Core elements of the Positive Health dialogue during patient consultations: a qualitative study exploring expert and user opinions in the Netherlands

Abstract

ObjectivesThe Alternative Dialogue (PHD), a dialogue technique which is based on Positive Health, is considered a potential method to improve patient-centred care within the Netherlands. This study aims to provide clarity on the core elements of the PHD and aims to assess to what extent the practical application of the PHD aligns with these core elements.DesignAn exploratory qualitative study using semi-structured interviews.SettingThe study was conducted among health professionals working in primary and secondary care in the Netherlands.ParticipantsThirteen experts were purposely sampled and included based on their involvement in the development, implementation or research of the PHD. Additionally, seven users, who applied the PHD in patient consultations and worked as a primary or secondary health professional participated, both self-selected and purposively sampled. They were included if they participated in a Positive Health training.ResultsThe analysis revealed consensus among experts and users about prioritizing the patient’s perspective, adopting a holistic health view, and promoting self-management and empowerment as main guiding principles. Consensus was also found regarding professional attitude, goals and outcomes and implementation conditions. Variability was observed in the role of behaviour change support as a guiding principle. Further, the PHD as intended by its developers seems more structured and comprehensive than often applied in practice. Discrepancies also emerged regarding target patient groups and applicable settings, highlighting the need for customization and tailored guidance within diverse contexts.ConclusionsWhile there is alignment on the main guiding principles of PHD, there are varying opinions regarding its specific tools and techniques. Clarity in terminology and delineation of the PHD, along with customization for diverse contexts, is crucial to address these challenges and to determine its effectiveness. This study provides initial insights to inform future research and practice in PHD implementation.STRENGTHS AND LIMITATIONSAs far as known, this is the first scientific study to systematically study the alignment of the core elements of the PHD as regarded by experts, with the practical application across a variety of professionsThe deliberate exclusion of a pre-formulated definition of the PHD in the selection criteria attempted to attain a realistic and impartial reflection of the actual application. However, it resulted in a wide variety of interpretations and, in combination with the amount of participating experts, might have caused an abundance of results and a difficulty in identifying and isolating the PHD as a uniformly implemented intervention.The analysis of data was guided by the Framework Methods to systematically guide the process of theme abstraction and data interpretation.The selection methods may have resulted in participation bias and/or reporting bias, which may have affected the results.Due to the nature of the PHD and the effects the Dutch culture and the Dutch healthcare system have on the application of the PHD, the generalizability of the study results cannot be guaranteed.