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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Integrating community-based health promotion programs and primary care: a mixed methods analysis of feasibility

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Aaron L. Leppin, Karen Schaepe, Jason Egginton, Sara Dick, Megan Branda, Lori Christiansen, Nicole M. Burow, Charlene Gaw, Victor M. Montori
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-018-2866-7) contains supplementary material, which is available to authorized users.

Abstract

Background

Implementation of evidence-based programs (EBPs) for disease self-management and prevention is a policy priority. It is challenging to implement EBPs offered in community settings and to integrate them with healthcare. We sought to understand, categorize, and richly describe key challenges and opportunities related to integrating EBPs into routine primary care practice in the United States.

Methods

As part of a parent, participatory action research project, we conducted a mixed methods evaluation guided by the PRECEDE implementation planning model in an 11-county region of Southeast Minnesota. Our community-partnered research team interviewed and surveyed 15 and 190 primary care clinicians and 15 and 88 non-clinician stakeholders, respectively. We coded interviews according to pre-defined PRECEDE factors and by participant type and searched for emerging themes. We then categorized survey items—before looking at participant responses—according to their ability to generate further evidence supporting the PRECEDE factors and emerging themes. We statistically summarized data within and across responder groups. When consistent, we merged these with qualitative insight.

Results

The themes we found, “Two Systems, Two Worlds,” “Not My Job,” and “Seeing is Believing,” highlighted the disparate nature of prescribed activities that different stakeholders do to contribute to health. For instance, primary care clinicians felt pressured to focus on activities of diagnosis and treatment and did not imagine ways in which EBPs could contribute to either. Quantitative analyses supported aspects of all three themes, highlighting clinicians’ limited trust in community-placed activities, and the need for tailored education and system and policy-level changes to support their integration with primary care.

Conclusions

Primary care and community-based programs exist in disconnected worlds. Without urgent and intentional efforts to bridge well-care and sick-care, interventions that support people’s efforts to be and stay well in their communities will remain outside of—if not at odds with—healthcare.
Zusatzmaterial
Additional file 1: a) Primary Care Clinician Survey. b) Stakeholder Survey. c) Participant Interview Guide. d) Sample Participant Quotes by PRECEDE Construct (PDF 784 kb)
12913_2018_2866_MOESM1_ESM.pdf
Literatur
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