Health Promotion Advice Research Articles

How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.

Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care. To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation. Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022. Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women. HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly. Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Self-care advice for patients after surgery for oesophageal cancer - a mixed-methods systematic review.

The aim of the literature review was to identify and synthesise research on self-care advice for oesophageal cancer survivors. A mixed-methods systematic review and synthesis of existing literature on the topic. Five databases were searched for studies providing information on self-care advice for survivorship after oesophageal cancer surgery, in English, with no time filter. The Critical Appraisal Skills Program was used to assess the risk of bias. Data were presented by textual descriptions and grouping of data. Among the 13 studies included in the review, five pieces of self-care advice were identified; reconstructing eating habits, bed-head elevation, health-promoting advice, monitoring symptoms and body functions, and involving family and friends. The self-care advice was experienced to be hard work, but worth the effort. They also provided reassurance and an increased understanding of bodily changes and social consequences of the disease and treatment. Thereare is little evidence-based self-care advice for oesophageal cancer survivors. However, the existing self-care advice was appreciated and contributed to an increased understanding of the situation. Comprehensible and easy-to-follow recommendations should be provided to all oesophageal cancer survivors. Evidence-based self-care advice helpful for the individual oesophageal cancer survivor may be imperative to cope with the consequences of oesophagectomy after hospital discharge.

The role of the radiographer in promoting health: A qualitative examination of diagnostic radiographer perspectives at a Scottish Major Trauma hospital

IntroductionPublication of Government directives and initiatives have signalled a shift in healthcare priorities, with growing emphasis on prevention and early intervention. In comparison to other allied health professions, perceptions of Diagnostic Radiographers of their contribution to addressing these initiatives and role in promoting health, has not been explored. There is limited evidence on current practices, knowledge and confidence in providing health promotion advice to patients within this professional group. This study aimed to investigate the perceptions of Diagnostic Radiographers of their role in promoting health. MethodsSemi-structured focus groups were conducted with 20 Diagnostic Radiographers recruited via convenience sampling from a Scottish Major Trauma Hospital. Focus groups were transcribed and analysed using thematic analysis. ResultsFindings demonstrated a lack of awareness and understanding of government initiatives and professional body recommendations surrounding health promotion. Diagnostic radiographers felt ill-equipped to provide appropriate and impactful health promotion advice and reported lack of time as a barrier to contributing to such activities. ConclusionDiagnostic Radiographers noted a willingness to undertake additional training to enable them to participate and were able to identify areas where they could adopt health promotion activities in their clinical practice. Addressing the barriers to participation is essential to empower Diagnostic Radiographers to contribute to the health promotion agenda. Implications for practiceThere is a need to address profession specific education at pre-registration and post-qualification levels, to ensure Diagnostic Radiographers are equipped with the knowledge, skills and confidence to promote health to their patients. Strong leadership is essential for creating a positive environment to facilitate education, training and the acceptance of health promotion as a key part of a diagnostic radiographer's role.

An examination of the diversity of beer and cider products sold in Irish supermarkets in the context of health promotion advice

Aim: Current health promotion advice relating to the consumption of beer and cider in Ireland is very firmly based on nominal pints and half pints of beer. This study sought to determine if the assumed alcohol strength of beer and cider available in a sample of mainstream supermarkets was appropriate. This study also sought to examine if the assumed size of containers of beer and cider was accurate. Methods: All beer and cider products in a purposive sample of Irish mainstream supermarkets was examined. Data was input into SPSS and examined. Results: There is a substantial level of variation in the container size and alcohol content of beer available in mainstream supermarkets in Ireland. Discussion: Current health promotion advice in Ireland is out of date and does not enable people to easily monitor their drinking and follow healthy drinking guidelines. The obvious answer is the enactment of the Public Health (Alcohol) Act, 2018, that has already been passed requiring alcohol containers to display the number of grams of alcohol contained. However, this element of the legislation, despite being passed into law, has yet to be either enacted, or even given a date for enactment.

Correlation Between History of Infectious Disease with Stunting in Toddler

Stunting is a chronic nutritional problem caused by a long period of malnutrition. Prolonged malnutrition can decrease body resistance, making it susceptible to disease. This study aims to analyze the correlation of the history of infectious disease with stunting cases in toddlers at the Working Area of Sumberjambe Health Center. The research design used a correlation design with a cross-sectional study approach. The sample of this research was 376 toddlers. For the sampling technique, we used stratified random sampling. The research was conducted in May 2021 using questionnaire instruments. Analyze the data using the Spearman Rho test with an α = 0.05. Result: Based on data analysis obtained from 376 respondents, 274 respondents (72.9%) experienced a history of diseases with frequent categories, and 102 respondents (27.1%) experienced a history of diseases with infrequency categories. This study concludes with a correlation between historical infectious diseases and stunting. Based on the results regarding health promotion, the prevention of recurrent or sustainable pain in toddlers needs to be improved to overcome the problem of stunting. Moreover, giving health promotion advice for mothers to provide exclusive breast milk and nutritious food and maintain food hygiene and shelter for children are essential to avoid stunting.

Community paediatric clinics and their role in supporting developmental outcomes and services for children living in disadvantaged communities.

Children living in disadvantaged communities have substantially increased risk for deleterious health and developmental outcomes. A considerable proportion of developmental delay is avoidable; however if children do not receive appropriate treatment within this critical period, damage can be irreparable. Community paediatric clinics provide medical and developmental assessment; deliver health promotion services, counselling, and advice to caregivers; and referral to services. The aim of this study was to systematically search, appraise, and synthesise the literature exploring the role of community paediatric clinics in supporting developmental outcomes and services for children living in disadvantaged communities. Electronic databases were searched using a carefully developed search strategy. Validated tools and appropriate guidelines assessed quality and confidence in evidence. Data analysis and mixed-methods synthesis was guided by the Segregated Framework for Mixed-Method Systematic Reviews. Eighteen studies were selected for inclusion. Areas of emphasis in the literature include the identification and monitoring of developmental delay; engagement of vulnerable families; relational working with children, families, and local services; referral to early intervention services; parental empowerment, practitioner capacity building; and tackling barriers to healthcare access. Through use of a child and family-centred model of care, community paediatric clinics can better meet the needs of vulnerable populations.

Gender and Age Association with Physical Activity and Mood States of Children and Adolescents in Social Isolation during the COVID-19 Pandemic

Background: The outbreak of COVID-19 had a huge impact on daily life. It greatly reduced our physical activity (PA) and caused an increase in negative emotions. The emotions of different ages and sexes were impacted during the pandemic but the most severely influenced were adolescents. Therefore, the study’s main purpose was to explore the influence of age and gender on adolescent physical activity and emotions during the pandemic. Methods: The subjects of the present study were 14,045 adolescents aged 10–18 years from the Yan’an Shaanxi province. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was used to investigate the PA and Profile of Mood States (POMS) was used to investigate adolescents’ mood states. Results: we found that girls and boys have significant differences in total PA and moderate PA (p < 0.01). The adolescents’ PA levels of different ages had significant differences (p < 0.01). Meanwhile, boys had higher negative emotion scores (anger, fatigue, depression, confusion) than girls. Girls, in contrast, had higher positive emotion scores (self-esteem, vigor) (p < 0.01). With increasing age, the increase in emotional states seems to diminish (p < 0.01). Conclusions: Results show long-term social isolation causes reduced PA and increased negative mood states. Girls’ PA was higher than boys, and boys had higher levels of mood disturbances. PA and levels of mood disturbances were significantly associated with age from 10 to 18 years old. This research study aimed to help the correlation department understand the relationship between PA and mood states of adolescents of different ages and sexes during COVID-19. Providing health promotion and preventative advice for different sex and age groups has expanded globally.

COVID-19 vaccine hesitancy in the UK: a longitudinal household cross-sectional study

BackgroundThe approved COVID-19 vaccines have shown great promise in reducing disease transmission and severity of outcomes. However, the success of the COVID-19 vaccine rollout is dependent on public acceptance and willingness to be vaccinated. In this study, we aim to examine how the attitude towards public sector officials and the government impact vaccine willingness. The secondary aim is to understand the impact of ethnicity on vaccine-willingness after we explicitly account for trust in public institutions.MethodsThis cross-sectional study used data from a UK population based longitudinal household survey (Understanding Society COVID-19 study, Understanding Society: the UK Household Longitudinal Study) between April 2020-January 2021. Data from 22,421 participants in Waves 6 and 7 of the study were included after excluding missing data. Demographic details in addition to previous survey responses relating to public sector/governmental trust were included as covariates in the main analysis. A logit model was produced to describe the association between public sector/governmental mistrust and the willingness for vaccination with interaction terms included to account for ethnicity/socio-economic status.ResultsIn support of existing literature, we identified those from BAME groups were more likely to be unwilling to take the COVID-19 vaccine. We found that positive opinions towards public sector officials (OR 2.680: 95% CI 1.888 – 3.805) and the UK government (OR 3.400; 95% CI 2.454—4.712) led to substantive increase in vaccine willingness. Most notably we identified this effect to vary across ethnicity and socio-economic status with those from South Asian background (OR 4.513; 95% CI 1.012—20.123) and possessing a negative attitude towards public officials and the government being the most unwilling to be vaccinated.ConclusionsThese findings suggests that trust in public sector officials play a key factor in the low vaccination rates particularly seen in at-risk groups. Given the additional morbidity/mortality risk posed by COVID-19 to those from lower socio-economic or ethnic minority backgrounds, there needs to be urgent public health action to review how to tailor health promotion advice given to these groups and examine methods to improve trust in public sector officials and the government.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Old-New Challenges? Poverty and Menstruation: Young Girls and Women in the Mirror of Disadvantaged Situation

Abstract Disadvantaged situation means not just a kind of negative social phenomenon, but its effects manifesting on the economic and social fields are also significant. Regarding its complexity, a holistic view is necessary to approach it, and explore the developed situation, define solution proposals, promote a better quality of life and finally, to monitor prevention processes and revise the proposals if necessary. In case of disadvantaged situation, the involvement of children and women requires special attention in all aspects. The Creative Region research group launched its various research in the multi-stage research of the Higher Education Institutional Excellence Program (in Hungarian: Felsőoktatási Intézményi Kiválósági Program, FIKP) started in 2018 on the University of Miskolc, in which the staff of the Faculty of Health got the opportunity to conduct the comprehensive health mapping of the rural population with the involvement of 25 settlements. Based on the results of the FIKP research, it has been supported from more approaches that disadvantaged situation and deprivation can significantly determine the health behaviour, health consciousness and future life prospects of people living there. The comprehensive research examined the characteristics of the health status of people living in disadvantaged settlements along different dimensions. Getting to know the mental health of young girls and the issue of menstruation days among both them and the adult female population were essential elements of the research. During data recording in 2018 with student girls under the age of 14, we experienced in a high number that the girls’ mental well-being was not ideal, and this also manifested in mild to moderate depression at more of them. The presence of domestic violence affecting them is also not negligible in the region. Our research performed in 2019 also supports that anxiety and the feeling of shame appear strongly among young girls on menstruation days as well, and a certain level of the omission of menstruation hygienic products can also be experienced in the region. Data collection performed in 2020 focused on the adult female population in which we experienced the similar phenomena as in case of young girls. In connection with showing the direction of the areas to be improved and defining the promoting prevention health promotion advice, we should have had to strive for adapting to the population’s demands and the professionals’ flexibility which support the more favourable acceptance of the proposals. The significance of individual care, individual competence improvement and personalized counselling and help is indispensable.

The Factors Affecting Health Promotion Implementation Relating to Hypertension Diets in the Elderly Families of Banjarmasin

Health Promotion is one of the independent nursing interventions that can improve the patients’ and famiies’ ability to handle hypertension. Health workers, especially nurses, are expected to give health promotion advice to elderly hypertension patients. They are therefore required to have a detailed understanding of the dietary factors which can affect this condition. This study uses observational research with a cross-sectional design and questionnaire. The research was conducted between December 2019 and March 2020. There are 30 respondents, selected via purposive sampling, comprised of families with elderly members suffering hypertension and living in the Andai River Area of Banjarmasin. Data analysis used chi-square and logistic regression tests. Univariate analysis showed most of respondents were in early adulthood and had a good knowledge of the subject. The bivariate test showed a significant relationship between age, attitude, occupation and knowledge with the implementation of Health Promotion on the Hypertension diet (p <0.05). Multivariate analysis indicates that knowledge was the most important factor with an OR = 16. Educational interventions concerning health promotion are able to improve the quality of life and the ability of elderly to understand every health information received.
 
 Keywords: Elderly Family, Health Promotion, Hypertension Diet

Self-assessed competence and need for further training among registered nurses in somatic hospital wards in Sweden: a cross-sectional survey

BackgroundProfessional competence and continuous professional development is essential for ensuring high quality and safe nursing care, and it might be important for motivating nurses to stay in the profession. Thus, there is a need to identify the developmental process of nursing competency. Assessment of competence and need for further training helps to identify areas for quality improvement, and to design interventions in order to facilitate continuous competence development in different work contexts. The current study aimed to 1) describe registered nurses’ self-assessment of clinical competence as well as the need for further training, and 2) explore possible differences between registered nurses with varying lengths of professional experience as a nurse (≤ 0,5 year, > 0,5–5 years, and ≥ 6 years).MethodsA cross-sectional survey design was applied, using the Professional Nurse Self-Assessment Scale of clinical core competencies II. Registered nurses (n = 266) working in medical and surgical contexts in hospitals in Sweden responded (response rate 51%). Independent student t-test and analysis of variance were carried out.ResultsRegistered nurses assessed their competence highest in statements related to cooperation with other health professionals; taking full responsibility for own activities; and acting ethically when caring for patients. They assessed their need for further training most for statements related to assessing patients’ health needs by telephone; giving health promotion advice and recommendations to patients by telephone; as well as improving a creative learning environment for staff at the workplace. For self-assessed competence and need for further training, differences between the groups for 35 and 46 items respectively, out of 50 were statistically significant.ConclusionsAlthough the registered nurses assessed their competence high for important competence components expected of professionals such as cooperation with other healthcare professionals, it is problematic that knowledge of interactions and side-effects of different types of medication were reported as having the highest need of training. Longitudinal follow up of newly graduated nurses regarding their continuous development of competence as well as further training is needed.

Midwives' and obstetricians' level of knowledge of appropriate gestational weight gain recommendations for pregnancy: A systematic review.

Excessive gestational weight gain (GWG) is a modifiable risk factor associated with maternal and infant health, and pregnancy outcomes. However, several factors influence the provision of health promotion advice including professional knowledge. This review aims to summarize published evidence relating to midwives' and obstetricians' knowledge of GWG guidelines. Electronic database searches were carried out using EMBASE, CINAHL, PubMed, Web of Science, and Cochrane Database. English-language studies and quantitative results were included. Identified studies were screened by two authors independently. Disagreements were discussed with a third reviewer. A review protocol was submitted for registration with PROSPERO in May 2019. From 10960 records identified in preliminary searches, 12 studies reporting on 2652 midwives and obstetricians collectively were included. All studies were conducted in high-income countries. Synthesis of data was difficult as guidelines and methods for assessing knowledge varied. Midwives were mainly reported as the leading participant, with limited data available on obstetrician knowledge. Both groups demonstrated insufficient knowledge of GWG guidelines. Self-reported knowledge was significantly higher than those assessed by direct knowledge. This review highlights a substantial gap in health care professionals' knowledge of GWG guideline content which needs to be addressed. Differences between professionals' direct knowledge and self-reported knowledge are important for clinical practice as it may inhibit the provision of evidence-based advice. It is important to accurately assess knowledge in this area to develop further training for midwives and obstetricians to improve health promotion during pregnancy.

Baby it's hot outside: Balancing health risks and energy efficiency when parenting during extreme heat events

In an increasingly heating global climate, parents find themselves charged with managing the health risks of young children during more frequent and extreme heat events. We outline heat health risks posed to children, contrast our experiences and highlight health promotion policy tools and advice available to parents caring for children during extreme heat events in three cities in the United States of America, Germany, and New Zealand. We argue that balancing health and energy needs requires a variety of policy approaches and communication of these to parents to ensure child health protection during extreme heat events.

Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes.

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.<br/> DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.<br/> SETTING: Two primary care physician-based practices.<br/> INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.<br/> MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.<br/> RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.<br/> Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.<br/> CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.

Brief health promotion in urgent care centres: a qualitative study of patients’ and nurse practitioners’ attitudes

As the number of people with long-term conditions who die prematurely rises, the need for health promotion has come to the fore. However, there is little evidence for how acceptable health promotion is for patients and service providers in nurse-led minor injury units, walk-in centres and urgent care centres.The authors undertook a qualitative study with 204 patients with high-risk behaviours and 14 nurse practitioners to examine their attitudes to a brief health promotion intervention. More than 65% of the patients thought the intervention was a good idea and should become part of practice; less than 1% said it was inappropriate. The nurse practitioners stated that there are opportunities for brief health conversations, but had mixed views about conducting them in this setting.The findings suggest that brief health promotion screening, advice, leaflets and referrals are acceptable in these settings. The authors recommend additional health promotion training, support and pragmatic policies to help nurse practitioners integrate health promotion into care provision.

Health promotion in adults with Down's syndrome: Experiences of caregivers.

Individuals with Down's syndrome rely on caregivers to support lifestyle behaviour change. It is therefore important to understand how caregivers put health recommendations into practice. Through conducting semi-structured interviews, the present study sought to understand the facilitators and barriers that caregivers faced when implementing health promotion advice. Five interviews were conducted with paid support staff and four with family carers of individuals attending a specialist multidisciplinary Down's syndrome health promotion screening clinic. Three main themes emerged in their accounts, including active promotion of weight management by caregivers, benefits of working practices such as record keeping and communication channels and the importance of having access to social care services and recreational activities. These findings have important implications for professionals working in specialised healthcare settings who may be able to tailor communication and services to better meet the needs of individuals with Down's syndrome and their caregivers.

MAINTAINING HEALTHY LIFESTYLE: RACIAL AND GENDER DIFFERENCES IN PHYSICIANS’ ADVICE TO OLDER ADULTS

Older adults are often excluded from physicians’ preventive health promotion recommendations. The influence of patient race and gender on the physician-patient relationship in maintaining good health has been extensively researched, but little is known about the influence of patient race and gender on physicians’ health promotion advice to the elderly. This study explored whether patient race and gender influence primary care physicians’ health promotion advice to older adults. The sample of 536 respondents (µage = 75.51, 75.2% female) was obtained from a NCI funded study of “Health Care Partnerships in Cancer Prevention and Care of Aged. Respondents were randomly selected community dwelling older adults who attend Senior Center programs, sponsored by Area Agencies on Aging (AAA) (Kahana, Lee, Kahana, Langendoerfer, & Marshall, 2015). Multivariate logistic regression analyses were used to control for sociodemographic and health factors while accounting for a complex sampling design. African American patients had greater odds than whites for receiving recommendations to eat a healthy diet (OR = 1.62) and exercise more (OR = 1.83). Elderly women reported fewer recommendations to eat a healthy diet (OR = .81) & exercise more (OR = .45) than did men. Notably, respondents of both races and genders believed that maintaining a healthy lifestyle is very effective. These findings demonstrate that African American and female older adults receive differential health promotional advice from physician and suggest the need for raising physician awareness about the value of prevention advice for all patients.

Breast cancer survivorship care plans: what are they covering and how well do they align with national guidelines?

Survivorship care plans (SCPs) provide key information about cancer treatment history and follow-up recommendations. We describe the completeness of breast cancer SCPs and evaluate guideline concordance of follow-up recommendations. We analyzed 149 breast cancer SCPs from two sites, abstracting demographics, cancer/treatment details, surveillance plans, and health promotion advice. SCP recommendations and provided information were compared to American Cancer Society/American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines. SCP information provided in > 90% of the plans included patient age; relevant providers; cancer stage; treatment details; and physical exam, mammogram, and health promotion recommendations. SCP components completed less frequently included post-treatment symptoms/side effects (67%). All SCPs at the community site were uniform but had the potential for oversurveillance if visits occurred every 3months in years 1-2 or every 6months in years 3-5 with multiple cancer providers. The academic site recommended three predominant patterns of follow-up: (1) primary care provider every 6-12months; (2) cancer team every 3-6months (year 1), every 6-12months (years 4-5); and (3) alternating oncology providers every 3-6months (years 1-2) then every 6months. Compared to guidelines, these patterns recommend under- and oversurveillance at various times. Mammography recommendations showed guideline concordance (annual) for 84%, oversurveillance for 10%, and were incomplete for 6%. SCPs of only 12/79 (15%) women on aromatase inhibitors recommended guideline-concordant bone density testing. SCP content is more complete for demographic and treatment summary information but has follow-up recommendation gaps. Efforts to improve follow-up recommendations are needed.

Physicians' perspectives on medication adherence and health promotion among cancer survivors.

Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear. This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists. Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P<.001). Although most physicians believed that at least 50% of cancer survivors would be adherent to medication regimens to prevent cancer recurrence, they also believed that, if patients were trying to lose weight, they would not remain medication-adherent. In interviews, oncologists expressed fear that providing health-promotion advice would distress or overwhelm patients. Additional health-promotion barriers identified by thematic analysis included: identifying cancer as oncologists' focal concern, time pressure, insufficient behavior change training, and care coordination challenges. Facilitators included perceiving a patient benefit and having health-promotion resources integrated into the cancer care system. Physicians often do not have the time, expertise, or resources to address health promotion with cancer survivors. Research is needed to evaluate whether health-promotion efforts compromise medical regimen adherence, as physicians' responses suggest.