Hunter, C, Chew-Graham, CA, Langer, S, Drinkwater, J, Stenhoff, A, Guthrie, EA and Salmon, P (2014) 'I wouldn't push that further because I don't want to lose her': a multiperspective qualitative study of behaviour change for long-term conditions in primary care. Health Expectations, 18 (6). 1995 -2010. ISSN 1369-7625

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BACKGROUND: Health outcomes for long-term conditions (LTCs) can be improved by lifestyle, dietary and condition management-related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. OBJECTIVE: To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. DESIGN: Multiperspective, longitudinal qualitative research involving six primary health-care practices in England. Consultations between patients with LTCs and health-care practitioners were audio-recorded. Semi-structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re-interviewed 3 months later. Framework analysis was applied to all data. PARTICIPANTS: Thirty-two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. RESULTS: Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient-practitioner relationship. CONCLUSION: Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners' accounts and behaviours needs to be addressed within primary health-care organizations.

Item Type: Article
Additional Information: © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd., 18, pp.1995–2010 1995 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords: Adult, Aged, Aged, 80 and over, behaviour change, Chronic Disease, chronic illness, Disease Management, England, Female, Health Behavior, health-care professional-patient interaction, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Motivation, Physician-Patient Relations, primary health care, Primary Health Care, Qualitative Research
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
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Depositing User: Symplectic
Date Deposited: 02 Dec 2016 12:08
Last Modified: 02 Dec 2016 12:12

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