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Table 3 Barriers and facilitators for delivering health promotion activities

From: Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

 

PATIENT

GENERAL PRACTITIONER/ GENERAL PRACTICE

ATTITUDE GENENERAL PRACTITIONER

HEALTH PROMOTION PROGRAM

HEALTHCARE SYSTEM/ GOVERNMENT

BARRIERS

Lack of patients’ motivation to change unhealthy behaviour *

Results are difficult to measure

Patients do not appreciate it when GPs of PNs discuss their lifestyles

Lack of proven effectiveness of health promotion programs

The hours of PN are not fully compensated financially

Unhealthy lifestyle is socially accepted, especially drinking alcohol

Lack of skills among GPs and PNs to discuss lifestyle and develop health promotion programs

Group sessions seems to be more effective compared with individual counselling, but most of the health promotion programs in general practice are individual

Lack of overview of health promotion programs

Lack of reimbursements and subsidies to start new health promotion programs in general practice

Patients deny or lie about their actual lifestyles

Lack of time among GPs to discuss lifestyle with patients and develop health promotion programs

GPs state discussing lifestyles is a waste of time

Lack of continuity of health promotion programs, due to short-term reimbursements and subsidies

GPs have to meet too many strict requirements of healthcare insurance companies, to receive reimbursement and subsidies (e.g. registration, accredited courses)

Patients are unaware of their unhealthy lifestyles

Dietician and addiction care consultant disappear due to lack of patients

Consultation hours are more focused on treatment instead of on prevention

Not all patients can be reached in general practice

Lack of trust among GPs and PN in reimbursement and subsidies due to continuous changes

Patients experience barriers to live a healthy lifestyle (e.g. co-morbidity, lack of time)

GPs do not give patients referrals and motivate their patients as much as they can

GPs are sceptical about the effects and results of discussing lifestyle

Programs are not accessible, due to narrow inclusion criteria and affordability of programs

Contradictory policy of Dutch government (e.g. expensive healthy food, inconsistent smoking policy)

Behavioural change is a complex process for patients, especially when the environment does not change

Due to unhealthy behaviour of GPs and PNs (especially alcohol use) it is difficult to discuss lifestyles with patients

GPs think lifestyle is not important

Lack of health promotion programs

GPs and patients have to find out reimbursement and subsidies from insurance companies themselves

Letting patients pay contribution for health promotion programs does not work, especially not among low SES patients

Motivation of GPs and PNs decrease due to disappointing results

Programs are not accessible for patients due to waiting lists

Lack of collaboration between hospital and general practices with regard to health promotion activities

Due to stigma patients are not going to addiction care

Lack of collaboration between disciplines

 

Health promotion activities in general practice are not rewarded

Patients do not go to health promotion programs due to geographical barriers (E.g. distance to program)

Lack of room and housing

Contradictory information from insurance company towards patients

GPs forget to ask about lifestyles

FACILITATORS

Patients who are aware of their own lifestyles and who are motivated to change their lifestyles is a motivation for GPs and PNs

Availability of PNs in general practice: he/she has more time than GPs and plays a central role

GPs thinks it is worthwhile to discuss lifestyle with patients

Health promotion programs in general practice are familiar for patients

Reimbursements and subsidies determine participation and development of health promotion programs

Let patients do what they want to do; there is a bigger chance they will succeed

More collaboration and feedback due to availability of physiotherapist and dietician in general practice

GPs state it is part of their job to promote a healthy lifestyle

Easy accessible health promotion programs due to broad inclusion criteria and affordability

Umbrella of GP organization develop health promotion programs and clear policy

Patients are more motivated when they have insight in their results (e.g. blood sugar level)

Sufficient staff for developing and conducting lifestyle programs

GPs and PNs think they are skilled to discuss lifestyle with patients

Continuity of health promotion programs

 

Patients are more motivated to participate in a lifestyle program when they have to pay contribution

Familiarity between patients and GP and PNs is an advantage to discuss lifestyle

Healthy lifestyle of GP and PNs is a role model for patient

Best way to discuss lifestyle is in an open manner, not by using a protocol

 

Sufficient room and accommodation

 

Proven effectiveness of health promotion programs

Enthusiastic colleagues to develop and deliver lifestyle programs

Overview/ social map of disciplines and health promotion programs

  

Structured registration and labelling of patients at risk provide an overview for GPs

 

Availability and collaboration with sport facilities

 
  1. *Most cited factors are at the head of the table. E.g. ‘Lack of motivation by patients’ is mentioned by nineteen participants.