Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa.
BACKGROUND
The global epidemic of non-communicable disease (NCDs) has been linked with four modifiable risky lifestyle behaviours, namely smoking, unhealthy diet, physical inactivity and alcohol abuse. Primary care providers (PCPs) can play an important role in changing patient's risky behaviours. It is recommended that PCPs provide individual brief behaviour change counselling (BBCC) as part of everyday primary care. This study is part of a larger project that re-designed the current training for PCPs in South Africa, to offer a standardized approach to BBCC based on the 5 As and a guiding style. This article reports on a qualitative sub-study, which explored whether the training intervention changed PCPs perception of their confidence in their ability to offer BBCC, whether they believed that the new approach could overcome the barriers to implementation in clinical practice and be sustained, and their recommendations on future training and integration of BBCC into curricula and clinical practice.


METHODS
This was a qualitative study that used verbal feedback from participants at the beginning and end of the training course, and twelve individual in-depth interviews with participants once they had returned to their clinical practice.


RESULTS
Although PCP's confidence in their ability to counselling improved, and some thought that time constraints could be overcome, they still reported that understaffing, lack of support from within the facility and poor continuity of care were barriers to counselling. However, the current organisational culture was not congruent with the patient-centred guiding style of BBCC. Training should be incorporated into undergraduate curricula of PCPs for both nurses and doctors, to ensure that counselling skills are embedded from the start. Existing PCPs should be offered training as part of continued professional development programmes.


CONCLUSIONS
This study showed that although training changed PCPs perception of their ability to offer BBCC, and increased their confidence to overcome certain barriers to implementation, significant barriers remained. It is clear that to incorporate BBCC into everyday care, not only training, but also a whole systems approach is needed, that involves the patient, provider, and service organisation at different levels.
Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa. zmalan@sun.ac.za.
Zelra
Z
Malan
Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa. rm@sun.ac.za.
Robert
R
Mash
Chronic Diseases Initiative in Africa (CDIA), Faculty of Health Sciences, University of Cape Town, P/Bag X 3, Observatory, Cape Town, 7935, South Africa. km.murphy@uct.ac.za.
Katherine
K
Everett-Murphy
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D037001:Directive Counseling / Q000379:methods*; D004502:Education, Medical, Continuing / Q000379:methods*; D004509:Education, Nursing, Continuing / Q000379:methods*; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D036301:Qualitative Research; D012307:Risk Factors; D012309:Risk-Taking; D013019:South Africa