Table 2. Summary of key themes and supporting quotes from inductive thematic content analysis of interviews with general practitioners.

Discussion topic	Themes	Supporting quotes
Extent of lifestyle health discussions	‘Lifestyle’ behaviors discussed frequently but briefly	‘I would say the majority of consultations …  more than fifty percent but not every single one' (GP1) ‘Oh well, it doesn’t take very long to say, I mean I just said it a minute ago and it took about 30 s, so I mean, 30 s out of an 8-minute consult maybe' (GP15) ‘Most of the time they haven’t come for a health behavior thing, so we sort of just quickly screen it … so that would be … like a one-minute thing … but then we would get them to come back to discuss that further and then we’d have a you know a fifteen minute-consult on the topic' (GP2) ‘If someone comes in for something really quick and easy and you deal with that, then I might make time to then deal with some preventative health thing that you might not always get time to do at other times' (GP2). ‘Well it’s based on what they present with mostly, if it is relevant to the situation or, the concern, so say, they are lacking in a behavior and it’s linked to their condition, um, well that is when I would raise the issue' (GP19). ‘It just … spontaneous and opportunistic … If age and other factors suggest it, it becomes opportunistic' (GP9)
	Recognising the importance	‘For a lot of things, it is really important … a lot of chronic health issues are well managed or better managed with … a healthy lifestyle' (GP8). ‘Realistically, you do know that the research shows if you put the effort in now, then five or ten years down the track, you won’t be dealing with so many issues, so it should be a factor in practise' (GP23). ‘We should do it more’ (GP10)
Context of lifestyle discussions	Patient prompts – Proactive and reactive	Proactive ‘There’s a much more broad sort of discussion of general health maintenance without there being a problem to solve, it’s more of a … ‘do you do any exercise?’, ‘do you do this or that?’ just from a general health promotion point of view rather than as a method for assisting with fixing something or maintaining health' (GP8) ‘Sometimes they’ll come in and ask, ‘look I want to have a general screen done’ or ‘I’m worried about my smoking, can you help me quit?’ or weight … let’s talk about that' (GP4). ‘Patients who say, “look I really wanna lose weight, can you tell me what to do?”' (GP10) ‘There are other cases where it is for regular review so for instance GP management plans we will bring them in for regular reviews for chronic disease such as diabetes’ (GP4) Reactive ‘If someone comes in and they’re obese you might make the time to talk to them about that' (GP1). ‘It is focussed on a presenting concern, or something related to that concern, I mean so if they have asthma and are a smoker, I will focus on that as my primary behavioral focus for the patient' (GP12). ‘Sometimes when they come in with a cold for instance I’ll ask if they have asthma or do they smoke and that will be the direction I go with the lifestyle question' (GP4) ‘It may well come up if you’re sort of aware that the patient’s demeanour is … not normal or has changed or … you’re aware of stressors in their life' (GP5) ‘I do a random sugar level … if that’s high that will be the instigator for the discussion' (GP4) ‘If you’ve got a young university student that’s stressed and needs a deferral for an exam before exams … I’m not going to mention it … I’m just going to do what they want me to do' (GP10). ‘In a general day to day, you know, script refills, um, maybe injuries or broken bones or, um yeah, then no I will not discuss it. It definitely depends on what is presented in the consultation and whether the discussion is appropriate’ (GP21). ‘If you come in with a rolled ankle you’d probably think it was a bit peculiar if I said … “are you depressed?” and they’d go “no I’ve just got a sore ankle”' (GP8)
	Prompts to cue discussions	‘There’s reminders that come up on our practice software. … smoking and alcohol we have prompts if it hasn’t been recorded … I think you can set it up to prompt for other things … then sometimes we act on that prompt … not always' (GP1) ‘I’d go through perhaps in a more structured way … their presenting complaint … background history, which would include smoking, alcohol, exercise perhaps not so specifically because there isn’t a particular … interface on our software for exercise' (GP7)
	GP-initiated or collaboratively-initiated	‘Most of the time it would be the doctor sort of flagging it and getting them to think about other aspects of their life that they might not even be aware of that are unhealthy' (GP2). ‘I would say usually it is me as a doctor bringing it up rather than the patient, unless say they have specifically come in for weight loss or a smoking cessation consultation, they would be the most health concerns most commonly brought up by my patients' (GP18) ‘Some people will come and initiate it and then they’ll say, ‘look I’ve been feeling really low’ … ‘I’m crying most days’ or ‘I’m drinking half a bottle … a bottle of wine a night … I know this is not right’ … they’ll come in and they recognise it' (GP4). ‘People who will come in and say … ‘I think I’m depressed’ … in which case they’ve initiated it … at other times … it’s much more of a physical presentation and then it’s more of us initiating to say, “look I think this is possibly what’s causing the issues here”' (GP8)
	Cost to GP vs. benefit to patient	‘It really is dependent on what other concerns need to be address and to be honest, how much time I have at the end to enquire about these things' (GP26) ‘I’m booked every ten minutes so if it’s outside of that time, because obviously if it’s a busy day and I’m just fully booked, then they may have to reschedule' (GP10). ‘I think it is really important, but I am struggling for time, I might approach it again at another consultation' (GP23) ‘If someone’s got ten other illnesses that are more pressing to them you’re not going to suddenly go ‘let’s talk about your smoking’ um but if there’s something mild and then you can see it’s still important and you can get them to see it’s important then zone in on it' (GP2) ‘Sometimes you just need to deal with a crisis' (GP5). ‘It depends on the urgency of those changes, for instance, if a woman is pregnant and smokes. … we kind of … a bit more pushier and prescriptive about those … but if this is a patient … who has been smoking and is about seventy years we are a bit more casual' (GP11)
Content of lifestyle discussions	Ad hoc with a lack of a formal process	‘It’s probably more ad hoc if it’s just an addition to the consultation … if it’s not related to their presenting complaint it’s probably a bit more ad hoc' (GP1). ‘Ad hoc if I’m trying to bring up the conversation with the patient so I will … jump at that opportunity' (GP4). ‘Basically, I will just bring it up and have a chat with them' (GP24). ‘What is appropriate information for the patient is something that, yes something that I generally do on the spot as the situation arises and the discussion progresses’ (GP17) ‘In my own mind it’s structured because you’re going almost through a tick box in your own mind of things … I don’t get out a sheet and say, “let’s go through this”' (GP8) ‘I don’t try and make anything too formal ‘cause I think it’s bad enough telling a stranger you’re depressed, you’re very vulnerable … and I think there’s still a lot of stigma about psychological stuff' (GP10)
	Content of discussion dependent on prompt or clinical indicator	‘Sometimes its [lifestyle discussions] part of the management of that particular presenting complaint' (GP1). ‘You kinda use that to fuel your argument for presenting why they should make a health behavior change' (GP2)
	Giving basic health advice and education	‘Well its really just information I have collated over the years, it is a combination of things that we have, say published referrals within the general practise, or that we have received from other help practitioners, also some national guidelines' (GP15). It’s very basic' (GP10) ‘As a brief intervention … eat less food, mainly plants … look at how much you drink alcohol and how much you move. So, move more, eat less … So, that’s the kind of brief things that I would say to most people' (GP3). ‘If they’re really depressed, really anxious … they’re unable to think you know they just can’t concentrate, they can’t focus, they can’t make a decision, so it’s quite important just to take that away from them and say, ‘look this is what you need to do, bang bang bang’, keep it simple … then always get them back' (GP6). ‘I don’t go into too much detail. I pretty much will let the psychologist deal with it all. I’m just there to sort of say look this is what I think you can probably look at doing’' (GP10). ‘I provide a lot of psychoeducation around the sort of symptoms around depression and anxiety and try to … get people to understand, especially with anxiety, the need to take some responsibility themselves' (GP7). ‘If it’s a young man who is in their forties and have risks … the person who has chest pain and all that … we use the fear factor as well as the persuasive method’ (GP9) ‘I certainly provide some education … in terms of the services … I’ll often give them an information leaflet about say depression, anxiety, stress, ways to cope etc … I’ll direct them to websites such as Beyondblue and Blackdog Institute … I suggest sometimes apps on phones so like relaxation or mindfulness apps like headspace' (GP4) ‘If we discuss a lot of issues and they sort of get out and go ‘oh my God, now what am I supposed to do?’ … So, I often write it down' (GP6) ‘It’s hard to know … which services are available, who to go to, what are the specialties of say a clinical psych' (GP4)
Factors influencing initiation of lifestyle discussions	Patient readiness for change	‘It all depends on their readiness for change … Sometimes it’s just really a matter of promoting the discussion for them to think about it ‘cause they’re not actually quite at that stage read to change things … So, I guess we’ve got to ascertain that first' (GP1). ‘The first question I ask is ‘do you want to quit? Are you at a stage where … ?’ and if they say no, it’s like ‘ok let’s talk about it again later’ … ‘cause what’s the point?' (GP10). ‘Um yeah I guess, yeah mostly it is just how easily the conversation flows and you know, if they look like, um, they are about to fall asleep' (GP19). ‘There’s no point if … they’re already frowning and shaking their head when you say the word ‘exercise’ then there’s no point going on for another ten minutes about it … you have to back off a bit' (GP8) ‘Sometimes you just give up ‘cause you know they’re not going to change … what do you do? What can you do?' (GP10). ‘It can be very difficult to make that a primary part of your practise when you have other acute medical conditions and the likelihood of change is slim' (GP25). ‘The patient has to have some sort of buy in or it is a waste of my time and theirs’ (GP15)
	Patient acceptance and openness	‘Patients that it’s more difficult raising lifestyle issues with … I guess they’re the ones that are in denial about their disease … trying to bring that up is a lot more difficult … it’s a … much more sensitive issue … so you just … you tread gently and just say ‘have you ever thought about’ … so you very gently sort of introduce those topics' (GP6) ‘Once the issue’s raised it’s very easy to engage … and get them to talk as well … I think it’s kind of like a vent for them … suddenly yes, someone’s going to listen to me' (GP2)
	Patient accountability and responsibility	‘People are responsible for their own health ultimately' (GP1). ‘There’s only so much you can do with adults you … try and empower them to sort of sort out things themselves … there’s only so much you can do … to get them to change things … they’ve gotta be doing some of this by themselves' (GP8). ‘I mean, they are adult, at the end of the day you can just give advice but really you cannot make them do anything that they don’t want to' (GP23)
	Patient background factors	‘The younger demographic they’re not usually concerned um and it’s more just about educating them' (GP2) ‘There’s sort of a background script but it’s very much tweaked upon what the patient already knows' (GP8) ‘They’re quite motivated cohort … they’re well educated, well-motivated, they understand the importance of good nutrition and good health and stuff and they’re always trying to optimise that I guess' (GP6) ‘They [men] are less likely to open up to someone that they don’t know … that’s a generalisation but I think that’s still true to an extent' (GP1). ‘I haven’t had too many males come in talking openly … or if they have … it’s because their wife has pushed theme' (GP4). ‘Men rarely like to come in … you feel like you have to mention what you can in the time ‘cause it’s the only chance they get' (GP3)
	GPs’ role and knowledge	‘I don’t go into detail because I don’t have the knowledge, so I tend to suggest go and see a dietitian … an exercise physiologist … because I don’t have enough knowledge to know what to do' (GP11). ‘I tend to refer because I’m not a psychologist … If I felt I had the knowledge, then I would deal with it’ (GP10) ‘It may be a … 45-year-old lady and you think ‘oh my God she’s carrying far too much weight’ but unless … she raises that herself … it would be very confronting to say' (GP2). ‘I’m not going to mention any of this [lifestyle behaviors] … I’m just going to do what they want me to do basically, because they’re not going to want me to be discussing how much exercise they do’ (GP10) ‘I think I haven’t actually done my job unless I deal with that and then say, ‘let’s have a look at your blood pressure’ … ‘what’s happening in your life at the moment?’ … find out what is happening for all of this person' (GP3)
	Financial implications	‘Health promotion, I mean is obviously an essential part of general practise, but that is not the area where you see the immediate rewards. So, there is human tendency to then not spend as much time, which is the nature of the beast' (GP20). ‘There is no time or monetary benefit for prevention' (GP19)
	GP-patient relationship	‘For me I feel you have to be careful not to nag people, you do want them to come back' (GP14) ‘If I haven’t met them before … I’d probably have to see them a few times to gauge ‘is this their normal?, or “have I noticed a trend in terms of their flat affect?”’ (GP4) ‘The more long-term the relationship is, the more likely people are perhaps to trust you with information' (GP7). ‘They’re usually pretty good about telling me you know whether they smoke a lot of week … whether they use meth or whatever but they’re often not the sort of things you can ask the first time you know it’s … the rapport' (GP3) ‘Just have to be fairly accepting, at least initially, so that people feel that they’re not going to be slammed down' (GP3). ‘I would probably hope that by talking about things that they would come back, again and again, and it would be something that you would be able to chip away at as your relationship builds' (GP18). ‘It comes down to a … trust thing … you gotta have a rapport with patients' (GP5)
	Lack of time	‘I think behavior change cannot be done in a fifteen-minute consult' (GP10) ‘They can get a lot of useful information [from the dietician] that I don’t necessarily have the time to … pick apart' (GP3) ‘I don’t go into detail ‘cause … basically I don’t have the time' (GP10). ‘Well yeah, I mean if they are looking at changing behavior, I suppose allied health, well they have the opportunities and resources to sit down with them and really focus on an in-depth plan, much more than what I could get across in the 2–3 min that I am talking to them' (GP24). ‘Behavior change cannot be done in a 10-minute consult' (GP10)