Open Access Highly Accessed Research article

Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

Donna Patricia Manca12*, Michelle Greiver345, June C Carroll36, Ginetta Salvalaggio1, Andrew Cave1, Jess Rogers8, James Pencharz37, Carolina Aguilar1, Rebekah Barrett9, Shelley Bible2 and Eva Grunfeld103

Author Affiliations

1 Department of Family Medicine, University of Alberta, University of Alberta, 901 College Plaza, Edmonton, Alberta, T6G 2C8, Canada

2 Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive NW, Edmonton, Alberta, T6L 5X8, Canada

3 Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1 V7, Canada

4 North York Family Health Team, 240 Duncan Mill, North York, Toronto, Ontario, M3B 1Z4, Canada

5 Department of Family and Community Medicine, North York General Hospital, University of Toronto, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada

6 Department of Family Medicine Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada

7 Credit Valley Family Health Team, 2300 Eglinton Avenue West, Mississauga, Ontario, L5M 2V8, Canada

8 Centre for Effective Practice, 203 College Street, S 24 Suite 402, Toronto, M5T 1P9, Canada

9 Taddle Creek Family Health Team, 790 Bay St #306, Toronto, Ontario, M5G 1 N8, Canada

10 Ontario Institute for Cancer Research, Toronto, Ontario, Canada

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BMC Family Practice 2014, 15:66  doi:10.1186/1471-2296-15-66

Published: 11 April 2014



Our randomized controlled trial (The BETTER Trial) found that training a clinician to become a Prevention Practitioner (PP) in family practices improved chronic disease prevention and screening (CDPS). PPs were trained on CDPS and provided prevention prescriptions tailored to participating patients. For this embedded qualitative study, we explored perceptions of this new role to understand the PP intervention.


We used grounded theory methodology and purposefully sampled participants involved in any capacity with the BETTER Trial. Two physicians and one coordinator in each of two cities (Toronto, Ontario and Edmonton, Alberta) conducted eight individual semi-structured interviews and seven focus groups. We used an interview guide and documented research activities through an audit trail, journals, field notes and memos. We analyzed the data using the constant comparative method throughout open coding followed by theoretical coding.


A framework and process involving external and internal practice facilitation using the new role of PP was thought to impact CDPS. The PP facilitated CDPS through on-going relationships with patients and practice team members. Key components included: 1) approaching CDPS in a comprehensive manner, 2) an individualized and personalized approach at multiple levels, 3) integrated continuity that included linking the patients and practices to CPDS resources, and 4) adaptability to different practices and settings.


The BETTER framework and key components are described as impacting CDPS through a process that involved a new role, the PP. The introduction of a novel role of a clinician within the primary care practice with skills in CDPS could appropriately address gaps in prevention and screening.

Chronic disease; Prevention; Screening; Facilitation; Patient navigator