Physician perceptions of primary prevention: qualitative base for the conceptual shaping of a practice intervention tool

Abstract

BackgroundA practice intervention must have its basis in an understanding of the physician and practice to secure its benefit and relevancy. We used a formative process to characterize primary care physician attitudes, needs, and practice obstacles regarding primary prevention. The characterization will provide the conceptual framework for the development of a practice tool to facilitate routine delivery of primary preventive care.MethodsA focus group of primary care physician Opinion Leaders was audio-taped, transcribed, and qualitatively analyzed to identify emergent themes that described physicians' perceptions of prevention in daily practice.ResultsThe conceptual worth of primary prevention, including behavioral counseling, was high, but its practice was significantly countered by the predominant clinical emphasis on and rewards for secondary care. In addition, lack of health behavior training, perceived low self-efficacy, and patient resistance to change were key deterrents to primary prevention delivery. Also, the preventive focus in primary care is not on cancer, but on predominant chronic nonmalignant conditions.ConclusionsThe success of the future practice tool will be largely dependent on its ability to "fit" primary prevention into the clinical culture of diagnoses and treatment sustained by physicians, patients, and payers. The tool's message output must be formatted to facilitate physician delivery of patient-tailored behavioral counseling in an accurate, confident, and efficacious manner. Also, the tool's health behavior messages should be behavior-specific, not disease-specific, to draw on shared risk behaviors of numerous diseases and increase the likelihood of perceived salience and utility of the tool in primary care.

Barriers and Facilitators for the Implementation of Primary Prevention and Health Promotion Activities in Primary Care: A Synthesis through Meta-Ethnography

“…At this level we found: professionals' beliefs about PP&HP [8], [9], [23]–[25], [27]–[29], [31]–[49], [51]–[55],their experiences in dealing with a particular risk factor or required lifestyle modification [33], [49], [50],appropriate skills and knowledge [8], [9], [23]–[29], [31]–[37], [39]–[49], [51]–[54], their motivation [34]–[36], [37], [44], [48], [51], their attitudes [9], [23]–[25], [27], [28], [31], [33], [35]–[43], [46]–[49], [51]–[55] and their self-concept (self-confidence in their capacities and personal experiences with the problem: e.g., a smoker physician dealing with tobacco cessation or an obese nurse dealing with nutrition recommendations) [9], [23], [27]–[29], [33], [34], [37], [39], [41], [45]–[49], [51]–[53]. The beliefs are related to the consideration of risk as a disease or not, the effectiveness and/or efficiency of PP&HP activities, negative aspects (side-effects) of risk assessment and the medicalization of life, the use of medication as a preventive strategy (e.g., statins for cardiovascular-risk reduction), questions about which patients...…”

Potentials and pitfalls for nutrition counselling in general practice

“…It is therefore important that general practitioners indeed acknowledge and support their potential role in cardiovascular risk reduction (Mann & Putnam, 1989;Mirand et al, 2002). In practice, unfortunately, the level of preventive services usually lags behind the guidelines and recommendations (Cohen et al, 1994;Yarnall et al, 2003).…”

Dental Screening and Referral of Young Children by Pediatric Primary Care Providers

“…This relationship is supported by behavioral theory 21 but only a few empirical studies. 22 It might be important for dental health services in particular because physicians who choose to provide oral health services are practicing in an area for which they may have had little formal training. No validated practice guidelines or tools are available to inform screening and referral practices, and there are no screening or diagnostic tests available; thus, a decision on screening results requires referral to a specialist, in this case a dentist with whom they might not interact on a frequent basis.…”