Health Promotion In Primary Care Research Articles

How Do Cultural Factors Influence the Teaching and Practice of Mindfulness and Compassion in Latin Countries?

Network for Prevention and Health Promotion in primary Care (RD12/0005/0006) grant from the Instituto de Salud Carlos III of the Ministry of Economy and Competitiveness (Spain), co-financed with European Union ERDF funds (FEDER “Una manera de hacer Europa”).

Service use of older people who participate in primary care health promotion: a latent class analysis

BackgroundRecruiting patients to health promotion programmes who will benefit is crucial to success. A key policy driver for health promotion in older people is to reduce health and social care use. Our aim was to describe service use among older people taking part in the Multi-dimensional Risk Appraisal for Older people primary care health promotion programme.MethodsA random sample of 1 in 3 older people (≥65 years old) was invited to participate in the Multi-dimensional Risk Appraisal for Older people project across five general practices in London and Hertfordshire. Data collected included socio-demographic characteristics, well-being and functional ability, lifestyle factors and service use.Latent class analysis (LCA) was used to identify groups based on use of the following: secondary health care, primary health care, community health care, paid care, unpaid care, leisure and local authority resources. Differences in group characteristics were assessed using univariate logistic regression, weighted by probability of class assignation and clustered by GP practice.ResultsResponse rate was 34% (526/1550) with 447 participants presenting sufficient data for analysis. LCA using three groups gave the most meaningful interpretation and best model fit. About a third (active well) were fit and active with low service use. Just under a third (high NHS users) had high impairments with high primary, secondary and community health care contact, but low non-health services use. Just over a third (community service users) with high impairments used community health and other services without much hospital use.ConclusionOlder people taking part in the Multi-dimensional Risk Appraisal for Older people primary care health promotion can be described as three groups: active well, high NHS users, and community service users.

The implementation of health promotion in primary and community care: a qualitative analysis of the \u2018Prescribe Vida Saludable\u2019 strategy

BackgroundThe impact of lifestyle on health is undeniable and effective healthy lifestyle promotion interventions do exist. However, this is not a fundamental part of routine primary care clinical practice. We describe factors that determine changes in performance of primary health care centers involved in piloting the health promotion innovation ‘Prescribe Vida Saludable’ (PVS) phase II.MethodsWe engaged four primary health care centers of the Basque Healthcare Service in an action research project aimed at changing preventive health practices. Prescribe Healthy Life (PVS from the Spanish “Prescribe Vida Saludable) is focused on designing, planning, implementing and evaluating innovative programs to promote multiple healthy habits, feasible to be performed in routine primary health care conditions. After 2 years of piloting, centers were categorized as having high, medium, or low implementation effectiveness. We completed qualitative inductive and deductive analysis of five focus groups with the staff of the centers. Themes generated through consensual grounded qualitative analysis were compared between centers to identify the dimensions that explain the variation in actual implementation of PVS, and retrospectively organized and assessed against the Consolidated Framework for Implementation Research (CFIR).ResultsOf the 36 CFIR constructs, 11 were directly related to the level of implementation performance: intervention source, evidence strength and quality, adaptability, design quality and packaging, tension for change, learning climate, self-efficacy, planning, champions, executing, and reflecting and evaluating, with —organizational tracking added as a new sub-construct. Additionally, another seven constructs emerged in the participants’ discourse but were not related to center performance: relative advantage, complexity, patients’ needs and resources, external policy and incentives, structural characteristics, available resources, and formally appointed internal implementation leaders. Our findings indicate that the success of the implementation seems to be associated with the following components: the context, the implementation process, and the collaborative modelling.ConclusionsIdentifying barriers and enablers is useful for designing implementation strategies for health promotion in primary health care centers that are essential for innovation success. An implementation model is proposed to highlight the relationships between the CFIR constructs in the context of health promotion in primary care.

Beyond the consultation room: Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers.

BackgroundPrimary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities.ObjectiveTo identify proposals to approach HP in the context of primary care according to health‐care users aged 45‐75 years, key community informants and primary care centre (PCC) workers.MethodsDescriptive‐interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi‐structured interviews were carried out. A thematic interpretive contents analysis was carried out.ResultsParticipants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health‐care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person‐centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness.ConclusionsAccording to a socio‐ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions.

Efficacy of a Communication Skill Training Fostering Health Promotion in Primary Care: A Mixed Method Analysis

Background: Health related behavior is an important determinant of chronic disease, with a high impact on public health. Thus, motivating and assisting people to change their unfavorable health behavior is a major challenge for health professionals. Patients increasingly seek more active participation in healthcare decisions. Thus, communication skills of general practitioners (GPs) are crucial for a successful health promotive counseling, and there is a need of sound competences in communication techniques among them. Methods: We developed a training program using case vignettes and standardized patients (SPs) and evaluated its effectiveness among GPs and their patients at different levels using a validated evaluation model. Levels refer to a. acceptance and satisfaction; b. adoption of knowledge and skills; c. behavior change in regard to communication competence; d. impact on daily work with results in the targeted aim. Results: Participants' ratings in all levels were positive, between 3.9 and 5.0 on a 5- point Likert scale. Self-rated communication knowledge and skills improved significantly with ratings of 3.4 to 3.7 before and 4.2 to 4.5 after the training course (p < 0.01). Only the integration of the new role into daily work was not, or not yet, changed by the training, but the perceived communication competence and working quality of participating GPs improved. Conclusion: Communication skills and competence, as well as patient-centeredness and empathy, are crucial for GPs for helping patients to change and sustain their health behavior. Within communication skill trainings for GPs fostering health promotive counseling, the SP method is a promising format of medical education at pre- and postgraduate level, with a potentially high impact on public health.

Repercussões do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) na Reforma Curricular de Escolas Médicas Participantes do Programa de Incentivos às Mudanças Curriculares dos Cursos de Medicina (Promed)

RESUMO O objetivo do estudo foi analisar, na perspectiva dos coordenadores, as repercussões do PET-Saúde no processo de reforma curricular das escolas de Medicina participantes do Promed. Trata-se de pesquisa qualitativa, com utilização de grupos focais com coordenadores do PET-Saúde de 12 escolas médicas. Foi evidenciado que o PET-Saúde fortaleceu o desenvolvimento curricular, contribuindo especialmente no que diz respeito à consolidação da Atenção Primária como local privilegiado para as práticas de ensino-aprendizagem. As contribuições mais expressivas do PET-Saúde foram relacionadas à produção de conhecimento voltada para as necessidades do SUS e ao fortalecimento da integração ensino-serviço, aspectos que se configuraram como pontos de estrangulamento no contexto do Promed. O PET-Saúde, ao envolver profissionais não docentes (preceptores), acabou contribuindo para a melhoria dos serviços de saúde onde atua, ao capacitar, valorizar e empoderar esses profissionais. O papel do PET-Saúde foi menos enfatizado na pós-graduação e educação permanente voltadas para as necessidades do SUS. A oferta dessas oportunidades educacionais em estreita articulação com o SUS continua sendo um desafio para as políticas de formação profissional na área da saúde.

Prévention et promotion de la santé : quels modèles pour soutenir l’évolution des pratiques en soins de santé primaires ?

Published operating models about preventive health care and health promotion in primary care were sought with the aim of (1) compiling a functional inventory; and (2) to formulate working hypotheses for the improvement of clinical practice towards more efficiency and more equity. Narrative literature review, using keywords related to the various prevention classes, health promotion, primary care, practice models and health care delivery. The diversity of models led to a multi-criteria analysis. Twelve models were selected. Their characteristics were unevenly distributed. The models, whose authors announce that they apply to prevention, mainly describe approaches that focus on individuals within physician-patient relationship, and take into account practice organization. Some socio-ecological and systems models illustrate health promotion: educational practice, group- or population-based targets, community environment and social determinants of health. There is little room for patients in elaborating the models, as they have little role in health care systems. The definitions of prevention, health promotion and patient education greatly differ from one model to another. Little is known about practical implementation of the models; assessment data are scarce. Some elements valued by health promotion could be integrated to health care: empowerment of citizens, addressing community environment; increased involvement in local health professionals' networks; integration of individual and collective approaches within the same health care facilities to address simultaneously individual customization, efficiency and equity objectives. These developments may call for adaptation in vocational training and continuous professional development: communication skills, awareness to public health concepts, and early and longitudinal exposure to community-based learning experiences for students.

Using the iPod Touch for Patient Health Behavior Assessment and Health Promotion in Primary Care.

BackgroundThere is a growing recognition of the importance of lifestyle behavior change for health promotion and disease prevention, as well as the concomitant influence of patient–physician communication on effective behavior change. Mobile technology is increasingly being recognized as an important and efficient tool to collect patients’ health behavior data and facilitate patient–physician communication.ObjectiveThe aim of this study was to assess the feasibility of an iPod touch-based health behavior assessment (HBA) tool in enhancing patient–physician collaborative goal-setting for health promotion in primary care.MethodsA total of 109 patients from three primary care clinics in central Texas completed a brief HBA, which was programmed on an iPod touch device. An instant feedback report was generated for the patient and their physician simultaneously to facilitate collaborative goal-setting. Within approximately 7 days of the HBA, the patients were phoned for a follow-up survey for their feedback on the iPod touch–based HBA and resultant patient–physician communication.ResultsPatients were able to complete an HBA on the iPod touch with ease. Among those who completed the follow-up survey (n=83), 30% (25/83) reported that their physicians discussed the HBA report with them, while 29% (24/83) established behavior change goals with them. More than 90% (75/83) of the patients reported positive experiences with the iPod touch–based HBA.ConclusionsIt is feasible to use mobile tools for HBA in the primary care setting. The HBA also facilitated patient–physician communication on behavior change. However, more research is needed on the effectiveness of large scale dissemination of mobile-based HBA technology on health communication and behavior change for preventing or managing lifestyle-related chronic conditions, such as obesity, diabetes, cancer, or heart diseases.

Promotion Of Primary Health Care In Pakistan: A Case Study Of The Role Of Non-Governmental Organizations In Promoting Primary Health Care In Karachi

The present study “Promotion of Primary Health Care in Pakistan: A Case Study of the Role of Non-Governmental Organizations (NGOs) in Promoting Primary Health Care in Karachi” is aimed at determining the role of NGOs in the promotion of primary health Care sector in Pakistan with special reference to Karachi. The primary objective of this research is to evaluate the role and performance of relevant NGOs working in Karachi in the health sector. It is a quantitative research. A questionnaire based to obtain the opinions of respondents. The health care is the basic responsibility of the state. However, the NGOs play their role in promoting the health care facilities. It was noted that the primary health care system is still not working properly. NGO sector was given a wide room and finances but unfortunately they did not make the required contribution. Their lack of technical knowledge and accountability was a factor in their failure. The prevailing attitude towards health care among the masses has not changed despite the efforts of the NGO sector. Therefore the basic health conditions of the masses at the grass roots level continue to be poor. The stake holders in the health care sector should rethink about their strategies to improve health care facilities in Karachi.

Incremento de la participación de Atención Primaria en la asistencia al virus de la inmunodeficiencia humana: opinan los profesionales de las unidades hospitalarias

AimTo determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. DesignQualitative study using in-depth interviews. LocationInfectious Diseases Unit in the University Hospital «Virgen de la Victoria» in Málaga. ParticipantsHealth professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. MethodConvenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. ResultsHospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. ConclusionsPhysicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care.

An examination of the factors affecting people’s participation in future health examinations based on community health exam interventions

Community-based intervention health examinations were implemented at a health care facility to comply with the government’s primary health care promotion policy. The theory of planned behavior model was applied to examine the effect that community-based health examinations had on people’s health concepts regarding seeking future health examinations. The research participants were individuals who had received a health examination provided at two branches of a hospital in central Taiwan in 2012. The hospital’s two branches held a total of 14 free community-based health examination sessions. The hospital provided health examination equipment and staff to perform health examinations during public holidays. We conducted an exploratory questionnaire survey to collect data and implemented cross-sectional research based on anonymous self-ratings to examine the public’s intention to receive future community-based or hospital-based health examinations. Including of 807 valid questionnaires, accounting for 89.4% of the total number of questionnaires distributed. The correlation coefficients of the second-order structural model indicate that attitudes positively predict behavioral intentions (γ = .66, p < .05), and subjective norms also positively predict behavioral intentions (γ = .66, p < .01). By contrast, perceived behavioral control has no significant relationship with behavioral intentions (γ = −.71, p > .05). The results of the first-order structural model indicated that the second-order constructs had a high explanatory power for the first-order constructs. People’s health concepts regarding health examinations and their desire to continue receiving health examinations must be considered when promoting health examinations in the community. Regarding hospital management and the government’s implementation of primary health care, health examination services should address people’s medical needs to increase coverage and participation rates and reduce the waste of medical resources.

Perfil nutricional de usuários do Programa HIPERDIA em Ananindeua, Pará, Brasil

Objective : To investigate the nutritional profile and understand the dietary habits of patients in the HIPERDIA Program aiming to contribute to the discussion on disease prevention and health promotion in primary care. Methods: From August 2011 to February 2012, students and tutors of the “Programa de Educacao pelo Trabalho para a Saude” (PET-Saude) of the Federal University of Para interviewed 125 individuals with hypertension and/ or diabetes registered in the Family Health Strategy of “Jardim Florestal” and “Murure” in the municipality of Ananindeua, Para state. We applied a structured questionnaire containing questions about socio-economic profile, clinical data, habits, and life style related to patients’ food consumption. Results: Among the respondents, 65.6% were diabetics and 84.8% were hypertensive. Most of the respondents (81.6%) claimed that they had been following a diet to control hypertension or diabetes mellitus, especially with regard to salt, fat, and sugar reduction. Overweight (BMI greater than 24.9 kg/m²) was a predominant factor in the population analyzed (73.6% of the respondents). Conclusion: The research participants were not following an adequate diet requirement. In this context, it is necessary to improve nutritional monitoring and implement socio-educational preventive measures in order to control chronic non-transmissible diseases, thus ameliorating people’s quality of life.

Swedish nurses encounter barriers when promoting healthy habits in children

To increase the understanding of difficulties in promoting healthy habits to parents, we explore barriers in health-care provision. The aim of this study is to describe nurses' perceived barriers when discussing with parents regarding healthy food habits, physical activity and their child's body weight. A mixed method approach was chosen. Nurses (n = 76) working at 29 different Child Health Care Centers' in an area in west Sweden were included in the study. Three focus group interviews were conducted and 17 nurses were selected according to maximum variation. Data were categorized and qualitative content analysis was the chosen analysis method. In the second method, data were obtained from a questionnaire distributed to all 76 nurses. The latent content was formulated into a theme: even with encouragement and support, the nurses perceive barriers of both an external and internal nature. The results identified four main barriers: experienced barriers in the workplace-internal and external; the nurse's own fear and uncertainty; perceived obstacles in nurse-parent interactions and modern society impedes parents' ability to promote healthy habits. The nurses' perceived barriers were confirmed by the results from 62 of the nurses who completed the questionnaire. Despite education and professional support, the health professionals perceived both external and internal barriers in promoting healthy habits to parents when implementing a new method of health promotion in primary care. Further qualitative studies are needed to gain deeper understanding of the perceived barriers when promoting healthy habits to parents.

Barriers in the Delivery of Preventive Procedures in Primary Health Care.

Objectives: Aim of the study was to evaluate general practitioners’ opinions on barriers in the delivery of preventive procedures and ways of solving the problem. 100s of physicians working in Primary Care Practices in Wielkopolska Region (Poland), during a period in 2010, filled questionnaires. Results: The most common barrier was lack of time and inadequate finances identified by 90% and 78% of doctors. Doctors’ or patients’ negative attitude to prevention was noted by 12% and 16% respondents. Insufficient skills and difficulties in updating knowledge were recognized by 9% of the doctors. As a solution 76% respondents pointed at increasing consultation time and 66% - to additional financial incentives. Some of surveyed doctors suggested the need for improvement of the national health programs and increasing their number. Workshops for medical staff were chosen by 48% of questioned doctors. Conclusions: 1. Lack of time is the main barrier in the delivery of preventive procedures in primary care. 2. According to the asked doctors financial incentives would increase the amount of health promotion in primary care.

Health Promotion in Primary Care

Rather than focussing on individuals, health promotion involves whole population of people. It supports personal and social development through providing information, providing education for health and enhancing life skills. By doing so, it increases the options available to people to exercise more control over their own health and their environments and to make choices conducive to health. This article focuses on the links between health promotion and health inequality and the ways in which GPs and the wider primary healthcare team can engage in health promotion activities to benefit their practice population both now and in the future.

Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients

BackgroundThe effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions.MethodsQualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers.ResultsGPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere.ConclusionsHPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.

From the Editors

From the Editors

Quality care: a link between clinical and public health approaches to HIV infection in developing countries

As the importance of quality in health care provision is increasingly recognised, it is opportune to consider quality care as a key link between clinical and public health approaches to human immunodeficiency virus (HIV) infection in developing countries, especially in sub-Saharan Africa. This region has the lion's share of the global epidemic and the least resources to respond. Looking at health problems using a 'quality lens' may help bridge the gaps between clinical care and public health, the current and desired standard of care, and prevention and treatment. Quality care, with prompt diagnosis and effective treatment, of people with HIV infection is crucial for good individual health outcomes, public health outcomes (in terms of decreased HIV transmission) and societal outcomes (increased productivity and decreased costs of health provision for HIV-related care). A spotlight on quality care can bring clinicians and public health practitioners together in working towards universal access to quality HIV care and prevention - one of the greatest health challenges faced in developing countries in Africa today.

Health promotion in primary care: evaluation of a systematic procedure and stage specific information for physical activity counseling.

Given the demographic development, healthy aging becomes more and more relevant. However, physical activity as an important health resource lacks dissemination in persons of older age in Switzerland. Thus, the present study aimed to develop and evaluate a feasible approach for physical activity promotion in the promising primary care setting. An expert panel developed two procedures for physical activity counselling in the primary care setting. The first complete procedure consisted of a written assessment and personal counselling by physicians. It was evaluated by focus groups with primary care physicians. The second modified procedure consisted of mailings to inactive patients selected by physicians. It was evaluated by a written questionnaire sent to participants. The study demonstrated that physical activity promotion through primary care has a high potential. However, core issues such as dealing with time pressure on physicians, applying screening instruments on a broad basis beyond high risk patients, expanding physicians' roles towards primary prevention as well as providing intervention materials actually comprehensible to patients need to be well considered. To facilitate large scale implementation of physical activity promotion, a range of flexible procedures should be provided so the physician can select and adapt them to his needs and desired role in health promotion. Further, physical activity promotion should be integrated into multidimensional health promotion to meet the diverse health needs of patients. The presented multi-stakeholder approach is generally recommended for future development of health promotion interventions.

Health promotion in primary care: evaluation of a systematic procedure and stage specific information for physical activity counseling.

Given the demographic development, healthy aging becomes more and more relevant. However, physical activity as an important health resource lacks dissemination in persons of older age in Switzerland. Thus, the present study aimed to develop and evaluate a feasible approach for physical activity promotion in the promising primary care setting. An expert panel developed two procedures for physical activity counselling in the primary care setting. The first complete procedure consisted of a written assessment and personal counselling by physicians. It was evaluated by focus groups with primary care physicians. The second modified procedure consisted of mailings to inactive patients selected by physicians. It was evaluated by a written questionnaire sent to participants. The study demonstrated that physical activity promotion through primary care has a high potential. However, core issues such as dealing with time pressure on physicians, applying screening instruments on a broad basis beyond high risk patients, expanding physicians' roles towards primary prevention as well as providing intervention materials actually comprehensible to patients need to be well considered. To facilitate large scale implementation of physical activity promotion, a range of flexible procedures should be provided so the physician can select and adapt them to his needs and desired role in health promotion. Further, physical activity promotion should be integrated into multidimensional health promotion to meet the diverse health needs of patients. The presented multi-stakeholder approach is generally recommended for future development of health promotion interventions.