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Johansson, Helene
Publications (10 of 22) Show all publications
Al-Alawi, K., Johansson, H., Al Mandhari, A. & Norberg, M. (2019). Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman. Primary Health Care Research and Development, 20, Article ID E3.
Open this publication in new window or tab >>Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman
2019 (English)In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, article id E3Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches.

BACKGROUND: The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines.

METHOD: A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.

FINDINGS: The study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

Place, publisher, year, edition, pages
Cambridge University Press, 2019
Keywords
Oman, diabetes care, perception, primary health care, team-based management
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150612 (URN)10.1017/S1463423618000282 (DOI)000460940900001 ()29737963 (PubMedID)2-s2.0-85046698625 (Scopus ID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2019-04-04Bibliographically approved
Al-Alawi, K., Al Mandhari, A. & Johansson, H. (2019). Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study. BMC Health Services Research, 19, Article ID 18.
Open this publication in new window or tab >>Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 18Article in journal (Refereed) Published
Abstract [en]

BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Oman, Primary health care, Health service challenges, Type 2 diabetes, Health care providers
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-155965 (URN)10.1186/s12913-019-3866-y (DOI)000455209900007 ()30621675 (PubMedID)
Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-04-02Bibliographically approved
Sorensen, J., Johansson, H., Jerdén, L., Dalton, J., Sheikh, H., Jenkins, P., . . . Weinehall, L. (2019). Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State. HEALTH SERVICES RESEARCH AND MANAGERIAL EPIDEMIOLOGY, 6, Article ID UNSP 2333392819862122.
Open this publication in new window or tab >>Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State
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2019 (English)In: HEALTH SERVICES RESEARCH AND MANAGERIAL EPIDEMIOLOGY, ISSN 2333-3928, Vol. 6, article id UNSP 2333392819862122Article in journal (Refereed) Published
Abstract [en]

Introduction: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. Methods: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. Results: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. Conclusions: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2019
Keywords
primary prevention, health-care guidelines, behavioral counseling, hospital administrators
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-162329 (URN)10.1177/2333392819862122 (DOI)000477857600001 ()31384624 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-22Bibliographically approved
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
Kardakis, T., Jerdén, L., Nyström, M. E., Weinehall, L. & Johansson, H. (2018). Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare: a two-year follow up. BMC Health Services Research, 18, Article ID 227.
Open this publication in new window or tab >>Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare: a two-year follow up
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 227Article in journal (Refereed) Published
Abstract [en]

Background: Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients' unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods: Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results: Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients' tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions: Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients' lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses' attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians' uptake and use of the CPGs.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Implementation, Lifestyle, Clinical practice guidelines, Primary health care, Preventive health services, alth promotion, Smoking, Counselling
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147310 (URN)10.1186/s12913-018-3023-z (DOI)000428883500004 ()29606110 (PubMedID)
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2018-06-09Bibliographically approved
Jerdén, L., Dalton, J., Johansson, H., Sorensen, J., Jenkins, P. & Weinehall, L. (2018). Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients' expectations and experiences. Global Health Action, 11(1), Article ID 1438238.
Open this publication in new window or tab >>Lifestyle counseling in primary care in the United States and Sweden: a comparison of patients' expectations and experiences
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2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1438238Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite various guidelines, shortcomings in lifestyle counseling in primary care have been demonstrated. Comparisons between countries may provide insight on how to improve such counseling. To the best of our knowledge, studies comparing patients' views of lifestyle counseling beween the United States (US) and European countries have not been reported.

OBJECTIVES: To quantify and compare patients' perspectives in the US and Sweden on primary care providers' counseling on weight, eating habits, physical activity, smoking, and alcohol consumption.

METHODS: In a cross-sectional study, 629 patients from Sweden and the US completed a telephone interview about their experiences after a visit to a physician in primary care. The survey focused on patients' perception of the importance of healthy lifestyle habits, their need to change, their desire to receive support from primary care, and the support they had actually received. Data were analyzed using chi-square or Fisher's exact test.

RESULTS: For three of the four lifestyle habits, the proportion saying they needed to change was higher in the US. The exception was for alcohol, where Swedish subjects indicated a greater need to change. Among those stating a need to change, the proportion saying that they would like to have support from primary care was generally above 80% in both countries. The proportion of US patients reporting that their primary care provider had initiated a discussion of lifestyle modification was, with the exception of alcohol, roughly double the level reported by the Swedish patients.

CONCLUSIONS: This study demonstrates high and quite similar patient expectations concerning lifestyle counseling in both countries, but more frequent initiation of discussions of most lifestyle issues in US primary care. Further studies, e.g. qualitative interviews with physicians, and medical record reviews, are required to better understand what can explain the differences between countries indicated by the study.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Sweden, USA, alcohol drinking, counseling, health behavior, health promotion, lifestyle, prevention, primary health care, smoking
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-145657 (URN)10.1080/16549716.2018.1438238 (DOI)000427795600001 ()29495947 (PubMedID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
Johansson, H., Weinehall, L., Sorensen, J., Dalton, J., Jenkins, P. & Jerden, L. (2017). Lifestyle counseling in primary care: The views of family physicians in United States and Sweden. Paper presented at 10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017. European Journal of Public Health, 27(suppl_3), 333
Open this publication in new window or tab >>Lifestyle counseling in primary care: The views of family physicians in United States and Sweden
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2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 333-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: The role of primary care professionals in lifestyle counseling is receiving attention at the national level in many countries. The U.S. and Sweden are two countries currently establishing priorities in these areas. A study comparing the countries demonstrates large differences between the extents that family physicians report being engaged in counseling on lifestyle issues, and how important they perceive it to be (Weinehall et al. Counseling on lifestyle habits in the United States and Sweden. BMC Family Practice 2014;15:83).

With the overall aim of facilitating lifestyle counselling in primary care, the objective of the present qualitative study was to explore further the views of American and Swedish family physicians about lifestyle counseling, in order to clarify the differences in attitudes and practices in the two countries.

Methods: In total, twenty-nine semi-structured interviews were conducted with family physicians representing the county councils of Stockholm and Dalarna in Sweden, and the Bassett Healthcare Network, Upstate New York, U. S. Data were analyzed using qualitative content analysis.

Results/Conclusions: Preliminary results show that the majority of the informants in both countries believe that addressing lifestyle issues is important and a natural part of their work. However, the study indicates that the U.S. physicians to a higher extent work in a more systematic way with risk factor management and routinely ask about lifestyle habits as part of existing work processes. They also expressed to a higher extent that they themselves, despite lack of time, must engage in lifestyle counseling, due to limited access to collegial support and referral services. The Swedish doctors, on the other hand, are able to limit their own role and responsibility due to support from other professions in the health care center/access to referral services.

Key messages:

  • This study provide insight into how Swedish and U.S family physicians view the role of behavioral risk factor management in their clinical practice.
  • Understanding professionals ‘take’ on lifestyle interventions, is invaluable, as they serve on the ‘front line’ in the battle to improve health outcomes in both countries.
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143078 (URN)10.1093/eurpub/ckx189.078 (DOI)000414389803186 ()
Conference
10th European Public Health Conference Sustaining resilient and healthy communities Stockholm, Sweden 1–4 November 2017
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-06-09Bibliographically approved
Weinehall, L., Johansson, H., Sorensen, J., Jerdén, L., May, J. & Jenkins, P. (2014). Counseling on lifestyle habits in the United States and Sweden: a report comparing primary care health professionals' perspectives on lifestyle counseling in terms of scope, importance and competence. BMC Family Practice, 15(1), 83
Open this publication in new window or tab >>Counseling on lifestyle habits in the United States and Sweden: a report comparing primary care health professionals' perspectives on lifestyle counseling in terms of scope, importance and competence
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2014 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, no 1, p. 83-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The role of primary care professionals in lifestyle counseling for smoking, alcohol consumption, physical activity, and diet is receiving attention at the national level in many countries. The U. S. and Sweden are two countries currently establishing priorities in these areas. A previously existing international research collaboration provides a unique opportunity to study this issue.

METHODS: Data from a national survey in Sweden and a study in rural Upstate New York were compared to contrast the perspectives, attitudes, and practice of primary care professionals in the two countries. Answers to four key questions on counseling for tobacco use, alcohol consumption, physical activity, and eating habits were compared.

RESULTS: The response rates were 71% (n = 180) and 89% (n = 86) in the Sweden and the U.S. respectively. U.S. professionals rated counseling "very important" significantly more frequently than Swedish professionals for tobacco (99% versus 92%, p < .0001), physical activity (90% versus 79%, p = .04), and eating habits (86% versus 69%, p = .003). U.S. professionals also reported giving "very much" counseling more frequently for these same three endpoints than did the Swedish professionals (tobacco 81% versus 38%, p < .0001, physical activity 64% versus 31%, p < .0001, eating 59% versus 34%, p = .0001). Swedish professionals also rated their level of expertise in providing counseling significantly lower than did their U.S. counterparts for all four endpoints. A higher percentage of U.S. professionals expressed a desire to increase levels of counseling "very much", but only significantly so for eating habits (42% versus 28%, p = .037).

CONCLUSIONS: The study demonstrates large differences between the extent that Swedish and American primary care professionals report being engaged in counseling on lifestyle issues, how important they perceive counseling to be, and what expertise they possess in this regard. Explanations might be found in inter-professional attitudes, the organization of healthcare, including the method of reimbursement, traditions of preventive healthcare, and cultural differences between the two countries. Further studies are needed to explore these questions, with the aim of facilitating improved lifestyle counseling in primary care.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Attitudes, Counseling, Guidelines, Health promotion, Life style, Prevention, Primary care, Sweden, USA
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-90543 (URN)10.1186/1471-2296-15-83 (DOI)000336057900001 ()24886390 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0944
Available from: 2014-06-24 Created: 2014-06-24 Last updated: 2018-06-07Bibliographically approved
Johansson, H. (2014). Ekonomiska styrsystem och sjukdomsförebyggande insatser i primärvården: En sammanställning av landstingens/regionernas regelverk för år 2013. Umeå: Umeå universitet
Open this publication in new window or tab >>Ekonomiska styrsystem och sjukdomsförebyggande insatser i primärvården: En sammanställning av landstingens/regionernas regelverk för år 2013
2014 (Swedish)Report (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. p. 32
Series
Public Health Report Series, ISSN 1651-341x ; 2014:1
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-88234 (URN)
Available from: 2014-04-28 Created: 2014-04-28 Last updated: 2018-06-07Bibliographically approved
Kardakis, T., Weinehall, L., Jerdén, L., Nyström, M. E. & Johansson, H. (2014). Lifestyle interventions in primary health care: professional and organizational challenges. European Journal of Public Health, 24(1), 79-84
Open this publication in new window or tab >>Lifestyle interventions in primary health care: professional and organizational challenges
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2014 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, p. 79-84Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Interventions that support patient efforts at lifestyle changes that reduce tobacco use, hazardous use of alcohol, unhealthy eating habits and insufficient physical activity represent important areas of development for health care. Current research shows that it is challenging to reorient health care toward health promotion. The aim of this study was to explore the extent of health care professional work with lifestyle interventions in Swedish primary health care, and to describe professional knowledge, attitudes and perceived organizational support for lifestyle interventions.

METHODS: The study is based on a cross-sectional Web-based survey directed at general practitioners, other physicians, residents, public health nurses and registered nurses (n = 315) in primary health care.

RESULTS: Fifty-nine percent of the participants indicated that lifestyle interventions were a substantial part of their duties. A majority (77%) would like to work more with patient lifestyles. Health professionals generally reported a thorough knowledge of lifestyle intervention methods for disease prevention. Significant differences between professional groups were found with regard to specific knowledge and extent of work with lifestyle interventions. Alcohol was the least addressed lifestyle habit. Management was supportive, but structures to sustain work with lifestyle interventions were scarce, and a need for national guidelines was identified.

CONCLUSIONS: Health professionals reported thorough knowledge and positive attitudes toward lifestyle interventions. When planning for further implementation of lifestyle interventions in primary health care, differences between professional groups in knowledge, extent of work with promotion of healthy lifestyles and lifestyle issues and provision of organizational support such as national guidelines should be considered.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-79767 (URN)10.1093/eurpub/ckt052 (DOI)000330838200018 ()23722861 (PubMedID)
Available from: 2013-09-02 Created: 2013-09-02 Last updated: 2018-06-08Bibliographically approved
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