title: Beyond the consultation room: Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers.
abstract: Primary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities.
  
  
  
  To identify proposals to approach HP in the context of primary care according to health-care users aged 45-75 years, key community informants and primary care centre (PCC) workers.
  
  
  
  Descriptive-interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out.
  
  
  
  Participants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person-centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness.
  
  
  
  According to a socio-ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|Universitat Autònoma de Barcelona, Bellaterra, Spain.
authors.forename: Anna
authors.identifier: 0000-0002-0889-2002
authors.initials: A
authors.lastname: Berenguera
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|Universitat Autònoma de Barcelona, Bellaterra, Spain.|Universitat de Girona, Girona, Spain.
authors.forename: Mariona
authors.initials: M
authors.lastname: Pons-Vigués
authors.affiliation: Instituto de Investigación Biomédica de Málaga (IBIMA), Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moreno-Peral
authors.affiliation: Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.|Instituto de Investigación Sanitaria de Palma, Palma, Spain.
authors.forename: Sebastià
authors.initials: S
authors.lastname: March
authors.affiliation: Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.|Instituto de Investigación Sanitaria de Palma, Palma, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Ripoll
authors.affiliation: Research and Development Unit, Fundació Sant Joan de Déu, Barcelona, Spain.|School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Rubio-Valera
authors.affiliation: Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Palma de Mallorca, Spain.
authors.forename: Haizea
authors.initials: H
authors.lastname: Pombo-Ramos
authors.affiliation: Aragon Institute for Health Research (IIS Aragon), Aragón, Spain.|Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: Asensio-Martínez
authors.affiliation: Consultora, especialista en investigación cualitativa y salud, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Bolaños-Gallardo
authors.affiliation: Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Palma de Mallorca, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Martínez-Carazo
authors.affiliation: Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, REDIAPP, IBSAL, Salamanca, Spain.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Maderuelo-Fernández
authors.affiliation: Social and Health Care Research Center, University of Castilla-La Mancha, Castilla-la-Mancha, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Martínez-Andrés
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|Universitat Autònoma de Barcelona, Bellaterra, Spain.|Universitat de Girona, Girona, Spain.
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Pujol-Ribera
mesh_terms: D000368:Aged; D003153:Community Health Services / Q000458:organization & administration; D003159:Community-Institutional Relations; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012931:Social Environment; D013030:Spain
keywords: health promotion; lifestyle; primary health care; primary prevention; qualitative research