What are the barriers and facilitators to effective health promotion in urgent and emergency care? A systematic review

Abstract

Background There are potential health gains such as reducing early deaths, years spent in ill-health and costs to society and the health and care system by encouraging NHS staff to use encounters with patients to help individuals significantly reduce their risk of disease. Emergency department staff and paramedics are in a unique position to engage with a wide range of the population and to use these contacts as opportunities to help people improve their health. The aim of this research was to examine barriers and facilitators to effective health promotion by urgent and emergency care staff. Methods A systematic search of the literature was performed to review and synthesise published evidence relating to barriers and facilitators to effective health promotion by urgent and emergency care staff. Medical and social science databases were searched for articles published between January 2000 and December 2021 and the reference lists of included articles were hand searched. Two reviewers independently screened the studies and assessed risk of bias. Data was extracted using a bespoke form created for the study. Results A total of 19 papers were included in the study. Four themes capture the narratives of the included research papers: 1) should it be part of our job?; 2) staff comfort in broaching the topic; 3) format of health education; 4) competency and training needs. Whilst urgent and emergency care staff view health promotion as part of their job, time restraints and a lack of knowledge and experience are identified as barriers to undertaking health promotion interventions. Staff and patients have different priorities in terms of the health topics they feel should be addressed. Patients reported receiving books and leaflets as well as speaking with a knowledgeable person as their preferred health promotion approach. Staff often stated the need for more training. Conclusions Few studies have investigated the barriers to health promotion interventions in urgent and emergency care settings and there is a lack of evidence about the acceptability of health promotion activity. Additional research is needed to determine whether extending the role of paramedics and emergency nurses to include health promotion interventions will be acceptable to staff and patients.

Effectiveness and implementation of interventions for health promotion in urgent and emergency care settings: an umbrella review

“…No review level evidence was identified for physical activity or diet and nutrition. Evidence suggests this may be because staff are worried about discussing these topics with patients due to seeming insensitive or stigmatising patients, so few studies or interventions have been conducted in these areas despite patients reporting they are most interested in these topics [3].…”

“…However, there are barriers for clinicians in delivering such interventions which relate to lack of knowledge, lack of time and resources and personal discomfort with regard to impact on the relationship with patients [31]. These barriers have also been reported in a review of wider health promotion activities in UEC settings [3] and will need to be addressed to increase the frequency and impact of health promotion interventions delivered in UEC. There was generally minimal reporting of aspects of implementation in effectiveness reviews.…”

“…There are potential benefits for patients, health services and society for using UEC settings to deliver health promotion interventions. These include prevention of ill-health, improved health and improved quality of life for patients; reduced health inequalities; reduced healthcare costs; and benefits for the economy and employers due to reductions in days lost at work and costs from sickness absence [3,4].…”

Pacientų Sveikatos Mokymas Priėmimo – Skubiosios Pagalbos Skyriuje

“…Nustatyta, kad konkrečiai ligai skirtas mokomasis vaizdo įrašas yra santykinai nebrangi priemonė tikslingam pacientų mokymui priėmimo -skubiosios pagalbos laukiamajame. Tyrimai rodo, kad efektyviam pacientų sveikatos mokymui naudojami kombinuoti sveikatos mokymo metodai, tačiau norint juos pritaikyti, reikia struktūrinių ir kultūrinių pokyčių [15]. Atlikti tyrimai patvirtina, kad būtina tobulinti personalo kompetencijas pacientų sveikatos mokymo srityje [13].…”

Paramedic To Provider Consultation Challenges in the Emergency Department in Kazakhstan: An Online Survey

“…[15][16][17] Experts believe that the way out of this situation is to implement an individualized educational approach to the patient, constantly improve the skills of the staff of the emergency medicine department, reduce the impact of risk factors on the health of patients, as well as the development and implementation of emergency medical care algorithms that can be adapted for wide use. 18,19 Another approach for optimizing the provision of emergency medical care is the use of telephone communication by paramedics for preliminary consultation with emergency department providers and notification of the need to involve consultants in examining a patient. This practice is widely used in developed countries and brings significant benefits in terms of reducing the time to make decisions about patient management and improving outcomes.…”