Primary Health Care Challenges Research Articles

Navigating the Challenges of Primary Health Care in Selected Local Government Authorities in Tanzania: Bringing Lipsky’s Theory in Its Requisite Panorama

Introduction The robust delivery of primary health care (PHC) service is a complex interplay of key stakeholders, including policymakers, citizens, the government, parliamentarians, academics, and street-level bureaucrats - health staff in this context. While each of these players has a stake in ensuring robust PHC delivery, this paper specifically examines the role of street-level bureaucrats (SLBs) in dealing with service delivery challenges in Local Government Authorities (LGAs) in Tanzania. Although the engagement with these actors gained momentum in the decentralization reforms of the 1990s, their contribution has been slow. The question remains: How can SLBs cope with LGAs’ predicaments to enhance service delivery? Lipsky’s (1980) theory focuses on this contention by proposing that under challenging encounters, SLBs can develop specific patterns of practices to deal with the status quo. Methods Data were collected through interviews with policymakers at Mvomero District and Moshi Municipal Councils. To assess the effectiveness of primary health care services attributes such as authority, accountability, and access were closely examined. A thematic review of the literature was conducted to corroborate the findings from the interviews. Results The findings indicate that SLBs can cope with complex and challenging situations related to PHC delivery by rationing resources, simplifying their work environment, or exiting from turbulent environments. Although the engagement of SLBs gained momentum during the decentralization reforms of the 1990s, their contribution has been slow. The primary factor hindering their effectiveness is the inability to establish a mutually beneficial relationship between the Central Government and LGAs. Conclusion The government's attempts to control SLBs' behaviors, including limiting their intrinsic and extrinsic motivation, undermine their client responsiveness. Empowering SLBs and fostering a more collaborative relationship between the central government and LGAs is essential to enhance PHC delivery.

Female genital mutilation among migrants in Spain: healthcare system responses and challenges.

Female Genital Mutilation/Cutting is a human rights violation deeply rooted in gender inequality. The detection of women who have suffered the practice poses a series of challenges in primary healthcare. Intersectoral actions with an intersectional approach can acknowledge the complexity of the issue that can enhance safe and dialogical environments.

Primary health care challenges: insights from older people with multimorbidity in Malawi – a qualitative study

BackgroundThe global population is undergoing a significant surge in aging leading to increased susceptibility to various forms of progressive illnesses. This phenomenon significantly impacts both individual health and healthcare systems. Low and Middle Income Countries face particular challenges, as their Primary Health Care (PHC) settings often lack the necessary human and material resources to effectively address the escalating healthcare demands of the older people. This study set out to explore the experiences of older people living with progressive multimorbidity in accessing PHC services in Malawi.MethodsBetween July 2022 and January 2023, a total of sixty in-depth interviews were conducted with dyads of individuals aged ≥ 50 years and their caregivers, and twelve healthcare workers in three public hospitals across Malawi’s three administrative regions. The study employed a stratified selection of sites, ensuring representation from rural, peri-urban, and urban settings, allowing for a comprehensive comparison of diverse perspectives. Guided by the Andersen-Newman theoretical framework, the study assessed the barriers, facilitators, and need factors influencing PHC service access and utilization by the older people.ResultsThree themes, consistent across all sites emerged, encompassing barriers, facilitators, and need factors respectively. The themes include: (1) clinic environment: inconvenient clinic setup, reliable PHC services and research on diabetic foods; (2) geographical factors: available means of transportation, bad road conditions, lack of comprehensive PHC services at local health facility and need for community approaches; and (3) social and personal factors: encompassing use of alternative medicine, perceived health care benefit and support with startup capital for small-scale businesses.ConclusionThis research highlights the impact of various factors on older people’s access to and use of PHC services. A comprehensive understanding of the barriers, facilitators, and specific needs of older people is essential for developing tailored services that effectively address their unique challenges and preferences. The study underscores the necessity of community-based approaches to improve PHC access for this demographic. Engaging multiple stakeholders is important to tackle the diverse challenges, enhance PHC services at all levels, and facilitate access for older people living with progressive multimorbidity.

Estimating the Health Care Providers’ Number Needed in Northwest Health Service Centers of Tehran Based on Workload Index

Background: One of the major challenges of primary health care (PHC) in developing countries is supplying the growing needs of the populations with sufficient and skilled health workers. In this context, use of a simple and relevant workforce planning method such as Workload Indicators of Staffing Need (WISN) could help authorities allocate adequate number of professionals to health centers to meet the health needs of target populations. Methods: This was a descriptive-analytical study, and WISN methodology was used at 48 Comprehensive Health Centers (CHC) located in the northwest of Tehran, in 2022. The present study was conducted in 7 steps and included measures such as the available work Stime, initial and final required manpower, extracurricular activities and their coefficients, standard work activity and workload, and scheduling activities. Results: According to the collected data, the total number of health care workers needed for the covered population was calculated to be approximately 1018 people, and the ratio of available manpower to the required manpower was reported as 24%; this indicated a 76% difference in the number of health care providers regarding the implementation of complete service package. Conclusion: The results of the research showed that if all the referrals are made through network, the network would likely have a shortage of human resources. Although the standard workload in most cases is lower than anticipated based on the reviewed performance regarding the health care provided, this can be caused by not going to the center to receive services, going to the private sector, and also not knowing about the services that can be provided.

Designing an innovative primary health care model for the Iranian health system: A mixed methods study protocol

IntroductionToday, the main strategy of countries to improve the health status of people is primary health care (PHC). The present study has two main objectives: 1) scoping review and mapping of the characteristics of innovative PHC models in different countries, 2) developing and validating a model for innovative PHC considering the PHC conditions and challenges of the Islamic Republic of Iran. MethodsThe study will be performed in five phases. In this regard, first, a scoping review will be conducted to investigate the characteristics of innovative PHC. Second, a qualitative study will be performed on the PHC challenges in Iran. Third, another qualitative study will be conducted to identify the appropriate components for Iran's innovative PHC system, using the opinions of experts in this field. In the fourth phase, using the panel of experts, a suitable model will be designed for the Iranian PHC system. Eventually, in the fifth phase, the goals and components of the model developed by experts will be evaluated through a Delphi study, and the validity of the model will be measured using appropriate criteria. ResultsThe findings of this research provide considerable insight into how Iran's PHC system will be able to consider innovative models and changes in response to a new context and newly emerged problems. ConclusionGiven the importance of PHC in the present era and the need to pay more attention to and strengthen it for all communities, it seems necessary to conduct studies and provide appropriate conditions for the development of PHC.

Main Challenges of Primary Health Care in Five Latin American Countries

This article provides a description of integrated primary healthcare strategies in five Latin American countries to assess options for the implementation of a healthcare system based on Primary Care. Based on a document review of scientific articles and official documents from multilateral organisations, ministries, or health entities, it was possible to synthesise the Primary Health Care strategies that had been implemented to derive the main proposals that were potentially transferable. Argentina, Chile, Colombia, and Mexico have Primary Health Care actions aimed at promoting health and preventing diseases; Cuba is highlighted as a reference because of its family health model. The main difficulties are from healthcare system based on the neoliberal model and segmentation and fragmentation of healthcare services.This study provides important aspects of Primary Health Care, in terms of the need to revitalise with a family and community approach, integrating health services at three levels of primary prevention, intersectoral factors, community empowerment, resource allocation and training in human skills, as well as strengthening mental health and sexual health programmes. It concludes with suggestions for a more integrated Primary Health Care based on the strategies implemented and the local needs of the countries under study.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis.

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of the health services and mortality (DESVELA cohort): qualitative study protocol for a prospective cohort study in a hybrid analysis.

Maintaining or acquiring healthier health-oriented behaviours and promoting physical and mental health amongst the Spanish population is a significant challenge for Primary Health Care. Although the role of personal aptitudes (characteristics of each individual) in influencing health behaviours is not yet clear, these factors, in conjunction with social determinants such as gender and social class, can create axes of social inequity that affect individuals' opportunities to engage in health-oriented behaviours. Additionally, lack of access to health-related resources and opportunities can further exacerbate the issue for individuals with healthy personal aptitudes. Therefore, it is crucial to investigate the relationship between personal aptitudes and health behaviours, as well as their impact on health equity. This paper outlines the development, design and rationale of a descriptive qualitative study that explores in a novel way the views and experiences on the relationship between personal aptitudes (activation, health literacy and personality traits) and their perception of health, health-oriented behaviours, quality of life and current health status. This qualitative research is carried out from a phenomenological perspective. Participants will be between 35 and 74 years of age, will be recruited in Primary Health Care Centres throughout Spain from a more extensive study called DESVELA Cohort. Theoretical sampling will be carried out. Data will be collected through video and audio recording of 16 focus groups in total, which are planned to be held in 8 different Autonomous Communities, and finally transcribed for a triangulated thematic analysis supported by the Atlas-ti program. We consider it essential to understand the interaction between health-related behaviours as predictors of lifestyles in the population, so this study will delve into a subset of issues related to personality traits, activation and health literacy.Clinical trial registration: ClinicalTrials.gov, identifier NCT04386135.

Nurse's Leadership Challenges in Primary Health Care: A Focus Group Analysis in Albania

For health and care systems to succeed in the future, primary head nurses must demonstrate leadership. A focus group discussion was used to assess the primary head nurses' leadership abilities in 2022 in Albania. The focus group was composed of 12 primary head health care nurses, two men and ten women, with a mean age of 40 ± (SD) years old. Eight participants were charged with the duty of head nurse for more than five years, while seven participants were in the position of paid head nurse for more than five years. The majority of nurses reported they lack a clearly defined, written job description relevant to the position. Additionally, they stated that they lacked a reference work plan based on which to organize and coordinate the associated healthcare service activities. Participants indicated that the role of the head nurse in daily practice is more focused on the work as a service nurse than as a head nurse. The majority of nurses reported having never received training expressly related to their role as head nurses. The most crucial aspects of the head nurse position were efficient planning and organization of work, vaccination, infrastructure improvement, and the effective use of human resources. The results of this study can be used by head nurses in primary healthcare settings to address and deal with problems in their leadership roles. The findings can also be used by policymakers when developing new regulations or guidelines for nursing leadership competencies. In addition to functioning in a crisis situation, nurse leaders have to demonstrate their capacity for effective leadership and transparent communication. In this regard, training is recommended.

Πρόσβαση σε Υπηρεσίες Πρωτοβάθμιας Φροντίδας Υγείας και Βαθμός Ικανοποίησης: Δεδομένα της Ελληνικής Πραγματικότητας

Public health services in Greece have been under persistent pressure, due to the constant fiscal crisis. Health policies related to Primary Health Care (PHC) in the country, despite long-term restructuring efforts, need to be reviewed and redefined. The aim of this study is to analyse the accessibility and satisfaction rates in Greece, as part of the health policies for the PHC of the country. We performed research for the analysis of data with respect to the accessibility to PHC and the investigated data included satisfaction, accessibility, and waiting times. Data were obtained from the European Statistical Authority (EuroStat). A literature search was performed also in the PubMed database, using as appropriate indexing words «quality indicators», «health care», «primary health care», «Greece», and «fiscal crisis». We found that, before the onset of the economic crisis (2004-2008) in Greece, the proportion of citizens unable to access the PHC struc- tures ranged from 4% to 5.5% (2008). During the fiscal crisis period, this figure has almost doubled to 9% (2014). Similarly, the satisfaction of patients from PHC services showed a particularly downward trend. The pre-crisis rate ranged from 94.7% to 92.6% (2008), declining steadily over the crisis and dropping to just 88.8% (2013). The year 2016 appears to be a turning point, to the patterns found up to that time, where the accessibility improved. The Greek fiscal crisis has created many challenges in PHC in relation to the accessibility and satisfaction of citizens with the services provided. In conclusion, the goal of further improvement of the provided primary care services can be achieved by the Greek state through strategic planning, which will take into account the nowadays and particular socio-economic conditions.

Estrutura e responsividade: a Atenção Primária à Saúde está preparada para o enfrentamento da Covid-19?

ABSTRACT The COVID-19 pandemic reinforced the need for global efforts to grant universal health coverage and access, which imposes management challenges for Primary Health Care (PHC). This study aimed to develop and apply an instrument to assess the PHC Units’ responsiveness to COVID-19, based on co-production efforts between university researchers and PHC technical teams. The instrument composed of two modules, included identification, operating hours, workforce, work process, structure, equipment, furniture, supplies, Personal Protection Equipment (PPE), Symptomatic Respiratory Patient (SRP) examinations and follow-up, information, surveillance, integration, communication, and management. All the 165 PHC Units in Brasília were invited to complete the instrument. Main results: there was physical structure adaptation (adequate configuration of waiting rooms, internal and external spaces allowing safe distance); provision of PPE and COVID-19 tests; active search for SRP/COVID-19 suspects by phone, mobile or home visits; monitoring flows of patient transfer and telehealth implementation. In conclusion, the PHC Units reorganized their services to meet the demands of the pandemic context. Providing information about structure and responsiveness of PHC Units may subside health systems for planning and decision-making at different levels of management, which is crucial to determine strategies to empower and reinforce PHC responsivity in situations of pandemics and other calamities.

Pharmacy in the future: A consumer perspective

Pharmacy in the future: A consumer perspective

Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

BackgroundType 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP).MethodsThe study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets.ResultsAltogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72).ConclusionsMultimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

Employing nurse practitioners in general practice: an exploratory survey of the perspectives of managers.

INTRODUCTION Establishing the nurse practitioner (NP) workforce in New Zealand is a viable solution to health and workforce challenges in primary health care. General practices have been slow to implement NP services. Managers of general practices are central to the employment and development of NP roles. AIM To explore the perspectives of managers on employing NPs in general practice. METHODS An electronic survey was used to collect demographic and numerical data, which were analysed descriptively and analytically using SPSS (version 26). Written answers to open-ended questions were analysed qualitatively. RESULTS In total, 143 managers participated in the survey (response rate 39.7%); 54 (37.8%) worked in practices employing at least one NP. Of respondents, 88.9% (n = 127) agreed or strongly agreed that NPs could enhance continuity of care (89/143, 62.2%), improved access to services and medications (89/143, 62.2%) and filled a gap that added value to health care (97/143, 67.8%). Practices employing NPs had statistically significant higher levels of agreement about the advantages of NPs than practices not employing NPs. Challenges and enablers to employing NPs were themed under organisational environment, NP scope of practice and role, and NP workforce development. DISCUSSION This exploratory study revealed that there is little knowledge about the NP workforce in surveyed general practices. Ongoing work is required to improve knowledge for employing general practices, including dissemination of information about NP education and training, scope and models of care, and ability to generate business income.

Primary Health Care in Brasil in the times of COVID-19: changes, challenges and perspectives.

The pandemic of Coronavirus Disease 2019 (COVID-19) has put pressure on countries' health systems. Although attention is mostly directed at the hospital sector, since many critically ill people will need intensive care, Primary Health Care (PHC) has also been disrupted. In Brasil, a universal and free health system has existed since the 1988 Constitution, which re-organized the PHC to attend the population. However, like other countries, the Brazilian health system is being overloaded with the increase in the large number of COVID-19 cases. It is worth reflecting on the changes and challenges in PHC during the COVID-19 pandemic in Brasil.

Establishing a community advisory group (CAG) for partnership defined quality (PDQ) towards improving primary health care in a peri-urban setting in KwaZulu-Natal, South Africa

BackgroundCommunity advisory groups (CAGs) have been shown to be catalysts who bridge the gap between communities and primary health care facilities by sustaining good working relationships through community engagement to improve the quality of the health care services. This study aimed to explore the establishment, operation, and accomplishments of a CAG towards building a strong partnership between the health facilities and local communities in support of the Partner Defined Quality (PDQ) process, to improve the delivery of quality maternal and neonatal care in a peri-urban setting in the province of KwaZulu-Natal, South Africa.MethodsThe study used a qualitative exploratory research design. Recruitment followed a purposive sampling approach. The study targeted leadership representatives from the community, potential beneficiaries, and health care providers in the selected catchment areas. Participants were identified during community mobilization events that took place during the preparatory stage to ensure key stakeholder support. A participatory research approach was used to discuss membership, composition, the selection criteria, including formulation, and agreement on terms of reference of the CAG membership, roles and responsibilities. A rapid assessment method was used for data collection and analysis of establishment of the CAG, its activities and accomplishments.ResultsThe community nominated 24 CAG members during the consultative meetings and the organogram provides clear terms of reference, roles and responsibilities. Immediately after inception, the CAG used four indicators (weaknesses, threats and risks, strengths, and opportunities) to review the community and primary health care challenges that affect their communities. These CAG activities were linked with the phases of the PDQ process. The CAG committed itself going forward to continue to create an enabling environment for all stakeholders working to improve the well-being of the community, especially the PDQ teams working on improving the care of pregnant mothers and their babies pre- and post-delivery.ConclusionThis work shows that developing community relationships and infrastructure are critical initial stages before embarking on PDQ planning and implementation. Empowerment, local ownership, funding, technical resources and ongoing support are critical elements for sustainability of CAG activities.

Role of telemedicine in healthcare during COVID-19 pandemic in developing countries

Abstract: COVID-19 is a public health emergency of international concern. Ensuring primary healthcare during this pandemic appeared to be a great challenge. Primary healthcare services are being disrupted due to lockdown, lack of protective gears and hospital facilities, risk of infection spread to non-COVID patients and health professionals. People with acute and chronic ailments including diabetes, pregnancy, obesity, chronic respiratory diseases, cardiovascular disease, cancer, mental health conditions are in trouble. In this article, the challenges in primary healthcare in developing countries during COVID-19 pandemic have been analyzed and the role of telemedicine in addressing these challenges has been discussed. Telemedicine can play an important role in this pandemic by minimizing virus spread, utilizing the time of healthcare professionals effectively and in alleviating mental health issues.

Patient safety challenges in primary health care: a scoping review.

to identify the patient safety challenges described by health professionals in Primary Health Care. a scoping review was conducted on the LILACS, MEDLINE, IBECS, BDENF, and CINAHL databases, and on the Cochrane, SciELO, Pubmed, and Web of Science libraries in January 2019. Original articles on patient safety in the context of Primary Health Care by health professionals were included. the review included 26 studies published between 2002 and 2019. Four categories resulted from the analysis: challenges of health professionals, administration challenges of health services, challenges with the patient and family, and the potential enhancing resources for patient safety. patient safety challenges for Primary Care professionals are multiple and complex. This study provides insight into resources to improve patient safety for health care professionals, patients, administrators, policy makers, educators, and researchers.

Integration of nurses in general practice: A thematic synthesis of the perspectives of general practitioners, practice nurses and patients living with chronic illness.

To explore the views of general practitioners, practice nurses and patients on interprofessional collaboration in general practice and to understand to what extent the nurse-doctor relationship meets their needs and expectations. To address future challenges of primary health care, there is a need for integrated interprofessional collaboration care systems with a patient-centred focus. Worldwide, there is an integration of nurses in general practice. However, in a transitioning Belgian context little is known about the perspectives of three key stakeholder groups. The results of four qualitative descriptive primary studies were triangulated and a secondary analysis resulted in a thematic synthesis within a pragmatic research paradigm. Primary data were collected through individual, semi-structured interviews with 7 general practitioners, 19 practice nurses and 21 patients living with chronic illness in 26 primary care centres with different nurse integration levels. We conducted a secondary analysis for the thematic synthesis of the different stakeholders' perspectives. This study was reported in accordance with the COREQ checklist. Four overarching themes were found as follows: vision and mission at general practice level, patient-centred care, practice nurse role development and interprofessional collaboration. Interprofessional collaboration within general practice ensures better response to patient needs. Evolution of the practice nurse role to autonomous decision-making can be facilitated by clear vision and mission, team communication, complementarity of responsibilities and trust-based professional relationships. The key for patient-centred care in a well-organised practice is a clear vision and mission and well-defined task description for interprofessional collaboration. General practice is urging for systematic guidance for the sustainable integration of a practice nurse. Our study highlights opportunities and challenges to nurse integration in general practice from key stakeholders' perspectives, which can inform other transitioning contexts.

Beliefs and attitudes towards lifestyle change and risks in primary care \u2013 a community-based study

BackgroundPromoting a positive lifestyle change is a challenge for primary health care. The aim of this study was to analyze health and risk-related beliefs and attitudes in relation to lifestyle and lifestyle change in a rural community.MethodsThe study was based on a five-year follow-up data of the Lapinlahti study (N = 361). The same structured questionnaire was used at baseline and follow-up with lifestyle items. These were ranked as unhealthy (− 1), neutral (0) or healthy (+ 1). At baseline, participants took a stand on 29 statements related to beliefs and attitudes towards health and health promotion on a 5-point Likert scale. A factor analysis yielded two attitude factors (Factor 1 = underrating risks/resistant to change); (Factor 2 = helplessness/pessimism). The factors were divided into tertiles.ResultsThere was a linear positive trend (P < 0.001) in baseline lifestyle scores between the tertiles of Factor 1. A positive follow-up change of lifestyle score was found in all tertiles of Factor 1. For Factor 2, the difference between tertiles at baseline was non-significant. There was a significant positive change in all tertiles of Factor 2. Those who were underrating/ resistant but not helpless/pessimistic had the most significant positive lifestyle change. Those who were underrating/resistant and helpless/pessimistic did not improve their lifestyles.ConclusionsBeliefs and attitudes are related to lifestyle. Subjects with underrating and resistant attitudes with pessimism/helplessness seem to have a low potential for lifestyle change while those with resistant attitudes without pessimism and helplessness may have the most significant potential for lifestyle change. These findings suggest that it is possible to identify different groups of people with different needs and readiness and ability for health behavior change.