A qualitative exploration of paediatric health professional views on talking about health promotion and lifestyle behaviour change with hospital patients and families in an acute setting

Abstract

BackgroundPolicy documents consistently present healthy lifestyle behaviours as a means to reduce population mortality and morbidity and the economic burden faced by the NHS (Department of Health, 2004, 2006, 2010). The NHS Future Forum report (2012) states that every health-care professional should intervene by engaging in motivational conversations with patients about lifestyle behaviour change and thus “make every contact count”. Despite health-care policies emphasising this responsibility, evidence is scarce for the effectiveness and long-term effect across NHS settings and staff groups, presenting a barrier to the formulation of evidence-based guidance for behaviour change (House of Lords, 2011). There is discordance between the directive to prioritise initiatives such as make every contact count and knowledge of effective strategies to implement such initiatives in practice, with little knowledge of staff readiness and understanding of such brief opportunistic advice. We therefore explored through a qualitative study the views of health professionals on talking about health promotion and lifestyle behaviour change with hospital patients and their families. We aimed to understand barriers to integration into routine practice and identify areas in which staff could be supported to make every contact count. Methods33 semistructured interviews were undertaken by a non-clinical researcher with clinical staff (junior doctors, allied health professionals, nurses, and health-care assistants) from inpatient and outpatient settings at Birmingham Children's Hospital, Birmingham, UK. Participants were pragmatically selected on the basis of staff and researcher availability and staff mix. Interview findings were analysed with a thematic framework analytical approach, which consisted of an iterative process of transcription of the interviews; re-familiarisation with interview content; systematic open coding of interview content, including consideration of conflicting data; production of a coding framework; and then re-coding of interview content in line with the framework. To enhance reliability, data were independently coded by additional researchers. After coding of all interview content, codes were collated into key themes. Qualitative analysis software was used to support the analytical process (NVivo, version 9.2). FindingsTwo emergent superordinate themes capture the views of health professionals in relation to talking about health promotion and lifestyle behaviour change: (1) barriers and facilitators of health promotion activity, including the clinical setting, environmental constraints, staff's own health behaviours and confidence, the patient's medical condition, and family culture and beliefs; and (2) the education approach to health promotion—ie, provision of information in itself was seen as sufficient to change behaviour. InterpretationIn implementation of policies for health promotion and lifestyle behaviour change into new settings, exploration of health professional views and understanding is important. Unless barriers and facilitators to staff delivery of brief opportunistic advice are understood and addressed in education, training, and service delivery, implementation is unlikely to deliver change, even though NHS staff regarded health promotion as part of their duty of care. Staff beliefs and behaviours, patient and family related factors, and the challenge of engaging in lifestyle conversations in the hospital setting itself are key factors. FundingNational Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country.