Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

Abstract

BackgroundThe number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study.MethodThis qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews.ResultsAll GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive.ConclusionGPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.

Advocated but Sidelined: Health promotion for the elderly in the Netherlands

“…Indicated and disease -oriented prevention use individual interventions as a tool, while universal and selective prevention are mostly community based. We have also described other distinctions that are used to classify HP in Appendix 1 [8]. These distinctions are also used by main stakeholders to describe responsibilities regarding the funding and financing of HP.…”

“…The national strategy that regulates HP for older adults is based on several policy documents and it is best reflected through integrated prevention based programs such as Nationaal Programma Ouderenzorg [9] and BeterOud (BeterOud.nl). The main goal of this program is to provide healthy independent living of older adults including fall prevention, mental health prevention and social inclusion [8,10]. On the local level, the main role for HP for older adults is given to municipalities and the GGD.…”

“…The older adults perceived them as trustworthy persons. HPs that are advertised or implemented by GPs usually have better success among the older adults, than large national interventions [8].…”

Depth of the patient–doctor relationship and content of general practice consultations: cross-sectional study

“…In other studies, it has been shown that GPs are concerned about potentially detrimental effects for the patient-doctor relationship in giving lifestyle advice to patients they know well, 27 and there are many barriers to the effective delivery of health promotion advice and lifestyle counselling. 28,29 Patients report that a more personal relationship with their GP 'created motivation and an obligation to change', however, with the delivery of lifestyle counselling in primary care settings.…”

Efficacy of a Communication Skill Training Fostering Health Promotion in Primary Care: A Mixed Method Analysis

“…The change of role and modern communication techniques are beyond the traditional patterns of GPs' training and professional work, and there is room for improvement in the pre-and postgraduate medical education in regard to communication training [8]. Besides that, there are multiple barriers to be considered towards the implementation of health promotive counseling in ambulatory primary care, such as low self-efficacy in regard to counseling skills, lack of time, and low reimbursement [9][10][11]. Our study provides further knowledge about the effects of a GP training program in modern communication techniques.…”