| 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 | Â | 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 | Â | |
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 |  |