Abstract
BackgroundPrimary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities.Methods and FindingsA meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were considered thus limiting extrapolation to other contexts.ConclusionsSeveral factors affect PP&HP. This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice.
Highlights
Primary care (PC) is the area of the health care system most suited to offering primary prevention and health promotion (PP&HP) activities as it is accessible, provides continuity of care and is used by a large proportion of the population [1,2]
This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice
We aim to identify and synthesize, using the meta-ethnographic technique, available qualitative research into barriers and facilitators identified by PC patients to develop PP&HP activities
Summary
Primary care (PC) is the area of the health care system most suited to offering primary prevention and health promotion (PP&HP) activities as it is accessible, provides continuity of care and is used by a large proportion of the population [1,2]. A five-level ecological model was designed to fit the following barriers and facilitators affecting PC professionals: intrapersonal (professionals’ beliefs about PP&HP, experience, skills, knowledge, and self-concept); interpersonal (patients' attitudes and behavior with respect to PP&HP and PC professionals relationship with specialists, health center managers and staff); institutional (workload, time limitations, referral options, biomedical-model predominance); community (social and cultural backgrounds of the population served, local referral resources, mass-media messages, pharmaceutical-industry campaigns, and the relative importance of PP&HP in university curricula); and public policy (private and public health-system models). Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. For the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities
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