Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients

Abstract

BackgroundThe effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions.MethodsQualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers.ResultsGPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere.ConclusionsHPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.

Prévention et promotion de la santé : quels modèles pour soutenir l’évolution des pratiques en soins de santé primaires ?

“…2. La plupart des modèles parlent des patients, mais très peu ont été construits avec eux [25,26]. Une approche ontologique simple, s'intéressant à ce qui conditionne leur positionnement dans la dyade médecin-patient, et leurs relations à l'environnement immédiat, est toutefois présente dans quelques modèles [14,15,18].…”

“…Certains modèles systémiques de type socio-écologique illustrent le concept de promotion de la santé [18,23,25,26]. Ces modèles en intègrent à des degrés divers certaines caractéristiques distinctives : approche des groupes ou des populations, prise en compte des milieux de vie ou des déterminants sociaux de la santé [18,23,25,26].…”

“…Le système de mots-clés structurés du MeSH n'est pas conçu pour effectuer des recherches sur des concepts, ce qui explique le grand nombre de résultats initiaux pour le petit nombre de Deux exceptions notables ont été relevées dans cette étude : celle du cadre théorique bidimensionnel de Calderon [25], basé sur une recherche qualitative dans un contexte de soins, et celle des cercles de culture de Heidemann & Almeida [26]. La première se développe dans le cadre de la promotion de la santé dans la relation individuelle.…”

“…On remarque cependant une progression de l'attention aux usagers entre les modèles, de la prise en compte des caractéristiques personnelles des patients [14,15,18,25,26], puis à celle des milieux de vie [16-18, 23, 25, 26], puis des déterminants sociaux [18], jusqu'au ciblage de groupes d'usagers, pouvant potentiellement remettre en question le pouvoir médical [18,23,26].…”

Implementation of healthy lifestyle promotion in primary care: Patients as coproducers

“…Furthermore, barriers to implementing lifestyle promotion include willingness of the clinician, lack of time, and lack of training and knowledge [11][12][13][14].…”