Healthcare organization and management barriers and facilitators for health promotion in primary care

Abstract

Abstract Background There are challenges in translating evidence-based interventions into practice, and the need for health care organization, management, and policy changes to align with health promotion activities within the health and social care system is well-documented. This study aims to elucidate the role of these factors as barriers/facilitators influencing the implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain. Methods Seven focus groups were conducted with 49 health professionals from 6 primary care centers participating in the Prescribing Healthy Life (PVS) program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management, and policy. Results The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow, and (3) available resources to carry out the program. Specific barriers related to high caseloads, contracting issues, short consultation times, and lack of appointment times for lifestyle counselling. Other barriers/facilitators were related to CFIR constructs networks and communication, culture, relative priority, and leadership engagement. A set of nine specific barriers-facilitators emerged. Conclusions In some centers, certain facilitators addressed barriers identified in other centers influencing implementation of a health promotion intervention in primary care. Proactive identification and modification of barriers by healthcare managers and policy makers can help to ensure effective integration of health promotion into primary care. Key messages Implementation science methods for program evaluation can help identify barriers and facilitators to health promotion implementation in primary care. Policy and incentives, compatibility, available resources, networks and communication, culture, relative priority, and leadership engagement influenced successful health promotion implementation.