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