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      Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers

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          Abstract

          Background

          The adoption of a healthy lifestyle, including physical activity, a healthy diet, moderate alcohol consumption and abstinence from smoking, is associated with a major decrease in the incidence of chronic diseases and mortality. Primary health-care (PHC) services therefore attempt, with rather limited success, to promote such lifestyles in their patients. The objective of the present study is to ascertain the perceptions of clinicians and researchers within the Basque Health System of the factors that hinder or facilitate the integration of healthy lifestyle promotion in routine PHC setting.

          Methods

          Formative research based on five consensus meetings held by an expert panel of 12 PHC professionals with clinical and research experience in health promotion, supplied with selected bibliographic material. These meetings were recorded, summarized and the provisional findings were returned to participants in order to improve their validity.

          Results

          The Health Belief Model, the Theory of Planned Action, the Social Learning Theory, "stages of change" models and integrative models were considered the most useful by the expert panel. Effective intervention strategies, such as the "5 A's" strategy (assess, advise, agree, assist and arrange) are also available. However, none of these can be directly implemented or continuously maintained under current PHC conditions. These strategies should therefore be redesigned by adjusting the intervention objectives and contents to the operation of primary care centres and, in turn, altering the organisation of the centres where they are to be implemented.

          Conclusion

          It is recommended to address optimisation of health promotion in PHC from a research perspective in which PHC professionals, researchers and managers of these services cooperate in designing and evaluating innovative programs. Future strategies should adopt a socio-ecological approach in which the health system plays an essential role but which nevertheless complements other individual, cultural and social factors that condition health. These initiatives require an adequate theoretical and methodological framework for designing and evaluating complex interventions.

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          Most cited references85

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          Stages and processes of self-change of smoking: toward an integrative model of change.

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            Changing provider behavior: an overview of systematic reviews of interventions.

            Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not easily accessible to policy makers and professionals. To identify, appraise, and synthesize systematic reviews of professional educational or quality assurance interventions to improve quality of care. An overview was made of systematic reviews of professional behavior change interventions published between 1966 and 1998. Forty-one reviews were identified covering a wide range of interventions and behaviors. In general, passive approaches are generally ineffective and unlikely to result in behavior change. Most other interventions are effective under some circumstances; none are effective under all circumstances. Promising approaches include educational outreach (for prescribing) and reminders. Multifaceted interventions targeting different barriers to change are more likely to be effective than single interventions. Although the current evidence base is incomplete, it provides valuable insights into the likely effectiveness of different interventions. Future quality improvement or educational activities should be informed by the findings of systematic reviews of professional behavior change interventions.
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              Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group.

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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2008
                14 October 2008
                : 8
                : 213
                Affiliations
                [1 ]Primary Care Research Unit of Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
                [2 ]Deusto Health Centre, Basque Health Service (Osakidetza), Bilbao, Spain
                [3 ]Renteria Health Centre, Basque Health Service (Osakidetza), Renteria, Spain
                [4 ]Alza Health Centre, Basque Health Service (Osakidetza), Donostia-San Sebastian, Spain
                [5 ]Health Plan Service in Gipuzkoa. Department of Health of the Basque Government
                [6 ]O+berri Institute, Basque Foundation for Health Innovation and Research, Sondika, Spain
                [7 ]Cruces Hospital, Basque Health Service (Osakidetza), Barakaldo, Spain
                [8 ]"Prescribe Vida Saludable" group, Bilbao, Spain
                Article
                1472-6963-8-213
                10.1186/1472-6963-8-213
                2577098
                18854033
                5c2563e2-b3a4-4680-b608-548d9e5ac815
                Copyright © 2008 Grandes et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 February 2008
                : 14 October 2008
                Categories
                Research Article

                Health & Social care
                Health & Social care

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