Background
Aim
Methods
Design
Setting and recruitment of participants
Informant | Age (years) | Profession | Years of clinical experience | Years working within PHC |
---|---|---|---|---|
Managers | ||||
PHC centre 1, M1 | 52 | Physiotherapist | 28 | 28 |
PHC centre 1, M2 | 43 | Nurse, Midwife | 18 | 5 |
PHC centre 2, M | 40 | Physiotherapist | 14 | 12 |
PHC centre 3, M | 55 | Care administrator | 38 | 18 |
PHC centre 4, M | 43 | District nurse | 19 | 13 |
PHC centre 5, M | 54 | District nurse | 28 | 18 |
Internal facilitators | ||||
IF 1 | 33 | Midwife | 4 | 2,5 |
IF 2 | 36 | District nurse | 9 | 2 |
IF 3 | 31 | Physiotherapist | 9 | 8 |
IF 4 | 57 | Nurse | 21 | 1,5 |
IF 5 | 58 | Nurse | 32 | 15 |
IF 6 | 49 | Physiotherapist | 22 | 13 |
IF 7 | 58 | District nurse | 36 | 33 |
IF 8 | 47 | Occupational therapist | 25 | 1,5 |
IF 9 | 40 | Physiotherapist | 15 | 12 |
IF 10 | 30 | District nurse | 8 | 5 |
FGD | Total N | Age in years, min–max (mean) | Sex, M/W | Profession | Years of clinical experience, min–max | Years working within PHC, min–max |
---|---|---|---|---|---|---|
A | 7 | 30–59 (48,4) | 2/5 | 1 Midwife, 2 District nurses, 1 Physiotherapist, 2 General practitioners, 1 Counsellor | 8–34 | 6 months -27 |
B | 4 | 34–50 (41,5) | 0/4 | 1 Physiotherapist, 1 Assistant nurse, 1 Midwife, 1 Counsellor | 5-12a | 4–7 |
C | 4 | 49–63 (58,2) | 0/4 | 1 Counsellor, 1 Nurse, 2 District nurses | 11–42 | 2–22 |
D | 6 | 25–65 (50,3) | 1/5 | 1 Physiotherapist, 1 General practitioner, 1 Counsellor, 1 District nurse, 1 Assistant nurse, 1 Care administrator | 5–38 | 3–36 |
E | 5 | 26–49 (42,2) | 2/3 | 1 Counsellor, 1 Physiotherapist, 1 District nurse, 2 General practitioners | 3–12 | 3–9 |
Data collection
Data analysis
Meaning unit/quotation | Sub-category | Category |
---|---|---|
We conduct this because we can see that people are feeling worse, their health is not good, more people are becoming sick and children are gaining weight. I can’t believe it. Already after one year, we had three patients with escalating weight curves. So we’ve got to start early with it. | A healthy lifestyle-promoting practice serves the needs of patients (facilitator) | A healthy lifestyle-promoting practice meets patients’ needs and should be co-produced with the patient |
I think our patients will favour it because you expect that we in healthcare should talk [about lifestyle habits] (…). There's a lot of talk about it in society, lifestyle habits, health promotion, etc. So it will be natural that the primary care centre, which plays a big part, should also discuss it. So they [i.e. the patients] may wonder why we haven’t done this before. | Patients’ positive expectations of health promotion in PHC (facilitator) | |
What the patient is comfortable with, not how the patient feels uncomfortable (…) Instead, evoke thoughts and maybe positively in the patient. | Patients’ needs and preferences must be considered while avoiding infringing on the patient’s autonomy (facilitator) |
Ethical considerations
Results
CFIR domain | CFIR construct | Category and sub-category |
---|---|---|
Innovation characteristics | Complexity | Changing to a healthy lifestyle-promoting practice is challenging and requires persistence to achieve sustainability • Changing to a healthy lifestyle-promoting practice is difficult (barrier) • Behaviour change is challenging to address and achieve as an HCP (barrier) |
Outer setting | Patient needs and resources | A healthy lifestyle-promoting practice meets patients’ needs and should be co-produced with the patient • A healthy lifestyle-promoting practice serves the needs of the patients (facilitator) • Patients’ positive expectations of health promotion in PHC (facilitator) • Patients’ needs and preferences must be considered while avoiding infringing on the patient’s autonomy (facilitator) |
Characteristics of individuals | Knowledge and beliefs | Understanding the purpose of changing to a healthy lifestyle-promoting practice is crucial • Shared beliefs and knowledge on the impact of health promotion (facilitator) • Insufficient knowledge of guidelines and tools for health promotion (barrier) |
Self-efficacy | • Beliefs in capabilities but uncertainty in practicalities (facilitator/barrier) | |
Individual stage of change | • Variations from enthusiasm to potential reluctance in the ability to change health-promoting practice (facilitator/barrier) | |
Other personal attributes | • Desire to work with health promotion and make a positive contribution (facilitator) | |
Inner setting | Networks and communications | Need structures, inter-professional teams and a sense of common purpose for a healthy lifestyle-promoting practice • Other HCPs’ competence and health-promoting practices are unknown (barrier) |
Implementation climate | • The necessity that all HCPs participate and work mutually towards the same goal (facilitator/barrier) | |
- Tension for change | • A health-promoting practice is crucial for future PHC (facilitator) • A health-promoting practice is better than standard practice (facilitator) | |
- Compatibility | • A healthy lifestyle-promoting practice is compatible with current practice but needs improved structures (facilitator/barrier) | |
- Goals and feedback | • Importance of goals and feedback (barrier) |
Innovation characteristics
Changing to a healthy lifestyle-promoting practice is challenging, requiring persistence to achieve sustainability
“That we will hope because that's the meaning. If I think so? If I’m frank, I don’t think it's that easy. And to make it to something sustainable that isn’t just this year- that's what you hope for, and that is why it is so difficult. But we will hope for it” (IF 6, PHC centre 3).
“What was it that made you not do this? And how would you change to make it happen? It’s a lot because you want to give as much information as possible and say you could do this, but it doesn’t work out. They know it, but they don’t get it right, and getting them on board from wanting to change lifestyle to actually do it is quite a lot of work” (FGD E, PHC centre 5).
Outer setting
A healthy lifestyle-promoting practice should meet patient needs and be co-produced with the patient
“But then there’s this dilemma, as you say: I seek health care because of my back. We receive – we don’t call in patients for a health-promoting dialogue. Instead, they call us and have back pain, a stomach ache, a fever or something else. They’re coming (to us) seeking something… and then it's about… well, how can you get it in, so to say” (FGD D, PHC centre 4).
Characteristics of individuals
Understanding the purpose of changing to a healthy lifestyle-promoting practice is crucial
“I would like to emphasise how important this is and what it can lead to in public health… in a broader perspective. With better public health, the pressure [on PHC] may decrease. And prevention. Many of these patients might not have needed to seek health care if they’d received preventive help. This [health promotion] can make it easier in the future. So motivating why it should be done is especially important” (IF2, PHC centre 1).
“And the awareness that a minor change can greatly impact a person’s life, which I think everyone [i.e. HCP] has within their [professional] field. So one can understand this is not that difficult because I can already do it. I shall only apply it in a new field. And that this is my responsibility because the whole body is my responsibility” (Manager, PHC centre 1).
“The biggest change is maybe this part. It’s often quite divided. This is the physician’s task. This is the nurse’s task. This is the counsellor’s, the physiotherapist’s, etc., task. (…). Because this would include all of us, it also implies a change in a way where we are all equal. And that’s new, and everyone will not appreciate it. Some will push it over on someone else; this is not mine, it´s the counsellor’s, and so on” (IF 8, PHC centre 4).
“Regardless of how we twist and turn this, the driving force must come from here [i.e. PHC]. People from the outside cannot come and push; that won’t work” (Manager, PHC centre 1).
Inner setting
Need structures, inter-professional teams, and a common purpose for a healthy lifestyle-promoting practice
“What do we offer a person who wants to quit smoking? How is it organised here at the centre? Do we refer them to hospital? How much [and] which drugs should you prescribe when supporting smoking cessation? To what extent do we do that here at the centre? There’s a good deal more information and knowledge I need” (IF 4, PHC centre 2).
“We should do the same thing. It shouldn’t matter if the patient meets me who is super interested in this, or someone else, some new colleague. It should be the same, in a way” (IF 10, PHC centre 5).
“We know the population is growing, that it will be more elderly and the people will be increasingly sicker at the same time as we in the healthcare will have no possibility to hire personnel corresponding to the need. So, if we look ahead, we know there will be a giant health care need and we will not sort it out” (Manager, PHC centre 1).
“I see lifestyle habits as the common thread running through everyone from counsellors to physios. Those in child and maternity care work a lot with it, so it’s in line with what we already do. So, it will be nothing new under the sun. I think all professionals know what to do with the lifestyle habits, but we don’t have a structured practice today” (IF 9, PHC centre 5).