Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography.
Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography.
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DOI：
10.1371/journal.pone.0089554
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Fernández A
中科院分区：
文献类型：
--
作者：
Rubio-Valera M;Pons-Vigués M;Martínez-Andrés M;Moreno-Peral P;Berenguera A;Fernández A
证据支持实施初级预防和健康促进（PP&HP）活动，但初级保健（PC）专业人员对实施这些活动表现出阻力。其目的是综合现有的定性研究的障碍和促进PC医生和护士在实施PP和HP成人。对三个数据库进行了系统检索，并辅以人工检索。所包括的35篇文章相互翻译，并对所提取的概念进行了新的解释。根据专业人士的PP&HP活动的影响因素在PC的实施被拟合成一个五层次的生态模型：个人因素，人际过程，制度因素，社区因素和公共政策。在个人内部层面，我们发现专业人士的信念，PP和HP，经验，技能和知识，自我概念。病人、专科医生、诊所管理者和同事对PP和HP的态度和行为（人际因素）影响实施PP和HP的可行性。机构一级：PC被认为是实施PP和HP的有利条件，但工作量，缺乏时间和转诊资源，以及生物医学模式（优先考虑疾病治疗）的优势阻碍了PP和HP的实施。财务激励措施和指导方针、警报/提醒等工具的有效性取决于专业人员对它们的态度。社区因素包括患者的社会和文化特征（宗教、经济资源等），地方转诊资源、大众媒体信息和制药业运动，以及大学课程中对PP和HP的重视。最后，政策影响资源的分配，从而影响PP和HP的执行。在多风险管理中，对PP和HP活动实施中的障碍和促进因素的研究很少。该合成提供的概念概述导致了PC中PP和HP设计的实际建议的制定。然而，这些建议的有效性需要得到证明。
Evidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults. A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP. Research on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual overview provided by this synthesis resulted in the development of practical recommendations for the design of PP&HP in PC. However, the effectiveness of these recommendations needs to be demonstrated.
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
影响因子：
3.6
作者：
Campbell, R.;Pound, P.;Donovan, J.
通讯作者：
Donovan, J.
影响因子：
2.4
作者：
Britten, Nicky;Campbell, Rona;Pill, Roisin
通讯作者：
Pill, Roisin
影响因子：
4.2
作者：
Boase, Sue;Mason, Dan;Cohn, Simon
通讯作者：
Cohn, Simon
影响因子：
2.9
作者：
Carlfjord S;Lindberg M;Andersson A
通讯作者：
Andersson A