A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the dutch construction industry

Abstract

BackgroundLifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands.MethodsPrior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison.ResultsHypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS.ConclusionThe findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.

Process Evaluation of the Nationwide Implementation of a Lifestyle Intervention in the Construction Industry

“…Another group stated they lacked a clear idea of the added value of the counseling trajectory. 22 Even though participants evaluated the counselors as competent, the present finding that none of the counselors attained the basic competence level for motivational interviewing technique indicates that there was room for improvement. A higher MI proficiency might increase the counselors' ability to motivate employees to continue the trajectory.…”

“…In a qualitative study prior to implementation of the HUC intervention, the OPs foresaw that referrals would be hampered by numerous barriers, including lack of time, perceived lack of motivation among the employees, and a lack of trust in the capacity of the lifestyle counselors. 22 Although several adaptations were made before implementation to address those barriers, based on the low reach, we feel that the implementation strategies of the nationwide implementation were insufficient to achieve effective referral. On the basis of their studies on the successful scale up of the Diabetes Prevention Program in Finland and Australia, Oldenburg et al concluded that ''recruitment of participants by the nurses and the relatively small but important supporting role of the GPs maximized the high uptake of the program in Australia.''…”

“…This finding is also in line with the results of the earlier study on barriers and facilitators to the implementation of the HUC intervention, where a group of employees expressed a strong preference for independence. 22 Those employees did see the need to change their lifestyle, but preferred to do it themselves, ie, without a counselor. Another group stated they lacked a clear idea of the added value of the counseling trajectory.…”

“…Second, the collaboration between counselors and OPs needs to be improved, so that OPs can prepare the ground for the lifestyle counselor, and the counselor and OP can come to a concerted effort in the CVD risk management process. 22 Third, if the OP remains responsible for referring employees, then his/her selfefficacy needs to be improved. Laws et al concluded that self-efficacy contributes to physicians' ability to make a referral, and several studies have shown that self-efficacy is key to behavior interventions.…”

“…Hence, shortly before the nationwide implementation, an additional study on the barriers and facilitators was performed. 22 On the basis of the finding that OPs were hampered in making a referral by administrative tasks tied to the intervention, the administrative tasks for OPs were minimized. The question was whether or not these preparations would lead to favorable implementation results.…”