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Table 3 Barriers and facilitators for delivering health promotion activities

From: Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

BARRIERS Lack of patients’ motivation to change unhealthy behaviour * Results are difficult to measure Patients do not appreciate it when GPs of PNs discuss their lifestyles Lack of proven effectiveness of health promotion programs The hours of PN are not fully compensated financially
Unhealthy lifestyle is socially accepted, especially drinking alcohol Lack of skills among GPs and PNs to discuss lifestyle and develop health promotion programs Group sessions seems to be more effective compared with individual counselling, but most of the health promotion programs in general practice are individual Lack of overview of health promotion programs Lack of reimbursements and subsidies to start new health promotion programs in general practice
Patients deny or lie about their actual lifestyles Lack of time among GPs to discuss lifestyle with patients and develop health promotion programs GPs state discussing lifestyles is a waste of time Lack of continuity of health promotion programs, due to short-term reimbursements and subsidies GPs have to meet too many strict requirements of healthcare insurance companies, to receive reimbursement and subsidies (e.g. registration, accredited courses)
Patients are unaware of their unhealthy lifestyles Dietician and addiction care consultant disappear due to lack of patients Consultation hours are more focused on treatment instead of on prevention Not all patients can be reached in general practice Lack of trust among GPs and PN in reimbursement and subsidies due to continuous changes
Patients experience barriers to live a healthy lifestyle (e.g. co-morbidity, lack of time) GPs do not give patients referrals and motivate their patients as much as they can GPs are sceptical about the effects and results of discussing lifestyle Programs are not accessible, due to narrow inclusion criteria and affordability of programs Contradictory policy of Dutch government (e.g. expensive healthy food, inconsistent smoking policy)
Behavioural change is a complex process for patients, especially when the environment does not change Due to unhealthy behaviour of GPs and PNs (especially alcohol use) it is difficult to discuss lifestyles with patients GPs think lifestyle is not important Lack of health promotion programs GPs and patients have to find out reimbursement and subsidies from insurance companies themselves
Letting patients pay contribution for health promotion programs does not work, especially not among low SES patients Motivation of GPs and PNs decrease due to disappointing results Programs are not accessible for patients due to waiting lists Lack of collaboration between hospital and general practices with regard to health promotion activities
Due to stigma patients are not going to addiction care Lack of collaboration between disciplines   Health promotion activities in general practice are not rewarded
Patients do not go to health promotion programs due to geographical barriers (E.g. distance to program) Lack of room and housing Contradictory information from insurance company towards patients
GPs forget to ask about lifestyles
FACILITATORS Patients who are aware of their own lifestyles and who are motivated to change their lifestyles is a motivation for GPs and PNs Availability of PNs in general practice: he/she has more time than GPs and plays a central role GPs thinks it is worthwhile to discuss lifestyle with patients Health promotion programs in general practice are familiar for patients Reimbursements and subsidies determine participation and development of health promotion programs
Let patients do what they want to do; there is a bigger chance they will succeed More collaboration and feedback due to availability of physiotherapist and dietician in general practice GPs state it is part of their job to promote a healthy lifestyle Easy accessible health promotion programs due to broad inclusion criteria and affordability Umbrella of GP organization develop health promotion programs and clear policy
Patients are more motivated when they have insight in their results (e.g. blood sugar level) Sufficient staff for developing and conducting lifestyle programs GPs and PNs think they are skilled to discuss lifestyle with patients Continuity of health promotion programs  
Patients are more motivated to participate in a lifestyle program when they have to pay contribution Familiarity between patients and GP and PNs is an advantage to discuss lifestyle Healthy lifestyle of GP and PNs is a role model for patient Best way to discuss lifestyle is in an open manner, not by using a protocol
  Sufficient room and accommodation   Proven effectiveness of health promotion programs
Enthusiastic colleagues to develop and deliver lifestyle programs Overview/ social map of disciplines and health promotion programs
   Structured registration and labelling of patients at risk provide an overview for GPs   Availability and collaboration with sport facilities  
  1. *Most cited factors are at the head of the table. E.g. ‘Lack of motivation by patients’ is mentioned by nineteen participants.