title: Strategies in health-promoting dialogues--primary healthcare nurses' perspectives--a qualitative study.
abstract: OBJECTIVE
  The aim of this study was to describe dialogic strategies about health and lifestyle used by primary healthcare nurses (PHNs) in the Västerbotten Intervention Programme (VIP) in Sweden.
  
  
  BACKGROUND
  The VIP offers all citizens aged 40, 50 and 60 in Västerbotten County an individual health check-up followed by a health-promoting dialogue with a specialist PHN. Inconsistencies in previous reports of the effects of lifestyle counselling and health promotion suggest that it is important to study dialogues about health and lifestyle to understand health-promoting strategies and to highlight aspects important to improving their effects.
  
  
  METHODS
  In 2010, we conducted in-depth interviews with ten experienced PHNs working with the VIP at eight healthcare centres in Västerbotten County, Sweden. Qualitative content analysis was used to illuminate the nurses' strategies in health-promoting dialogues. The Regional Ethics Board (Dno 06-126M) approved the study.
  
  
  RESULTS
  The PHNs used various strategies in dialogues about health and lifestyle that fell under the five themes 'Guiding patients vs. pressuring them; Adjusting to patients vs. directing the conversation; Inspiring confidence vs. instilling fear; Motivating and supporting patients vs. demanding responsibility; and lastly, Introducing emotionally charged subjects or avoiding them'.
  
  
  CONCLUSIONS
  The results of this study may add knowledge about the difficulties and opportunities in health counselling. In the discussion, we suggest professional reflection as a means to increase knowledge and awareness about the self and context in the process of health counselling.
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Hörnsten
authors.forename: Karin
authors.initials: K
authors.lastname: Lindahl
authors.forename: Kristina
authors.initials: K
authors.lastname: Persson
authors.forename: Kristina
authors.initials: K
authors.lastname: Edvardsson
mesh_terms: D006293:Health Promotion / Q000458:organization & administration*; D009723:Nurse-Patient Relations; D009740:Nursing Staff; D011320:Primary Health Care; D036301:Qualitative Research; D000078329:Workforce
keywords: health promotion; lifestyle counselling; nurse-centred; patient-centred; primary health care; qualitative content analysis; strategies