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Table 2 Factors influencing the implementation of MHBC interventions for CVD risk reduction

From: Implementing multiple health behaviour change interventions for cardiovascular risk reduction in primary care: a qualitative study

Themes Sub-themes Theoretical domain (TDF) Illustrative quote
Conceptualising health behaviour change Complexity of health behaviour change • Beliefs about patients’ capabilities to change their behaviour.
• Perceived patients’ environmental context and resources.
“It’s taking us a lifetime to form our behaviours, but they’re expecting us to change overnight. It’s not easy. So we know that changing these behaviours is not easy.” (Interview 15, Manager)
What is a “healthy behaviour”? • Patients’ and HCP’s knowledge of health behaviour.
• HCP’s emotion towards behaviour change and health behaviour.
“There’s a lot of different conflicting information, even for us in terms of the evidence, it’s still very – so I have to say to my patients, “This is the best I can tell you at the moment, that’s the best information I have.” Will it change? Yes, well it may change. But, you know, we are not saying these are absolute absolutes. This is what we know for the moment.”” (Interview 23, GP)
Health as a priority • Perceived patients’ goals to change behaviour.
• Perceived patients’ intention to change behaviour.
“So I would kind of usually very much always approach it by kind of where he is at in terms of his attitude to his health and what he feels, you know, he needs to adapt before I even say to him, “Look, here are your figures,” and take him through the meaning or the implications of them. So getting an idea of, of what his understanding is about his health and what concerns he has, to then build on them.” (Interview 20, GP)
Delivering MHBC interventions in primary care Beliefs about the intervention consequences • Beliefs about the consequences of implementing behaviour change interventions.
• HCPs emotions towards implementing behaviour change interventions.
• Reinforcement to implement behaviour change interventions.
“But I think generally the impression I get is the only thing I could tell you is that it’s a waste of time…But yes, generally felt that the brief intervention that you get, what’s the point?” (Interview 29, GP)
Multiple health behaviour change intervention • Environmental context and resources that discourages or encourages the implementation of MHBC interventions.
• Skills needed to implement MHBC intervention.
• Goals.
“I think you can’t obviously deal with everything at once... it would be up to the patient to decide what it is they would like to deal with in the first instance.” (Interview 1, Manager)
Who should implement health behaviour change interventions? • Social/professional role and identity.
• Social influences.
• Skills.
“And I think, I think probably [HCA] because she does more of the health promotion, but she probably has learnt more ways of kind of motivating people and, and has a different relationship with them. So tends to find out a bit about them personally and their family and things. (Interview 24, GP)
Skills to implement health behaviour change interventions • HCPs perceived knowledge about MHBC interventions.
• Skills needed to implement MHBC interventions.
• HCP’s beliefs about their capabilities to implement MHBC interventions.
“In terms of dietary requirements.... yes, it would be nice to just be more specific. Yes. I think, including me, we need more education on dietary advice, for sure.” (Interview 5, HCA)
Delivering the health check programme The NHSHC programme consists of several steps • Environmental context and resources.
• Skills needed to implement the health check.
• Patients perceived knowledge.
• Beliefs about capabilities.
“Time is always a major factor. Unfortunately, the GP-land, or practice nursing, as a rule, you’re dealing with everything.” (Interview 6, Nurse)
“You can’t give somebody advice if you’re not sure what you’re talking about.” (Interview 14, HCA)
The health check population • Behavioural regulation.
• Patients’ views of the programme social influences.
• Knowledge.
‘But I don’t think that the health check scheme works, because I think it’s targeting the wrong population and it’s, it just - as I said, I think it’s best done opportunistically when we see patients alongside other health issues, which might be more relevant even.’ (Interview 8, GP)
  1. TDF Theoretical Domains Framework, NHSHC NHS Health Check, GP general practitioner, HCA healthcare assistant