Open Access Highly Accessed Research article

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

Wytske W Geense1*, Irene M van de Glind1, Tommy LS Visscher2 and Theo van Achterberg1

Author Affiliations

1 Scientific Institute for Quality of Healthcare, IQ healthcare, Radboud University Nijmegen Medical Centre, the Netherlands, P.O. Box 9101, Nijmegen, HB, 6500, The Netherlands

2 Research Centre for the prevention of overweight, Zwolle, Windesheim and VU University, Zwolle/ Amsterdam, The Netherlands

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BMC Family Practice 2013, 14:20  doi:10.1186/1471-2296-14-20

Published: 9 February 2013



The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study.


This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews.


All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive.


GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.

Life styles; Family practice; Family nursing; Implementation; Qualitative study; Attitude