\u003cbr\u003e\u0026nbsp;NCD \u0026ndash; Non-communicable disease\u003cbr\u003e\u0026nbsp;NHS \u0026ndash; National Health Service\u003cbr\u003e\u0026nbsp;NICE \u0026ndash; National Institute for Health and Care Excellence\u003cbr\u003e\u0026nbsp;NIHR \u0026ndash; National Institute for Health and Care Research\u003cbr\u003e\u0026nbsp;OR \u0026ndash; Odds ratio\u003cbr\u003e\u0026nbsp;OT \u0026ndash; Occupational therapist\u003cbr\u003e\u0026nbsp;PH \u0026ndash; Public health (NICE guidance prefix)\u003cbr\u003e\u0026nbsp;RCGP \u0026ndash; Royal College of General Practitioners\u003cbr\u003e\u0026nbsp;SD \u0026ndash; Standard deviation\u003cbr\u003e\u0026nbsp;STATA \u0026ndash; Statistical software (StataCorp)\u003cbr\u003e\u0026nbsp;UK \u0026ndash; United Kingdom\u003cbr\u003e\u0026nbsp;WHO \u0026ndash; World Health Organization\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no other competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received a favourable opinion and was approved by the Imperial College Research Ethics Committee (ICREC #7696202) and complied with UK GDPR. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all subjects. Consent for publication is not applicable.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data is provided within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no funding. Austen El-Osta and Azeem Majeed are supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest London. The views expressed are those of the authors and not necessarily those of the NHS or the NIHR or the Department of Health and Social Care.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor Contributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors provided substantial contributions to the conception (AEO, SK), design (AEO, SA, AA), acquisition (AA, AEO) and interpretation (SA, SK, AA, SK, AM, AEO) of study data and approved the final version of the paper. AEO took the lead in planning the study with support from co-authors. SA carried out the data analysis with support from AEO. AEO is the guarantor.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eTwitter: \u003c/strong\u003e@austenelosta @ImperialSCARU\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO Noncommunicable diseases 2025 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrauer M, Roth GA, Aravkin AY, Zheng P, Abate KH, Abate YH, et al. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990\u0026ndash;2021: a systematic analysis for the Global Burden of Disease Study 2021. 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The Lancet. 2020;396(10258):1223-49\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRCGP Lifestyle medicine in general practice 2024 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rcgp.org.uk/your-career/gp-extended-roles/lifestyle-medicine-framework-practice\u003c/span\u003e\u003cspan address=\"https://www.rcgp.org.uk/your-career/gp-extended-roles/lifestyle-medicine-framework-practice\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEuropean Lifestyle Medicine Organizarion What is lifestyle medicine? 2026 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.eulm.org/what-is-lifestyle-medicine/\u003c/span\u003e\u003cspan address=\"https://www.eulm.org/what-is-lifestyle-medicine/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRCGP Introduction and overview of GPwER in lifestyle medicine 2024 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rcgp.org.uk/your-career/gp-extended-roles/lifestyle-medicine-framework-introduction\u003c/span\u003e\u003cspan address=\"https://www.rcgp.org.uk/your-career/gp-extended-roles/lifestyle-medicine-framework-introduction\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe New England Journal of Medicine (2002) Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. 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(19):1\u0026ndash;47\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNICE Behaviour change: individual approaches 2014 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nice.org.uk/guidance/ph49?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://www.nice.org.uk/guidance/ph49?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNICE Overweight and obesity management 2026 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nice.org.uk/guidance/ng246/chapter/Behavioural-overweight-and-obesity-management-interventions\u003c/span\u003e\u003cspan address=\"https://www.nice.org.uk/guidance/ng246/chapter/Behavioural-overweight-and-obesity-management-interventions\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDenniss E, Lindberg R (2025) Social media and the spread of misinformation: infectious and a threat to public health. Health Promot Int. ;40(2)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO, Infodemic (2025) [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/infodemic#tab=tab_1\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/infodemic#tab=tab_1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNHS Social prescribing 2026 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.england.nhs.uk/personalisedcare/social-prescribing/\u003c/span\u003e\u003cspan address=\"https://www.england.nhs.uk/personalisedcare/social-prescribing/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiely B, Croke A, Shea M, Boland F, Shea E, Connolly D, Smith SM (2022) Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. BMJ Open 12(10):e062951\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly MP, Barker M (2016) Why is changing health-related behaviour so difficult? Public Health 136:109\u0026ndash;116\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarteau TM, Hollands GJ, Fletcher PC (2012) Changing Human Behavior to Prevent Disease: The Importance of Targeting Automatic Processes. Science 337(6101):1492\u0026ndash;1495\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSagner M, Egger G, Binns A, Rossner S (2017) Lifestyle medicine: lifestyle, the environment and preventive medicine in health and disease. Academic\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A'Court C et al (2017) Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. J Med Internet Res 19(11):e367\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichie S, Van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6(1):1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuomilehto J, Lindstr\u0026ouml;m J, Eriksson Johan G, Valle Timo T, H\u0026auml;m\u0026auml;l\u0026auml;inen H, Ilanne-Parikka P et al Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. N Engl J Med. 344(18):1343\u0026ndash;1350\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall JM, Fowler CF, Barrett F, Humphry RW, MacRury SM et al (2020) Reply to Verougstraete. Comment on HbA1c determination from HemaSpot blood collection devices: comparison of home-prepared dried blood spots with standard venous blood analysis. Diabetic Medicine. ;37(9):1614-5\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarron E, Clark R, Hewings R, Smith J, Valabhji J (2018) Progress of the Healthier You: NHS Diabetes Prevention Programme: referrals, uptake and participant characteristics. Diabet Med 35(4):513\u0026ndash;518\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ (2020) Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews. Prev Sci 21(3):319\u0026ndash;331\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuck D, Baylis A, Dougall D, Robertson R (2018) A vision for population health: towards a healthier future\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrinkwater C, Wildman J, Moffatt S (2019) Social prescribing. BMJ 364:l1285\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH (2020) WHO package of essential noncommunicable (PEN) disease interventions for primary health care\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Imperial College London","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lifestyle medicine, Prevention, Health behaviour, Healthcare professionals, Trust and legitimacy, Health services implementation, Primary care, National Health Service, Cross-sectional survey, United Kingdom","lastPublishedDoi":"10.21203/rs.3.rs-8833633/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8833633/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study examines awareness, perceived legitimacy, trust and readiness for the implementation of lifestyle medicine within National Health Service (NHS) prevention pathways among community-dwelling adults and healthcare professionals in England. A secondary objective was to assess how professional training and system factors relate to the provision and intended use of lifestyle medicine services within the NHS.\u003c/p\u003e\u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eCross-sectional, self-administered online survey.\u003c/p\u003e\u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eUnited Kingdom; online survey administered in January 2026.\u003c/p\u003e\u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eAdults aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years living in the UK, recruited via a closed online panel using quota sampling to approximate national distributions by age, gender and ethnicity. A subgroup of respondents self-identified as healthcare professionals.\u003c/p\u003e\u003ch2\u003eMain outcome measures\u003c/h2\u003e \u003cp\u003ePrimary outcomes were perceived legitimacy of lifestyle medicine as a healthcare approach and intention to use an NHS lifestyle medicine service if available. Secondary outcomes included awareness and familiarity with the term \u0026ldquo;lifestyle medicine,\u0026rdquo; trust in different providers of lifestyle advice, perceived self-efficacy across lifestyle domains and - among HCPs - training, confidence, barriers and current provision of lifestyle-related advice.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 733 participants completed the survey, including 58 HCPs. Awareness of the term \u0026ldquo;lifestyle medicine\u0026rdquo; was limited in the general population (26.3%) but substantially higher among HCPs (62.1%). Despite this, there was broad agreement across groups regarding core lifestyle medicine domains; particularly nutrition, physical activity, sleep and stress management. Higher perceived legitimacy of lifestyle medicine was strongly associated with stated intention to use an NHS service. Trust in lifestyle advice was highest when delivered by clinicians with formal lifestyle medicine training and lower for non-medical professionals, even when formally trained. Among HCPs, formal training and greater confidence were strongly associated with provision of lifestyle-related advice, whereas perceptions of NHS support for lifestyle-based approaches were consistently low regardless of training status.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLifestyle medicine is widely viewed as legitimate and potentially valuable when anchored within professional training and NHS delivery but its implementation is constrained by limited public familiarity, variable workforce capability and low perceived system readiness. Strengthening training pathways, clarifying professional standards and enhancing institutional support may be critical to embedding lifestyle medicine within NHS prevention and long-term condition strategies\u003c/p\u003e","manuscriptTitle":"Legitimacy, trust and readiness for implementing lifestyle medicine in England: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 11:51:26","doi":"10.21203/rs.3.rs-8833633/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c21953ee-b873-41ab-99d8-e037407d5342","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T11:51:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 11:51:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8833633","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8833633","identity":"rs-8833633","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}