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Background Targeted health dialogues (THDs) have been implemented in primary care in many Swedish regions in an attempt to prevent cardiovascular disease and type 2 diabetes. A THD is a counselling meeting with a specially educated health dialogue coach. It is preceded by blood tests (cholesterol, plasma glucose), blood pressure measuring, anthropometric measures, and a lifestyle questionnaire. Health advice is given based on an illustrative health profile. In southern Sweden, all 40- and 50-year-olds are invited to a THD. Recently, a pilot project with similar THDs for 70-year-olds was performed at 14 healthcare centers. The aim of the present study was to examine the health dialogue coaches’ experiences of THDs in 70-year-olds. Methods Sixteen of 22 coaches consented to participate in the study. Twelve of 14 healthcare centers were represented. Data were collected through three focus groups, and two individual interviews, which were audio-recorded and transcribed verbatim, thereafter analyzed inspired by systematic text condensation. The researchers conducted the analyses separately, whereafter differences were discussed until consensus was reached. Results Support from all co-workers at the healthcare center and time for planning and reflection were mentioned as success factors for the implementation of THDs. The lifestyle questionnaire was perceived to be a bit too extensive for 70-year-olds, especially regarding physical activity and diet. Waist-hip ratio was perceived as a problematic measure. In particular, women often had high values despite a lean body composition and low BMI. Many coaches believed that the 70-year-old participants belonged to the healthier part of the population, and they also had the impression that there was a lower participation rate among immigrants, possibly due to language difficulties. The coaches enjoyed the THDs and believed that the 70-year-olds appreciated them as well. The THDs provided an opportunity to discuss not only cardiovascular risk factors but health issues and life in general. Conclusions The health dialogue coaches valued THDs with 70-year-olds highly, but minor adaptations of the information given, questionnaire and health profile were suggested in what the coaches thought could increase participation and facilitate the dialogues with this age group.
Background Targeted health dialogues (THDs) have been implemented in primary care in many Swedish regions in an attempt to prevent cardiovascular disease and type 2 diabetes. A THD is a counselling meeting with a specially educated health dialogue coach. It is preceded by blood tests (cholesterol, plasma glucose), blood pressure measuring, anthropometric measures, and a lifestyle questionnaire. Health advice is given based on an illustrative health profile. In southern Sweden, all 40- and 50-year-olds are invited to a THD. Recently, a pilot project with similar THDs for 70-year-olds was performed at 14 healthcare centers. The aim of the present study was to examine the health dialogue coaches’ experiences of THDs in 70-year-olds. Methods Sixteen of 22 coaches consented to participate in the study. Twelve of 14 healthcare centers were represented. Data were collected through three focus groups, and two individual interviews, which were audio-recorded and transcribed verbatim, thereafter analyzed inspired by systematic text condensation. The researchers conducted the analyses separately, whereafter differences were discussed until consensus was reached. Results Support from all co-workers at the healthcare center and time for planning and reflection were mentioned as success factors for the implementation of THDs. The lifestyle questionnaire was perceived to be a bit too extensive for 70-year-olds, especially regarding physical activity and diet. Waist-hip ratio was perceived as a problematic measure. In particular, women often had high values despite a lean body composition and low BMI. Many coaches believed that the 70-year-old participants belonged to the healthier part of the population, and they also had the impression that there was a lower participation rate among immigrants, possibly due to language difficulties. The coaches enjoyed the THDs and believed that the 70-year-olds appreciated them as well. The THDs provided an opportunity to discuss not only cardiovascular risk factors but health issues and life in general. Conclusions The health dialogue coaches valued THDs with 70-year-olds highly, but minor adaptations of the information given, questionnaire and health profile were suggested in what the coaches thought could increase participation and facilitate the dialogues with this age group.
Background The salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO). Method The study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness. Result The findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits. Conclusion This study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA. Trial registration Not applicable.
Background Meta-analyses of randomized trials suggest that health checks and health promotion interventions targeting behavior change in primary care do not prevent cardiovascular morbidity and mortality in the general population. However, whether such interventions are more effective in high-risk populations, such as people living in low socioeconomic settings, remains unclear, as they have been poorly represented in previous trials. Therefore, we aim to evaluate the effectiveness, cost-effectiveness, and implementation of systematic screening followed by an individually oriented, lifestyle-focused, health dialogue intervention for prevention of type 2 diabetes and cardiovascular disease, as compared to opportunistic screening, in primary care in socioeconomically disadvantaged areas. Methods Using an overall pragmatic approach and a cluster-randomized design with two arms, we aim to enroll 3000 participants aged 50–59 years from 30 primary care centers (PCCs) with an above-average level of Care Need Index in Stockholm Region, Sweden. PCCs will be randomized (1:1) either to a health dialogue intervention, which includes inviting enlisted patients to a systematic screening of risk factors followed by an individually oriented lifestyle-focused health dialogue, or to opportunistic screening, which includes screening patients for a smaller set of risk factors during an appointment at their PCC taking place for other reasons. The main outcome will be change in systolic blood pressure during 6- and 12-month follow-ups. Additional short-term outcomes will be changes in other biological risk factors, health-related quality-of-life, and lifestyle habits, as well as process and implementation outcomes, and unintended side effects. The long-term effect on type 2 diabetes and cardiovascular disease incidence and mortality will be examined using regional and nationwide registers. Changes in systolic blood pressure and other health outcomes will be analyzed using mixed-effect generalized linear modeling and mixed-effect Cox regression to capture variability between and within PCCs. A health economic evaluation will assess resource use and costs in the short- and long-term. Discussion This trial of lifestyle-focused health dialogues and opportunistic screening in primary care in socioeconomically disadvantaged areas in the largest region of Sweden has the potential to yield valuable insights that could support evidence-based policymaking. Trial registration ClinicalTrials.gov (NCT06067178). Prospectively registered September 27, 2023.
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