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Abedini F, Mokhtari Nouri J, Moradian ST. Spirituality, a Neglected Dimension in Improving the Lifestyle of Coronary Artery Patients by Nurses: A Scoping Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:381-388. [PMID: 39205837 PMCID: PMC11349168 DOI: 10.4103/ijnmr.ijnmr_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 12/16/2023] [Accepted: 12/16/2023] [Indexed: 09/04/2024]
Abstract
Background By modifying the lifestyle of patients, the risk factors of Coronary Artery Diseases (CADs) are adjusted. This study was performed with the aim to investigate the role of nurses in the lifestyle of coronary artery patients. Materials and Methods This scoping review was conducted with the question of the role of nurses in improving the lifestyle of coronary artery patients. This study was conducted in databases and search engines of ScienceDirect, Springer, Scopus, PubMed, MEDLINE, and Google Scholar for English texts, and in the Magiran and Scientific Information Database (SID) databases and search engines for the texts printed in Persian. The search for articles printed from 2012 to 2022 was conducted based on the keywords used in the title and abstract of the articles. The keywords used to search domestic databases included nursing, lifestyle and healthy lifestyle, and heart diseases (based on MeSH). Results Nurses have made significant efforts and performed interventions to improve the lifestyle of coronary artery patients through guidance and education regarding the improvement of their diet and mobility, compliance with their treatment regimen, and reduction of the risk factors of CAD. In the psychological dimension, they had a positive effect in some fields such as stress management and mental health. However, in the spiritual dimension, effective studies and interventions have not been conducted by nurses. Conclusions The role of nurses in the lifestyle of coronary artery patients is effective in the physical dimension, limited in the psychological dimension, and neglected in the spiritual dimension.
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Affiliation(s)
- Fahimeh Abedini
- Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Jamileh Mokhtari Nouri
- Medicine, Quran and Hadith Research Center, Nursing Management Department, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Alkhtib AO, Ali K, Sajnani AK, Anweigi L. Barriers and enablers for oral health promotion programs amongst primary healthcare stakeholders in Qatar - a qualitative investigation. BMC Oral Health 2023; 23:924. [PMID: 38007460 PMCID: PMC10676573 DOI: 10.1186/s12903-023-03633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Oral health of preschool children remains a concern globally. Primary healthcare providers are in a vital position to support preventive oral care programmes. This study explored current practices, perception and barriers of primary health care professionals towards oral health promotion program of children in Qatar. METHODS The qualitative research used focus group discussions and interviewed a total of 108 participants that were audio recorded and transcribed verbatim. Four major themes emerged and were analysed to explore contextual patterns within the data. RESULTS Participants acknowledged the high prevalence of caries in children and identified the causes in the local context which included parental practices, poor dietary habits, impact of culture lack of oral health knowledge, limitations in the healthcare system, and negative role of the media. However, complex barriers were exposed, including lack of time and ownership, system coordination between organizations, and lack of policy. CONCLUSION Health professionals and bureaucrats involved in decision-making held a positive attitude towards oral health prevention programs and were enthusiastic to initiate and support these programs.
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Affiliation(s)
- Asmaa Othman Alkhtib
- College of Dental Medicine, QU Health, Qatar University, Doha, 2713, Qatar
- Primary Health Care Corporation, Doha, Qatar
| | - Kamran Ali
- College of Dental Medicine, QU Health, Qatar University, Doha, 2713, Qatar
| | - Anand K Sajnani
- Faculty of Medicine, Caucasus International University, Tbilisi, Georgia
| | - Lamyia Anweigi
- College of Dental Medicine, QU Health, Qatar University, Doha, 2713, Qatar.
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Larsson K, Hagströmer M, Rossen J, Johansson UB, Norman Å. Health care professionals' experiences of supporting persons with metabolic risk factors to increase their physical activity level - a qualitative study in primary care. Scand J Prim Health Care 2023; 41:116-131. [PMID: 36927270 DOI: 10.1080/02813432.2023.2187668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To be regularly physically active is of major importance for the health of people with metabolic risk factors. Many of these persons are insufficiently active and in need of support. This study aimed to explore barriers and facilitators perceived by health care professionals' within Swedish primary care in their work to support persons with metabolic risk factors to increase their physical activity. DESIGN A qualitative design with focus group discussions was used. The data were analysed using qualitative content analysis with a manifest, inductive approach. SETTING Primary health care in five Swedish healthcare regions. SUBJECTS Nine physiotherapists, ten physicians and five nurses participated in six digital focus group discussions including two to six participants. RESULTS Barriers and facilitators to supporting persons with metabolic risk factors to increase their physical activity were found within four generic categories, where the barriers and facilitators related to each generic category: 'Patient readiness for change', 'Supporting the process of change', 'The professional role', and 'The organisation of primary care'. CONCLUSION The findings suggests that barriers and facilitators for supporting patients with metabolic risk factors can be found at several levels within primary care, from individual patient and the health care professionals to the organisational level. In the primary care setting, this should be highlighted when implementing support to increase physical activity in people with metabolic risk factors.KEY POINTSHealth care professionals within primary care are in a position to support people with metabolic risk factors to increase their physical activity.Barriers and facilitators to support the patients should be addressed at several levels within primary care.The study highlights factors on multiple levels such as professional responsibility, organisational prioritisation and resources, and the challenge to motivate behaviour change.
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Affiliation(s)
- Kristina Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden
| | - Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Norman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Islam KF, Awal A, Mazumder H, Munni UR, Majumder K, Afroz K, Tabassum MN, Hossain MM. Social cognitive theory-based health promotion in primary care practice: A scoping review. Heliyon 2023; 9:e14889. [PMID: 37025832 PMCID: PMC10070720 DOI: 10.1016/j.heliyon.2023.e14889] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Background Using a theoretical perspective to guide research design and implementation can result in a coherent preventative intervention model. Among theoretical frameworks, Bandura's Social Cognitive Theory (SCT) is particularly useful for studies focused on behavior change in health promotion research. Objective This scoping review explored and summarized the current evidence on health promotion interventions that integrated constructs of Social Cognitive Theory and the outcome of those interventions in primary care settings. Method ology: We conducted this scoping review using the PRISMA scoping review guidelines; we reviewed articles from five electronic databases and additional sources that were peer-reviewed journal articles reporting interventions applying SCT constructs and synthesized the outcomes following the interventions. Results Among 849 retrieved from multiple sources, 39 articles met our eligibility criteria. Most studies (n = 19) were conducted in the United States. Twenty-six studies followed a randomized control trial design. Most studies (n = 26) recruited participants utilizing the primary care network. All 39 studies mentioned "self-efficacy" as the most utilized construct of SCT to determine how behavior change operates, followed by "observational learning" through role models. Twenty-three studies integrated individual (face-to-face) or peered group-based counseling-training programs; eight interventions used telephonic health coaching by a specialist; eight studies used audio-visual mediums. All included studies reported positive health outcomes following the intervention, including increased self-reported moderate-to-vigorous physical activity, increased Knowledge of dietary intake, high-risk behaviors such as STIs transmission, adapting to a healthy lifestyle, and adherence to post-transplant medication. Conclusion Current evidence suggests that SCT-based interventions positively impact health outcomes and intervention effectiveness. The results of this study indicate the importance of incorporating and assessing several conceptual structures of behavioral theories when planning any primary care health promotion practice.
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Rønnevik DH, Pettersen B, Steinsbekk A, Grimsmo A. General practitioners' experiences of being involved in local public health work in Norway. A qualitative study. Scand J Prim Health Care 2022; 40:450-458. [PMID: 36380485 PMCID: PMC9848364 DOI: 10.1080/02813432.2022.2144958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM The aim was to explore how general practitioners experienced being involved in local public health work and how they worked with prevention and health promotion clinically after the introduction of the Public Health Act in 2012. DESIGN, SETTING AND SUBJECTS Qualitative study with focus groups interviews with 18 GPs from different municipalities in Norway. RESULTS The GPs said that they either had not at all or only to a limited extent been involved in local public health work in their municipalities. They reported finding it hard to prioritize individual disease prevention and health promotion in their clinical work. GPs thought of health promotion as something that mainly concerned healthy people at a group level. CONCLUSIONS Based on the experiences of the GPs in this study, there is a gap between governmental expectations to the role of GPs in public health, and how it works in practice.KEY POINTSWith the Norwegian Public Health Act launched in 2012, GPs were expected to contribute to better population health in their clinical work and as data providers to local public health surveillance.The GPs interviewed in this study said they had not been involved in local public health work, and they found it hard to give disease prevention and health promotion priority in their clinical work.GPs expressed various perceptions of what prevention and health promotion entails.
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Affiliation(s)
- Dag-Helge Rønnevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- CONTACT Dag-Helge Rønnevik Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Betty Pettersen
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Municipality of Trondheim, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anders Grimsmo
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Kim YS, Kim SA. Impact assessment of a primary care physician counseling program for youth population. Medicine (Baltimore) 2022; 101:e31916. [PMID: 36401378 PMCID: PMC9678552 DOI: 10.1097/md.0000000000031916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to investigate the impact of implementing a primary care physician (PCP) counseling program for the youth population with healthcare needs. This quasi-experimental study used a nonequivalent control group pretest-posttest design, and was conducted at Salim Health Innovation Clinic in Seoul between February and October 2019 comprising 46 participating youths (intervention group) and 48 nonparticipating youths (control group). After 6 months of implementation, drinking (alcohol use control) decreased significantly in the intervention group (0.84 points). There was a significant difference in the anxiety level with a decrease of 2.86 and 0.65 points in the intervention and control groups (P = .011) respectively. There was also a significant difference in the health responsibility domain (P = .04). Moreover, a significant difference in self-efficacy level was found with a mean increase of 0.18 and 0.16 points in the intervention and control groups (P = .001), respectively. The youth population is more prone to neglect self-care due to poor physical and mental health status and no hope for the future because of a lack of jobs and rising housing prices. The program reinforces health-promoting behavior for managing stress and practicing eating high-quality meals, regular exercise, and regular health screening, which can help implement continuous and effective healthcare.
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Affiliation(s)
- Yun-Su Kim
- Department of Nursing, Honam University, Gwangsan-gu, Gwangju, Republic of Korea
| | - Shin-Ae Kim
- Department of Family Medicine, Suwon Hospital, Gyeonggi-do Medical Center, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea
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Delpech R, Poncet L, Gautier A, Panjo H, Ourabah R, Mourey P, Baumhauer M, Pendola-Luchel I, Ringa V, Rigal L. The role of organization of care in GPs' prevention practice. Prim Health Care Res Dev 2021; 22:e74. [PMID: 34796821 PMCID: PMC8628563 DOI: 10.1017/s1463423621000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/25/2021] [Accepted: 10/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND General practitioners (GPs) do not systematically include preventive recommendations in their practice, and some characteristics of health care organization are associated with more systematic prevention. But the characteristics of health care organization may act in a nonuniform manner depending on the type of preventive care. Thus, one characteristic can be positively associated with one type of preventive care and negatively associated with another. Our aim was to investigate the association between health care organization in general practice and different areas of preventive care (immunization and addiction prevention), in search of nonuniform associations. METHODS We used a representative survey of 1,813 French GPs conducted in 2009. Four preventive care practices were studied: immunization through flu and HPV vaccination, and prevention of addictive behaviors concerning tobacco and alcohol use.Characteristics of GPs' health care organization and the social context of their practice were collected (spatial accessibility to GPs and socioeconomic level of the area of practice). We constructed mixed models to study associations and interactions between the organization variables and preventive care. RESULTS Four out of five characteristics of GPs' organization have uneven impacts on different types of preventive care (p-interaction < 10-4). For example, number of daily consultations is associated with better immunization prevention but with poorer prevention counseling in addictive behaviors. In contrast, working with digital medical files is uniformly associated with both types of preventive care (OR = 1.29 [1.15-1.45]; P < 10-4). CONCLUSION An approach centered on specific types of preventive care should help deepen our understanding of prevention and possibly help to identify a new typology for preventive care.
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Affiliation(s)
- Raphaëlle Delpech
- Department of General Practice, University of Paris-Saclay, Paris, France
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
| | - Lorraine Poncet
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
| | | | - Henri Panjo
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
- Institut National d’Études Démographiques (INED), Paris, France
| | - Rissane Ourabah
- Department of General Practice, University of Paris-Saclay, Paris, France
| | - Pascaline Mourey
- Department of General Practice, University of Paris-Saclay, Paris, France
| | - Mathilde Baumhauer
- Department of General Practice, University of Paris-Saclay, Paris, France
| | | | - Virginie Ringa
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
- Institut National d’Études Démographiques (INED), Paris, France
| | - Laurent Rigal
- Department of General Practice, University of Paris-Saclay, Paris, France
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
- Institut National d’Études Démographiques (INED), Paris, France
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Melariri HI, Kalinda C, Chimbari MJ. Enablers and hindrances to health promotion and disease prevention practices among healthcare workers in Nelson Mandela Bay Municipality, South Africa. Prev Med Rep 2021; 23:101462. [PMID: 34258174 PMCID: PMC8254112 DOI: 10.1016/j.pmedr.2021.101462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/16/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Health promotion (HP) and disease prevention (DP) practices among healthcare workers (HCWs) are key to achieving universal health coverage. This study identified HP and DP enablers and hindrances and compared them at different healthcare levels in Nelson Mandela Bay Municipality, South Africa. An exploratory cross-sectional study using a structured questionnaire was conducted among HCWs (n = 501) from 23 hospitals. Bivariate and multinomial regression were used to analyze the data. The highest number of participants (70.46%; n = 353) were from tertiary hospitals. Thirteen and Eight categories of enablers and hindrances respectively were identified. Of these, eleven enablers and six hindrances of HP and DP were associated with tertiary hospitals; no enabler was identified at both primary and secondary while one hindrance was associated with primary level of health care. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28-3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23-0.62) were the predictors of HP and DP among medical doctors, while staff induction training (Coeff: 0.62, 95% CI: 0.40-0.95) and performance appraisal (Coeff: 1.86, 95% CI: 1.16-2.98) were the enablers among allied health workers. On the other hand, 'facility promoting treatment more than prevention' (Coeff: 2.03, 95% CI: 1.30-3.14) and 'practice guidelines incorporating HP' (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers respectively. Our work indicates the need for an operational strategy designed considering enabling and hindering factors to HP and DP practices for empowering HCWs and enhancing health outcomes.
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Affiliation(s)
- Herbert I. Melariri
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- Eastern Cape Department of Health, South Africa
| | - Chester Kalinda
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
- University of Namibia, Faculty of Agriculture, Engineering and Natural Sciences, School of Science, Katima Mulilo Campus, P/Bag 1096, Katima Mulilo, Namibia
| | - Moses J. Chimbari
- University of KwaZulu-Natal, Department of Public Health, College of Health Sciences, Howard College Campus, Durban 4041, South Africa
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Kreffter K, Götz S, Lisak-Wahl S, Nguyen TH, Dragano N, Weyers S. Doctors as disseminators? Practicing physicians as multipliers for community-based prevention networks in a large city in western Germany. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Abstract
Aim
Practicing physicians have a special position as disseminators of community-based prevention for children. However, it is unclear to what extent physicians inform parents about programs. The study investigated: To what extent do physicians disseminate information about community-based prevention for children aged 0–7? Do differences exist along family’s socioeconomic position (SEP) and immigrant background?
Subject and methods
We conducted a retrospective cohort study in a German school entrance examination. Parents were invited to participate in a survey on community-based prevention with information about their awareness and information source. SEP was measured by parental education, immigrant background by country of birth. For nine services types, we counted how often parents named physicians and other professional groups as information sources. To estimate social differences, we calculated adjusted odds ratios (OR) with 95% confidence interval (CI).
Results
Survey participants included 6480 parents (response 65.49%). Compared to other information sources, physicians were mentioned less frequently. For example, regarding language therapy, 31.2% of parents were informed by healthcare/social services, and 4.4% by physicians. Lower educated parents were less frequently informed by physicians about counseling services (OR 0.58; 95% CI 0.46–0.73) compared to higher educated parents. Parents with immigrant background were informed less often about parenting skills courses (OR 0.79; 95% CI 0.70–0.90) compared to parents without immigrant background, but more often about language therapy (OR 1.47; 95% CI 1.13–1.91). No further social differences were observed.
Conclusion
The role of physicians as disseminators for community-based prevention is expandable. They should promote parenting skills courses in a socially sensitive way.
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Kosowan L, Katz A, Halas G, Singer A. Patient perspectives on tablet-based technology to collect risk factor information in primary care. BMC FAMILY PRACTICE 2021; 22:103. [PMID: 34039256 PMCID: PMC8157443 DOI: 10.1186/s12875-021-01443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This study explores the integration of the tablet-based RFIT in primary care clinics to support exploration of patient risk factor information. METHODS Qualitative study to explore patients' perspectives of RFIT. RFIT was implemented in two primary care clinics in Manitoba, Canada. There were 207 patients who completed RFIT, offered to them by eight family physicians. We conducted one-on-one patient interviews with 86 patients to capture the patient's perspective. Responses were coded and categorized into five common themes. RESULTS RFIT had a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Patients reported that the tablet-based RFIT provided a user-friendly interface that enabled self-reflection while in the waiting room. Patients discussed the impact of RFIT on the patient-provider interaction, utility for the clinician, their concerns and suggested improvements for RFIT. Among the patients who used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 min of PA a week, and 8.2% lived in poverty. CONCLUSION RFIT is a user-friendly tool for the collection of patient risk behaviour information. RFIT is particularly useful for patients lacking continuity in the care they receive. Information technology can promote self-reflection while providing useful information to the primary care clinician. When combined with practical tools and resources RFIT can assist in the reduction of risk behaviours.
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Affiliation(s)
- Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy and Departments of Community Health Science & Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave., Winnipeg, Manitoba, R3E 3P5, Canada.
| | - Gayle Halas
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander Singer
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kosowan L, Katz A, Halas G, LaBine L, Singer A. Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation. JMIR Form Res 2021; 5:e24382. [PMID: 33528376 PMCID: PMC7886616 DOI: 10.2196/24382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review. OBJECTIVE This study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. METHODS This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. RESULTS Clinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. CONCLUSIONS Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients' context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care.
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Affiliation(s)
- Leanne Kosowan
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, Winnipeg, MB, Canada
| | - Gayle Halas
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa LaBine
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alexander Singer
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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ALKHTIB A, TEMPLE-SMITH M, MESSER L, PIROTTA M, MORGAN M, SAJNANI A. Knowledge, attitudes and practices of primary health care providers towards oral health of preschool children in Qatar. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E205-E214. [PMID: 32803007 PMCID: PMC7419124 DOI: 10.15167/2421-4248/jpmh2020.61.2.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
Objective Health care providers can effectively participate in oral health promotion for children in primary care setting. Currently, there are no oral health promotion programs that involve primary health care professionals in Qatar. Hence, this study was undertaken to examine the knowledge, attitudes and practices of all health professionals who work in the Well baby Clinics in the primary health centers. Method A 23-item questionnaire was distributed across 20 primary health centers. The questionnaire sought information on the demographic data of health professionals, their knowledge of oral health and their practices and attitudes towards critical oral health issues. Data were examined by Pearson Chi-squared tests or Fisher’s Exact test (p = 0.05). Results The response rate of the health professionals was 67%. Only 35.7% of the 225 participants received some form of oral health training during their undergraduate programme. The participants would assess the dental problem of the child (p = 0.05) and discuss the importance of tooth brushing with the mother (p = 0.03). A significant number of respondents (p = 0.04) were unlikely to assess the children’s fluoride intake. There was a significant difference in the group of participants that would examine the child’s teeth (p = 0.1) and counsel the mothers on prevention of dental problems (p = 0.01). This group would also refer children to dentist at 12 months of age (p = 0.05). Conclusions Health professionals had a positive attitude towards the anticipatory guidance elements of oral health. However, the knowledge of healthcare professionals on childhood oral health is rather limited.
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Affiliation(s)
- A. ALKHTIB
- Correspondence: Asmaa Alkhtib Primary Health Care Corporation Doha Qatar - E mail: mail:
| | - M. TEMPLE-SMITH
- Department of general Practice, University of Melbourne, Melbourne, VIC, Australia
| | - L.B. MESSER
- Melbourne Dental School, University of Melbourne, Melbourne, VIC, Australia
| | - M. PIROTTA
- Department of general Practice, University of Melbourne, Melbourne, VIC, Australia
| | - M. MORGAN
- Melbourne Dental School, University of Melbourne, Melbourne, VIC, Australia
- Oral Health CRC, University of Melbourne, Melbourne, VIC, Australia
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13
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Cohidon C, Imhof F, Bovy L, Birrer P, Cornuz J, Senn N. Patients' and General Practitioners' Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study. J Prev Med Public Health 2019; 52:323-332. [PMID: 31588702 PMCID: PMC6780292 DOI: 10.3961/jpmph.19.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives The aim of this study was to describe general practitioners (GPs)’ opinions and practices of preventive care and patients’ opinions, attitudes, and behaviors towards prevention. Methods The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. Results Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. Conclusions Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.
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Affiliation(s)
- Christine Cohidon
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fabienne Imhof
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Laure Bovy
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Priska Birrer
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jacques Cornuz
- Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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14
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Cohidon C, Wild P, Senn N. A structural equation model of the family physicians attitude towards their role in prevention: a cross-sectional study in Switzerland. Fam Pract 2019; 36:297-303. [PMID: 29945256 PMCID: PMC6531892 DOI: 10.1093/fampra/cmy063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In contrast to many studies exploring barriers to preventive care in family medicine, there is less quantitative research regarding the self-perceived role of family physicians (FPs) in prevention and its predictive factors. Moreover, the existing studies considered this attitude as a homogeneous entity. The objective of this study is firstly, to characterize FPs' attitudes towards prevention taking into account nine different prevention themes, and secondly, to explore the factors that could be predictive of this attitude. METHODS The data stem from a cross-sectional national survey on prevention we conducted in Switzerland from 2015 to 2016 (170 physicians randomly drawn, online questionnaire). We first performed a confirmatory factor analysis to define a homogeneous latent variable regarding physicians' attitude towards prevention, then, a structural equation modeling to identify potential predictors. RESULTS The FP' attitude towards their role in preventive care was homogeneously positive whatever the topic (smoking, drinking dietary habits, physical activities, and more generally, cardiovascular risk factors) except for occupational risks and cannabis consumption. A feeling of good effectiveness was a positive predictor of this positive attitude while seniority, the lack of reimbursement and being a physician from the German-speaking area were negative predictors. CONCLUSION The FP' attitude about their role in prevention is homogeneous concerning the 'classical' topics of prevention, whereas they still under-recognize certain topics as important fields for prevention. To change this situation, we probably need a global effort to introduce other ways of thinking about prevention, including not only FP but also all stakeholders.
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Affiliation(s)
- Christine Cohidon
- Institute of Family Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pascal Wild
- Institute for Work and Health, Lausanne University and Geneva University, Lausanne, Switzerland.,INRS - National Research and Safety Institute, Vandoeuvre les Nancy, France
| | - Nicolas Senn
- Institute of Family Medicine, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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15
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Sorensen J, Johansson H, Jerdén L, Dalton J, Sheikh H, Jenkins P, May J, Weinehall L. Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State. Health Serv Res Manag Epidemiol 2019; 6:2333392819862122. [PMID: 31384624 PMCID: PMC6657119 DOI: 10.1177/2333392819862122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. METHODS Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. RESULTS Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. CONCLUSIONS Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.
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Affiliation(s)
- Julie Sorensen
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Helene Johansson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Lars Jerdén
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Faculty of Medicine, Umeå University, Umeå, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
| | - James Dalton
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Henna Sheikh
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Paul Jenkins
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - John May
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Lars Weinehall
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Faculty of Medicine, Umeå University, Umeå, Sweden
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Ippoliti R, Falavigna G, Montani F, Rizzi S. The private healthcare market and the sustainability of an innovative community nurses programme based on social entrepreneurship - CoNSENSo project. BMC Health Serv Res 2018; 18:689. [PMID: 30185186 PMCID: PMC6125879 DOI: 10.1186/s12913-018-3513-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022] Open
Abstract
Background CoNSENSo is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship on the healthcare market, and this work highlights the necessary conditions for the successful implementation of these entrepreneurial initiatives. Methods Considering municipalities in the Piedmont Region and those aged 65 or older as target population, the authors propose several negative binomial regression models to estimate the effectiveness of current private healthcare services in supporting the active aging process. Such effectiveness may represent the ex-ante (positive) reputation of these new social entrepreneurial initiatives on the market. Results According to our results, the private supply of healthcare services can effectively support the aging process. Indeed, given that the other predictor variables in the model are held constant, there are statistically significant negative relations between the number of hip fractures and the private supply of healthcare services by dental practitioners and psychologists (p-value < 0.05), as well as the private supply of opportunities for social interaction by coffee bars (p-value < 0.05). Conclusions The authors expect a favourable environment for the entrepreneurial initiatives of community nurses in mountain areas. Accordingly, policy makers cannot reject the hypothesis that the goals reached by the CoNSENSo project may be maintained for the sake of the future generations, avoiding its collapse as soon as public funding shifts to new programmes.
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Affiliation(s)
| | - Greta Falavigna
- Istituto di ricerca sulla crescita economica sostenibile (IRCrES) - Consiglio Nazionale delle Ricerche (CNR), Moncalieri, Italy
| | | | - Silvia Rizzi
- Direzione Sanità - Regione Piemonte, Torino, Italy
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17
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Kardakis T, Jerdén L, Nyström ME, Weinehall L, Johansson H. Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare - a two-year follow up. BMC Health Serv Res 2018; 18:227. [PMID: 29606110 PMCID: PMC5880081 DOI: 10.1186/s12913-018-3023-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/16/2018] [Indexed: 11/17/2022] Open
Abstract
Background Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients’ unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients’ tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients’ lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses’ attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians’ uptake and use of the CPGs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3023-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Therese Kardakis
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden. .,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 17177, Stockholm, SE, Sweden.
| | - Lars Jerdén
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden.,Center for Clinical Research Dalarna, Nissers väg 3, 79172, Falun, SE, Sweden.,School of Education, Health and Social Studies, Dalarna University, 79188, Falun, SE, Sweden
| | - Monica E Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 17177, Stockholm, SE, Sweden
| | - Lars Weinehall
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden
| | - Helene Johansson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90185, Umeå, SE, Sweden
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Pons-Vigués M, Berenguera A, Coma-Auli N, Pombo-Ramos H, March S, Asensio-Martínez A, Moreno-Peral P, Mora-Simón S, Martínez-Andrés M, Pujol-Ribera E. Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions. Int J Equity Health 2017; 16:99. [PMID: 28610633 PMCID: PMC5470288 DOI: 10.1186/s12939-017-0590-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. METHODS A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. RESULTS Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role. CONCLUSIONS Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.
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Affiliation(s)
- Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av. Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. .,Universitat de Girona, Girona, Spain.
| | - Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av. Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Núria Coma-Auli
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av. Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
| | - Haizea Pombo-Ramos
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Bilbao, Spain
| | - Sebastià March
- Primary Care Research Unit of Mallorca, Balearic Health Services-IbSalut, Palma, Spain.,Instituto de Investigación Sanitaria de Palma, Palma, Spain
| | - Angela Asensio-Martínez
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga (IBIMA), Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain
| | - Sara Mora-Simón
- Primary Care Research Unit, The Alamedilla Health Centre, Castilla and León Health Service (SACyL), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Maria Martínez-Andrés
- Social and Health Care Research Centre, University of Castilla- La Mancha, Cuenca, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av. Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Universitat de Girona, Girona, Spain
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19
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Berenguera A, Pons-Vigués M, Moreno-Peral P, March S, Ripoll J, Rubio-Valera M, Pombo-Ramos H, Asensio-Martínez A, Bolaños-Gallardo E, Martínez-Carazo C, Maderuelo-Fernández JÁ, Martínez-Andrés M, Pujol-Ribera E. Beyond the consultation room: Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers. Health Expect 2017; 20:896-910. [PMID: 28116774 PMCID: PMC5600227 DOI: 10.1111/hex.12530] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 01/24/2023] Open
Abstract
Background Primary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities. Objective To identify proposals to approach HP in the context of primary care according to health‐care users aged 45‐75 years, key community informants and primary care centre (PCC) workers. Methods Descriptive‐interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi‐structured interviews were carried out. A thematic interpretive contents analysis was carried out. Results Participants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health‐care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person‐centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness. Conclusions According to a socio‐ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions.
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Affiliation(s)
- Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Universitat de Girona, Girona, Spain
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga (IBIMA), Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain
| | - Sebastià March
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.,Instituto de Investigación Sanitaria de Palma, Palma, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.,Instituto de Investigación Sanitaria de Palma, Palma, Spain
| | - Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Barcelona, Spain.,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Haizea Pombo-Ramos
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Palma de Mallorca, Spain
| | - Angela Asensio-Martínez
- Aragon Institute for Health Research (IIS Aragon), Aragón, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Catalina Martínez-Carazo
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Palma de Mallorca, Spain
| | - José Ángel Maderuelo-Fernández
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, REDIAPP, IBSAL, Salamanca, Spain
| | - Maria Martínez-Andrés
- Social and Health Care Research Center, University of Castilla-La Mancha, Castilla-la-Mancha, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Universitat de Girona, Girona, Spain
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20
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Pétré B, Ketterer F, Vanmeerbeek M, Scheen A, Lair ML, Ziegler O, Böhme P, Guillaume M. [Cross-border evaluation of needs for training in therapeutic education of the patient for the management in type 2 diabetes and obesity: Survey by method of nominal group with healthcare professionals]. Presse Med 2016; 45:e351-e361. [PMID: 27242212 DOI: 10.1016/j.lpm.2016.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 11/27/2015] [Accepted: 02/23/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The design of continuous training programs in therapeutic patient education (ETP) should be inspired by needs shown by the professionals concerned in terms of mobilization or acquisition of skills in this domain. The objective of this study is to analyze needs expressed by healthcare professionals (HP) involved in patients' management presenting a type 2 diabetes (T2D) and/or obesity and to compare them with the existing recommendations. METHODS One hundred and five PS (general practitioners, dietitians and nurses) of 3 frontier regions of French-speaking European countries (France, Belgium and Grand duchy of Luxembourg) were questioned in 12 monodisciplinary groups according to the technique of the nominal group. Needs expressed by the participants were classified in the categories of the reference table of skills to dispense TPE (National Institute for Health Prevention and Education [INPES], 2013). RESULTS/DISCUSSION Among needs expressed by HP, 52 % of the votes targeted relational skills, 10 % of the skills relative to the biomedical techniques, 20 % of the skills relative to the educational techniques and 11 %, those of organization and the coordination. Seven percent of the proposals were out of the categories of the INPES. Results do not allow to establish profiles of skills according to the studied region or profession. The recognition of the TPE by the French legislation does not seem to influence in a major way the data. CONCLUSION The needs expressed by PS in the context of this study are focused on the relation HP/patient that is the heart of the TPE. It would however be necessary to raise awareness among HP in the acquisition of the other skills which concern in particular the animation of group, the interprofessional coordination, the consideration of the environment or more generally the procedures.
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Affiliation(s)
- Benoît Pétré
- Université de Liège, département des sciences de la santé publique, bâtiment B23, 4000 Liège, Belgique.
| | - Frédéric Ketterer
- Université de Liège, département de médecine générale, 4000 Liège, Belgique
| | - Marc Vanmeerbeek
- Université de Liège, département de médecine générale, 4000 Liège, Belgique
| | - André Scheen
- Centre hospitalier universitaire de Liège, service de diabétologie, nutrition et maladies métaboliques, Liège, Belgique
| | - Marie-Lise Lair
- Centre d'études en santé, centre de recherche public de la santé, 1445 Strassen, Luxembourg
| | - Olivier Ziegler
- CHRU de Nancy, université de Lorraine, hôpital Brabois-Adultes, service de diabétologie, maladies métaboliques, nutrition, Vandœuvre-lès-Nancy, France
| | - Philip Böhme
- CHRU de Nancy, université de Lorraine, hôpital Brabois-Adultes, service de diabétologie, maladies métaboliques, nutrition, Vandœuvre-lès-Nancy, France
| | - Michèle Guillaume
- Université de Liège, département des sciences de la santé publique, bâtiment B23, 4000 Liège, Belgique
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Vanmeerbeek M, Mathonet J, Miermans MC, Lenoir AL, Vandoorne C. [Preventive health care and health promotion: Which models for supporting the evolution of clinical practice in primary health care?]. Presse Med 2015; 44:e211-20. [PMID: 25943795 DOI: 10.1016/j.lpm.2014.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/23/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Published operating models about preventive health care and health promotion in primary care were sought with the aim of (1) compiling a functional inventory; and (2) to formulate working hypotheses for the improvement of clinical practice towards more efficiency and more equity. METHODS Narrative literature review, using keywords related to the various prevention classes, health promotion, primary care, practice models and health care delivery. The diversity of models led to a multi-criteria analysis. RESULTS Twelve models were selected. Their characteristics were unevenly distributed. The models, whose authors announce that they apply to prevention, mainly describe approaches that focus on individuals within physician-patient relationship, and take into account practice organization. Some socio-ecological and systems models illustrate health promotion: educational practice, group- or population-based targets, community environment and social determinants of health. There is little room for patients in elaborating the models, as they have little role in health care systems. The definitions of prevention, health promotion and patient education greatly differ from one model to another. DISCUSSION Little is known about practical implementation of the models; assessment data are scarce. Some elements valued by health promotion could be integrated to health care: empowerment of citizens, addressing community environment; increased involvement in local health professionals' networks; integration of individual and collective approaches within the same health care facilities to address simultaneously individual customization, efficiency and equity objectives. These developments may call for adaptation in vocational training and continuous professional development: communication skills, awareness to public health concepts, and early and longitudinal exposure to community-based learning experiences for students.
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Affiliation(s)
- Marc Vanmeerbeek
- CHU du Sart-Tilman B23, université de Liège, département de médecine générale, 4000 Liège, Belgique.
| | - Julien Mathonet
- CHU du Sart-Tilman B23, université de Liège, département de médecine générale, 4000 Liège, Belgique
| | - Marie-Christine Miermans
- CHU du Sart-Tilman B23, université de Liège, appui en promotion et en éducation pour la santé, école de santé publique, 4000 Liège, Belgique
| | - Anne-Laure Lenoir
- CHU du Sart-Tilman B23, université de Liège, département de médecine générale, 4000 Liège, Belgique
| | - Chantal Vandoorne
- CHU du Sart-Tilman B23, université de Liège, appui en promotion et en éducation pour la santé, école de santé publique, 4000 Liège, Belgique
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Primary care patients' perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis. PLoS One 2015; 10:e0125004. [PMID: 25938509 PMCID: PMC4418671 DOI: 10.1371/journal.pone.0125004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/19/2015] [Indexed: 02/04/2023] Open
Abstract
Background Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities. Methods and Findings A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were considered thus limiting extrapolation to other contexts. Conclusions Several factors affect PP&HP. This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice.
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Thomas K, Krevers B, Bendtsen P. Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative. BMC Health Serv Res 2015; 15:31. [PMID: 25608734 PMCID: PMC4312445 DOI: 10.1186/s12913-015-0688-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/09/2015] [Indexed: 01/10/2023] Open
Abstract
Background Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. Methods A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively. Results Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. Implementation: all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff. Conclusions Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.
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Affiliation(s)
- Kristin Thomas
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Barbro Krevers
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden.
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Luquis RR, Paz HL. Attitudes About and Practices of Health Promotion and Prevention Among Primary Care Providers. Health Promot Pract 2014; 16:745-55. [PMID: 25445979 DOI: 10.1177/1524839914561516] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Patient Protection and Affordable Care Act's emphasis on health promotion and prevention activities required an examination of the current practices of primary care providers in these areas. A total of 196 primary care providers completed a survey to assess current health promotion and prevention attitudes, practices, and barriers. Results of this study showed that family physicians in Pennsylvania recognize the importance of and their role in providing health promotion and prevention and offer advice in key behavioral and disease prevention areas. Results from the study suggest that their ability to provide these services is hindered by a lack of time and the heavy workload. Although most family physicians provided advice to patients in several health promotion and prevention areas, few participants reported that they referred patients to other health professionals. Finally, when it comes to preventive services, participants ranked blood pressure screening, tobacco use screening, and tobacco use cessation interventions as the most important services. Effective implementation of the Patient Protection and Affordable Care Act will require necessary resources and support of primary care providers to help patients achieve healthier lives.
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Thomas K, Bendtsen P, Krevers B. Implementation of healthy lifestyle promotion in primary care: patients as coproducers. PATIENT EDUCATION AND COUNSELING 2014; 97:283-290. [PMID: 25154336 DOI: 10.1016/j.pec.2014.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/01/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To explore and theorize how patients perceive, interpret, and reactin healthy lifestyle promotion situations in primary care and to investigate patients' role in implementation of lifestyle promotion illustrated by typologies. METHODS Grounded theory was used to assess qualitative interview data from 22 patients with varied experience of healthy lifestyle promotion. Data were analyzed by constant comparative analysis. RESULTS A substantive theory of being healthy emerged from the data. The theory highlights the processes that are important for implementation before, during, and after lifestyle promotion. Three interconnected categories emerged from the data: conditions for being healthy, managing being healthy, and interactions about being healthy; these formed the core category: being healthy. A typology proposed four patient trajectories on being healthy: resigned, receivers, coworkers, and leaders. CONCLUSION Patients coproduced the implementation of lifestyle promotion through the degree of transparency, which was a result of patients' expectations and situation appraisals. PRACTICE IMPLICATIONS Different approaches are needed during lifestyle promotion depending on a variety of patient-related factors. The typology could guide practitioners in their lifestyle promotion practice.
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Affiliation(s)
- Kristin Thomas
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, 58183 Linköping, Sweden.
| | - Preben Bendtsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, 58183 Linköping, Sweden; Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden
| | - Barbro Krevers
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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Holmberg C, Sarganas G, Mittring N, Braun V, Dini L, Heintze C, Rieckmann N, Muckelbauer R, Müller-Nordhorn J. Primary prevention in general practice - views of German general practitioners: a mixed-methods study. BMC FAMILY PRACTICE 2014; 15:103. [PMID: 24885100 PMCID: PMC4046439 DOI: 10.1186/1471-2296-15-103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Abstract
Background Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention. Methods Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention. Results Most respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions. Conclusions The mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.
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Affiliation(s)
- Christine Holmberg
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr, 73, 13347 Berlin, Germany.
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Rubio-Valera M, Pons-Vigués M, Martínez-Andrés M, Moreno-Peral P, Berenguera A, Fernández A. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography. PLoS One 2014; 9:e89554. [PMID: 24586867 PMCID: PMC3938494 DOI: 10.1371/journal.pone.0089554] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/21/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Evidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults. METHODS AND FINDINGS A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP. CONCLUSIONS Research on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual overview provided by this synthesis resulted in the development of practical recommendations for the design of PP&HP in PC. However, the effectiveness of these recommendations needs to be demonstrated.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
| | - Mariona Pons-Vigués
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Research Department, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Departamento de Psicología clínica y de la Salud, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María Martínez-Andrés
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - Patricia Moreno-Peral
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Research Unit, Distrito Sanitario Malaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (IMABIS Foundation), Málaga, Spain
| | - Anna Berenguera
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Research Department, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Departamento de Psicología clínica y de la Salud, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ana Fernández
- Research and Development Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Spanish Research Network on Preventative Activities and Health Promotion in Primary Care (RedIAPP), Spain
- Centre for Disability Research and Policy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Lalonde L, Goudreau J, Hudon É, Lussier MT, Bareil C, Duhamel F, Lévesque L, Turcotte A, Lalonde G. Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach. SAGE Open Med 2014; 2:2050312114522788. [PMID: 26770705 PMCID: PMC4607213 DOI: 10.1177/2050312114522788] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/09/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model-based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. OBJECTIVES An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model-based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation. METHODS Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program. RESULTS The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. CONCLUSION Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.
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Affiliation(s)
- Lyne Lalonde
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Johanne Goudreau
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Éveline Hudon
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marie-Thérèse Lussier
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Fabie Duhamel
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Lise Lévesque
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Alain Turcotte
- Direction of Professional Services, Centre de santé et de services sociaux de Deux-Montagnes, Deux-Montagnes, QC, Canada
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Fonseca M, Fleitas G, Tamborero G, Benejam M, Leiva A. Estilos de vida de los médicos de atención primaria: percepción e implicaciones sobre la prevención cardiovascular. Semergen 2013; 39:421-32. [DOI: 10.1016/j.semerg.2013.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/08/2013] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
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Kardakis T, Weinehall L, Jerdén L, Nyström ME, Johansson H. Lifestyle interventions in primary health care: professional and organizational challenges. Eur J Public Health 2013; 24:79-84. [PMID: 23722861 PMCID: PMC3901313 DOI: 10.1093/eurpub/ckt052] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Interventions that support patient efforts at lifestyle changes that reduce tobacco use, hazardous use of alcohol, unhealthy eating habits and insufficient physical activity represent important areas of development for health care. Current research shows that it is challenging to reorient health care toward health promotion. The aim of this study was to explore the extent of health care professional work with lifestyle interventions in Swedish primary health care, and to describe professional knowledge, attitudes and perceived organizational support for lifestyle interventions. METHODS The study is based on a cross-sectional Web-based survey directed at general practitioners, other physicians, residents, public health nurses and registered nurses (n = 315) in primary health care. RESULTS Fifty-nine percent of the participants indicated that lifestyle interventions were a substantial part of their duties. A majority (77%) would like to work more with patient lifestyles. Health professionals generally reported a thorough knowledge of lifestyle intervention methods for disease prevention. Significant differences between professional groups were found with regard to specific knowledge and extent of work with lifestyle interventions. Alcohol was the least addressed lifestyle habit. Management was supportive, but structures to sustain work with lifestyle interventions were scarce, and a need for national guidelines was identified. CONCLUSIONS Health professionals reported thorough knowledge and positive attitudes toward lifestyle interventions. When planning for further implementation of lifestyle interventions in primary health care, differences between professional groups in knowledge, extent of work with promotion of healthy lifestyles and lifestyle issues and provision of organizational support such as national guidelines should be considered.
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Affiliation(s)
- Therese Kardakis
- 1 Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden
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31
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de Granda-Orive JI, Solano-Reina S, Jiménez-Ruiz CA. [Smoking intervention in patients with cardiovascular diseases]. Aten Primaria 2013; 45:115-20. [PMID: 22409838 PMCID: PMC6985500 DOI: 10.1016/j.aprim.2011.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/17/2011] [Accepted: 12/19/2011] [Indexed: 11/25/2022] Open
Abstract
Smoking tobacco is the main cardiovascular risk factor and has a dose-dependent response. It has been shown that an aggressive policy, not only against consumption, achieves a significant decrease in cardiovascular deaths. Thus, we must provide and carry out activities to prevent or decrease the incidence of smoking (primary prevention), and to the early detection of the smoker and to reduce the prevalence (secondary prevention), and lastly to act on the effects of tobacco smoke, preventing complication and remissions (tertiary prevention). Thus, all health care levels must act in order that smokers do not develop cardiovascular disease when they quit smoking, both from Primary, as well as specialist care.
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Bell E, Seidel BM. The evidence-policy divide: a 'critical computational linguistics' approach to the language of 18 health agency CEOs from 9 countries. BMC Public Health 2012; 12:932. [PMID: 23110541 PMCID: PMC3515425 DOI: 10.1186/1471-2458-12-932] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/18/2012] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is an emerging body of literature suggesting that the evidence-practice divide in health policy is complex and multi-factorial but less is known about the processes by which health policy-makers use evidence and their views about the specific features of useful evidence. This study aimed to contribute to understandings of how the most influential health policy-makers view useful evidence, in ways that help explore and question how the evidence-policy divide is understood and what research might be supported to help overcome this divide. METHODS A purposeful sample of 18 national and state health agency CEOs from 9 countries was obtained. Participants were interviewed using open-ended questions that asked them to define specific features of useful evidence. The analysis involved two main approaches 1)quantitative mapping of interview transcripts using Bayesian-based computational linguistics software 2)qualitative critical discourse analysis to explore the nuances of language extracts so identified. RESULTS The decision-making, conclusions-oriented world of policy-making is constructed separately, but not exclusively, by policy-makers from the world of research. Research is not so much devalued by them as described as too technical- yet at the same time not methodologically complex enough to engage with localised policy-making contexts. It is not that policy-makers are negative about academics or universities, it is that they struggle to find complexity-oriented methodologies for understanding their stakeholder communities and improving systems. They did not describe themselves as having a more positive role in solving this challenge than academics. CONCLUSIONS These interviews do not support simplistic definitions of policy-makers and researchers as coming from two irreconcilable worlds. They suggest that qualitative and quantitative research is valued by policy-makers but that to be policy-relevant health research may need to focus on building complexity-oriented research methods for local community health and service development. Researchers may also need to better explain and develop the policy-relevance of large statistical generalisable research designs. Policy-makers and public health researchers wanting to serve local community needs may need to be more proactive about questioning whether the dominant definitions of research quality and the research funding levers that drive university research production are appropriately inclusive of excellence in such policy-relevant research.
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Affiliation(s)
- Erica Bell
- University Department of Rural Health, University of Tasmania, Private Bag 103, Hobart, TAS, 7001, Australia
| | - Bastian M Seidel
- School of Medicine, University of Tasmania, Private Bag 34, Hobart, TAS, 7001, Australia
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Ashby S, James C, Plotnikoff R, Collins C, Guest M, Kable A, Snodgrass S. Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese. Nurs Health Sci 2012; 14:189-96. [PMID: 22435756 DOI: 10.1111/j.1442-2018.2012.00677.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obesity is a global issue, with healthcare practitioners increasingly involved in clinical interactions with people who are overweight or obese. These interactions are opportunities to provide evidence-based healthy lifestyle advice, and impact on public health. This study used a cross-sectional survey of Australian healthcare practitioners to investigate what influenced the provision of healthy lifestyle advice to obese and overweight clients. A modified theory of planned behavior was used to explore knowledge translation processes. Knowledge translation was linked to three factors: (i) a healthcare practitioner's education and confidence in the currency of their knowledge; (ii) personal characteristics - whether they accepted that providing this advice was within their domain of practice; and (iii) the existence of organizational support structures, such as access to education, and best practice guidelines. To fulfill the potential role healthcare practitioners can play in the provision of evidence-based health promotion advice requires organizations to provide access to practice guidelines and to instill a belief in their workforce that this is a shared professional domain.
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Affiliation(s)
- Samantha Ashby
- Faculty of Health, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia.
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