Abstract
Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals’ (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals’ own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals’ delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.
Highlights
Unhealthy behaviors are important risk factors for long-term conditions such as cardiovascular diseases, diabetes, and cancer, making health behavior change a medical issue of worldwide importance (World Health Organization 2017)
Reviews were excluded if they (a) did not report healthcare professionals’ barriers and facilitators of providing health behavior change interventions, (b) were unsystematic, (c) were not of studies conducted with patient-facing healthcare professionals, and (d) were in a language other than English
The major factors extracted and synthesized from this review suggest that two key areas can be targeted for future interventions
Summary
Unhealthy behaviors are important risk factors for long-term conditions such as cardiovascular diseases, diabetes, and cancer, making health behavior change a medical issue of worldwide importance (World Health Organization 2017). Professionals to deliver opportunistic behavior change interventions to patients (Public Health England 2016; The Royal Australian College of General Practitioners (RACGP) (2017)), including smoking cessation, improving diet, increasing physical activity, and reducing alcohol intake. Healthcare professionals are an expected and trusted source of health behavior change advice (McPhail and Schippers 2012), and patients often welcome advice about behavior change even during routine primary care consultations, where health behavior is not the primary focus (Aveyard et al 2012). Behavior change interventions can be delivered in as few as 30 s (Aveyard et al 2016), and are cost effective, with the cost of delivery falling below the cost per quality-adjusted life-year (QALY) thresholds (National Institute for Health and Care Excellence 2014). Interventions delivered by patient-facing healthcare professionals enable interventions to have maximum reach, a lack of time to deliver interventions (Heslehurst et al 2014), or a perceived lack of knowledge or skills to deliver behavior change interventions (Yousefzadeh et al 2016) may impede delivery.
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