title: Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative.
abstract: BACKGROUND
  Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care.
  
  
  METHODS
  A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively.
  
  
  RESULTS
  Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis.
  
  
  METHODS
  all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff.
  
  
  CONCLUSIONS
  Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. kristin.thomas@liu.se.
authors.forename: Kristin
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. barbro.krevers@liu.se.
authors.forename: Barbro
authors.initials: B
authors.lastname: Krevers
authors.affiliation: Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden. preben.bendtsen@liu.se.
authors.forename: Preben
authors.initials: P
authors.lastname: Bendtsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009746:Nursing, Team / Q000379:methods* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult