Abstract
BackgroundImplementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients’ unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice.MethodsLongitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test.ResultsEighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients’ tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills.ConclusionsEven if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients’ lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses’ attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians’ uptake and use of the CPGs.
Highlights
Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services
Uptake and usage of clinical practice guidelines (CPGs) on lifestyle interventions The implementation of the CPGs was assessed by seven statements (Fig. 1) and by one open-ended question, which aimed to capture the perceived difficulties of the implementation
Less than a third of the health professionals reported that the CPGs had been implemented at the Primary health care centre (PHCC) to a high degree, and that they were very familiar with the content (Fig. 1)
Summary
Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. The introduction of interventions in the field of health orientation in health care, i.e. prevention and health promotion, has faced specific challenges resulting in a low frequency and quality of these services [5,6,7,8]. One of the specific challenges is that prevention and health promotion interventions are often not considered to have priority and healthcare professionals are ambiguous about how to prioritise [10, 11]. A study of general practitioners showed that their delivery of care was dominated by diagnosing and treating disease [12]. Knowledge gaps have been identified as hindering the implementation [11, 15, 20]
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