'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.
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Cheryl
C
Hunter
Research Institute, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, Staffs, UK.
Carolyn A
CA
Chew-Graham
Department of Psychology, Manchester Metropolitan University, Manchester, UK.
Susanne
S
Langer
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Jessica
J
Drinkwater
Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
Alexandra
A
Stenhoff
Manchester Mental Health and Social Care Trust, Manchester, UK.|University of Manchester, Manchester, UK.
Elspeth A
EA
Guthrie
Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
Peter
P
Salmon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D019468:Disease Management; D004739:England; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research
behaviour change; chronic illness; health-care professional-patient interaction; primary health care