Health-care users, key community informants and primary health care workers’ views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions

Abstract

BackgroundAlthough some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention.MethodsA descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out.ResultsHealth-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants’ profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role.ConclusionsGenerally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.

Qualitative evaluation of a complex intervention to implement health promotion activities according to healthcare attendees and health professionals: EIRA study (phase II)

“…However, we acknowledge that the current version of this intervention cannot yet be integrated in primary care practice until fundamental organisational changes that ensure feasibility and sustainability in real-world conditions take place. Even though the intervention was adapted and implemented following the recommendations of healthcare attendees and health professionals obtained in prior phases of the EIRA Project,2 3 8–10 further adjustments are required. For instance, in the EIRA Project, we concluded that for health promotion, it is essential to involve most primary care professionals, including administrative staff, to avoid tension and to challenge the notion that health promotion is voluntary or based on personal preference.…”

“…The EIRA Project started in Spain in 2012 with the objective to modify unhealthy behaviours in primary care patients following the MRC framework for complex interventions 6 7. To date, the first three phases have been completed 2 3 8–10. Specifically, the objective of the EIRA Project was to design, conduct and evaluate a complex, multirisk intervention to enhance adherence to the Mediterranean diet, increase insufficient physical activity and reduce smoking, cardiovascular risk factors and risk of depression in people aged 45–75 years that contact PHC services with at least two of these behaviours or risk factors.…”

A Proposal for Public Health Information System-Based Health Promotion Services

“…The execution of health services is undertaken by local health and medical institutions, mainly by public health centers (health and medical centers), health care centers, and health promotion centers. In the meantime, the performance management for health services is evaluated by local governments and public health centers [32][33][34]. (Figure 1).…”

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

“…The intervention was based on the Transtheoretical Model and Stages of Change [29,31] and was built on the results of the previous phases of the EIRA study [11,20,29,[21][22][23][24][25][26][27][28]. It had a maximum duration of 12 months and was carried out at the individual, group and community level in accordance to the stages of change and unhealthy behaviours (see Table 1).…”

“…Regarding this, the effectiveness-implementation hybrid trials with their dual approach offer the opportunity to assess the effectiveness of both an intervention and an implementation strategy [17,18] In 2012, the Spanish Primary Care Prevention and Health Promotion Research Network (redIAPP) [19] launched the EIRA study, a MHBC intervention targeting three unhealthy behaviours in people aged 45 to 75. The rst three phases (preclinical phase, phase I and phase II) followed the MRC framework [11,20,29,[21][22][23][24][25][26][27][28]. This article describes the results of phase III, in which we used a hybrid design with the aim of evaluating the effectiveness of a) a 12-month MHBC primary care intervention on reducing smoking, increasing physical activity and enhancing adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy in terms of acceptability, adoption, appropriateness, feasibility and delity.…”