Primary care patients' perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis.
BACKGROUND
Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities.


RESULTS
A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were considered thus limiting extrapolation to other contexts.


CONCLUSIONS
Several factors affect PP&HP. This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice.
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Unidad de Investigación del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
Patricia
P
Moreno-Peral
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Unidad de Investigación del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
Sonia
S
Conejo-Cerón
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Centre for Disability Research and Policy-Brain and Mind Research Institute, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
Ana
A
Fernández
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
Anna
A
Berenguera
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
María
M
Martínez-Andrés
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
Mariona
M
Pons-Vigués
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Departamento de Psicología, Sociología y Trabajo Social, Universidad Loyola Andalucía, Sevilla, Spain.
Emma
E
Motrico
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
Beatriz
B
Rodríguez-Martín
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Unidad de Investigación del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Centro de Salud El Palo, Málaga, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain.
Juan A
JA
Bellón
Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (RedIAPP), Barcelona, Spain; Research and Development Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
Maria
M
Rubio-Valera
D000884:Anthropology, Cultural; D004777:Environment; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007398:Interpersonal Relations; D011320:Primary Health Care; D011322:Primary Prevention