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Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study
Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.ORCID iD: 0000-0002-0483-8981
Department of Health and Welfare, Dalarna University, Falun, Sweden.
Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.ORCID iD: 0000-0002-9760-3785
2023 (English)In: BMC Primary Care, E-ISSN 2731-4553, Vol. 24, no 1, article id 122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC.

METHODS: In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis.

RESULTS: Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation.

CONCLUSIONS: The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs.

TRIAL REGISTRATION: This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860. Registered 03 March 2021.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 24, no 1, article id 122
Keywords [en]
Change Management, Clinical Practice Guidelines, Health Personnel, Healthy Lifestyle, Implementation Science, Primary Health Care, Qualitative Research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-106397DOI: 10.1186/s12875-023-02079-5ISI: 001012438000003PubMedID: 37328813Scopus ID: 2-s2.0-85162070185OAI: oai:DiVA.org:oru-106397DiVA, id: diva2:1775011
Funder
Örebro UniversityRegion Örebro County, OLL-969561Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2024-04-05Bibliographically approved

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Nilsing Strid, EmmaNilsagård, Ylva

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