Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case–control studies

Abstract

ObjectiveSpanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities.DesignTwo case–control studies.SettingPerformed in primary care of five Spanish regions.SubjectsIn the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not.Main outcome measuresTeam, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources.ResultsThe first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1).ConclusionsProfessional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

Qualitative evaluation of a complex intervention to implement health promotion activities according to healthcare attendees and health professionals: EIRA study (phase II)

“…This project encourages participation in community activities, particularly physical activity, even though many participants did not follow these recommendations. In agreement with the results of the systematic review by March et al , which shows that in primary care preventive interventions, the community might be more effective than the individual approach,30 health professionals underscored a more systematic use of social prescription in regular practice, which indicates an interest in implementing a more biopsychosocial model 31. This qualitative assessment suggests that despite early resistance, professionals and healthcare attendees became eventually aware of the importance of the community components of health promotion interventions.…”

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial

“…Moreover, as Barbara Starfield points out, to achieve “more effective, more efficient, safer and more equitable” PHC services, the emphasis should shift from treating diseases to caring for individuals and populations [ 7 ]. However, the implementation of health promotion and prevention interventions remains suboptimal mainly as a result of work overload and lack of time or training [ 8 – 10 ]. In addition to all these barriers, the most suitable model to approach behaviour change remains unclear, and there is a lack of theoretical basis of interventions, skills in helping people changing behaviour and knowledge of the local context in which these interventions are undertaken [ 11 – 13 ].…”

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

“…The training centre status had a negative effect on physical BC. The study by March et al [10] found a negative association between PHC training centres and health-promoting community activities. Recently, PHC interventions to increase physical activity have been integrated into usual practice in Spain [33,50], and non-training PHC centres might have been more motivated to promote physical activity BC.…”

“…We analysed the variables associated with smoking cessation, the change in physical activity and in adherence to a Mediterranean dietary pattern, as well as the change in any behaviour and in two or three behaviours, adjusting for possible confounding variables. Final models were chosen in accordance with the study objectives, prior research [10,11] and the nature of the variables (potential confounders, signi cant and clinically relevant variables). We also calculated an overall impact factor of the intervention on the target population according to an expanded impact formula for MHBC proposed by Prochaska et al [44].…”

“…In this regard, Primary Health Care (PHC) is considered the most convenient setting to promote BC, since it is highly accessible, has an integral approach to health and provides continuity of care [3,9]. However, the implementation of health promotion and prevention interventions in PHC remains suboptimal, mainly as a result of work overload and lack of time or training [10,11]. In addition to all these barriers, the most suitable model to approach BC remains unclear, and there is a lack of theoretical basis of interventions, skills in helping people changing behaviour and knowledge of the local context in which these interventions are undertaken [12][13][14].…”