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Table 2 Themes and illustrative quotes

From: Integration of chronic disease prevention and management services into primary care (PR1MaC): findings from an embedded qualitative study

Theme Illustrative quotes numbered
Positive effects of the intervention
Awareness 1 It got to me. (Patient #1, transcript #8, focus group)
2 It made me realize that eating well is important. (Patient #1, transcript #7, focus group)
3 Before, I would grab fries automatically. (Patient #1, transcript #5, focus group)
4 The program has turned yellow traffic lights on in the heads of people and prompted them to react. (PR1MaC Nutritionist, transcript #5, individual interview)
5 There was a patient, his children were overweight. We could see him becoming aware. He said: The kitchen pantry, we’re gonna change it. He was really changing their diet, decreased cookie consumption, juice… we could really see the differences. (PR1MaC Nutritionist, transcript #4, individual interview)
Improved motivation and empowerment 6 They gave me back control over my life, it’s not complicated, I’m the boss so I decide. So what comes in [food], I decide. (Patient 3, transcript #9, focus group)
7 We were aware, we were already careful about food. We worked out a lot. Yes, it didn’t change our health behaviour; our health behaviours were already good. It just reinforced them a bit. (Family member 1, focus group #2)
Improved knowledge 8 For me, it helped. Portions. They also taught me what went with what, I really liked that. Then a kinesiologist, it was the first time I met one. She told me how to do my exercises. (Patient 2, focus group #1)
9 The patient came in with her suitcase full of recipe books. Actually, she needed support. So I took the books one by one. No, that one you can put aside. This one is good. She completely changed her dietary habits after that. (PR1MaC nutritionist #2)
10 There were things that I knew, but when my doctor told me I had asthma: take this inhaler, this way, but that was it. While with the respiratory therapist, I received plenty of tips, good support, answers to my questions. (Patient 3, focus group #1)
Adoption of healthy lifestyle habits 11 It’s not obvious to stop eating salt, cheese, butter. I didn’t know about nutritionists. My encounters with her were worth it. She really helped me make a plan and a menu that wasn’t complicated. I had to put something into it too. At the end of three months, I could see lots of improvement. (Patient 2, focus group #5)
12 It wasn’t the exercise side for him. We already have a regular exercises routine. It’s really on the nutrition side to try and control... stabilise his cholesterol. So it helped. We learned a lot. How much salt, maximum, you need in a day. We write down our menus and we look at them closely. Oh no! Too much fat, let’s try something else. We added fruit instead of having a second serving or a bigger plate. (Family member 1, focus group #6)
13 Yes, change is huge, instead of staying put and watching TV, we do activities. That is the big difference, that’s life. (Family member, interview #7)
14 I told the nurse that I had never made any effort for that. I don’t want a diet or to meet a nutritionist. So she told me. Let’s make a deal. I said yes. Then, I started walking stairs. But I was gaining weight. Yet, often, I would just have supper. Then she said, yes, but you eat poorly. If you could eat breakfast, lunch and dinner, you’ll lose all the weight. I didn’t believe her. Then I lost 30 pounds in three months. (Patient 1, focus group #1)
Improvement in health status 15 In general it was successful; either an improvement in their cholesterol levels or an improvement in their diabetes or weight loss, depending on what we were working on. (PR1MaC nutritionist, interview #6)
16 I lost 40 pounds since September. It was really beneficial for me. The operation, forget that. They can call, but I won’t go. (Patient 1, focus group #4).
Improvement in quality of life 17 I continue to exercise. I don’t even run my errands by car, to go pay for my phone, I walk. For me this year, it passed free. It’s funny, no cold to this day, I am happy with that. (Patient 3, focus group #5)
18 I saw it, maybe at the second follow-up, the patient had changed. And I’m sure that even physically he had improved self-esteem. And I could feel it… the man would come to his encounters happy and proud of himself. (PR1MaC Nutritionist, interview #3)
Effects on family members 19 We saw young patients that lived with their parents, who brought documents back home. They showed them. It was the mother who cooked; she took that in hand so her child could eat better, but indirectly she makes everyone eat well. There were spouses too who engaged in that, so good support with their husband or wife, whatever. So it was a family investment. (PR1MaC Nurse, interview #4)
20 We thought we were good because he had lost 40 pounds, I lost 13. And I didn’t exercise like he did. (Family member 2, focus group #2)
Negative effects of the intervention
  21 I’m quite happy; I was successful in changing their dietary habits. For sure I would have liked to do a longer follow-up with them. Yes, it’s good, at the beginning we are motivated but after, what happens after three, 4 months. I think that when we are let loose all alone in nature, it’s not as easy, especially when vacations come up. So I think a longer follow-up is necessary. (PR1MaC Nutritionist, interview #1)
22 I thought it was a nice approach. But at some point, it’s over. But then, you know, I need a bit more, you know, motivation. (Patient 3, focus group #4)
23 Yes, yes, that’s what’s missing, follow-up [long term]. (Patient 3, focus group #4)
24 I started at 185, went up to 195 pounds. Oh, is there a problem? I’m on the PR1MaC diet and I just gained 10–15 pounds. Then I gained even more, I reached 22 pounds. There’s a problem, I am going to stop that diet, it’s urgent now. (Patient 3, focus group #3)
25 Well, he gave up. He didn’t come [to the encounter] because he gained weight. He wasn’t OK with that. I’m sure. I said, you should go; he said no. But I’m sure that he didn’t come because he had gained weight. (Family member 2, focus group #2)
26 It’s about motivation, well there are things that we don’t know, and there are things I would like to learn with the nutritionist. I find that I’m not losing weight anymore and that irritates me. (Patient 3, focus group #4)
27 We have lots of good results. But certain people we did not engage, we would see them in follow-ups and nothing had changed. It didn’t have any impact on their life. (PR1MaC nurse, interview #4)
28 We don’t pay enough attention to food. The mother in law cooks traditional foods, she makes dinner. She is used to using a lot of salt, pepper and butter. She’s 85 years old. I told her many times that it’s too salty… but at 85 years old, you won’t change her habits. But when I cook, I am careful with salt. (Patient 2, focus group #9)
29 And some others say… well in this case, she [spouse] doesn’t want to have anything to do with it and he makes his own food and she makes her own food. (PR1MaC nurse, interview #4)