Research article

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

Gonzalo Grandes¹ , Alvaro Sanchez¹ , Josep M Cortada² , Laura Balague³ , Carlos Calderon⁴ , Arantza Arrazola⁵ , Itziar Vergara⁶ and Eduardo Millan⁷ for the "Prescribe Vida Saludable" group⁸

¹Primary Care Research Unit of Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain

²Deusto Health Centre, Basque Health Service (Osakidetza), Bilbao, Spain

³Renteria Health Centre, Basque Health Service (Osakidetza), Renteria, Spain

⁴Alza Health Centre, Basque Health Service (Osakidetza), Donostia-San Sebastian, Spain

⁵Health Plan Service in Gipuzkoa. Department of Health of the Basque Government

⁶O+berri Institute, Basque Foundation for Health Innovation and Research, Sondika, Spain

⁷Cruces Hospital, Basque Health Service (Osakidetza), Barakaldo, Spain

⁸"Prescribe Vida Saludable" group, Bilbao, Spain

author email corresponding author email

BMC Health Services Research 2008, 8:213doi:10.1186/1472-6963-8-213

Published:	14 October 2008

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.