scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2019 ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
Health Behavior ◽  
Population Based ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Motivation To Change ◽  
Structured Interviews ◽  
Health Politics ◽  
The Social ◽  
Change Health Behavior

Abstract Background While treatment plays an important role in general practice, primary and secondary prevention of so-called health behavior diseases has become an urgent issue of health politics as well as an important task in general practice. Through an analytical lens of ‘motivational work’, we explore how preventive health dialogues unfold in Danish general practices, with the purpose of understanding the social interactions and temporal complexities embedded in preventive health dialogues. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues and 18 semi-structured interviews with patients and general practitioners. The TOF pilot study in 2016 made it possible to explore preventive health dialogues between GPs and patients in general practice. The intervention addressed early detection and prevention in general practice through an approach of population-based risk stratification. Results We found that both GPs and patients—in an interplay—affected motivational work in the health dialogues to occur as one-way communication characterized by biomedically based guidance, information, suggestions, and advice on risk factors. Our findings illustrate a tendency among GPs to do motivational work without facilitating dialogue, concerning neither the underlying social causes of the behavior nor the patients’ possibilities to change their health behavior. We furthermore found that patients took part in reproducing the biomedical and treatment-oriented focus in the clinical encounter. Patients’ perspectives and expectations with regard to the structure and content of the health dialogues influenced whether and how GPs sought to promote and awaken patients’ motivation to change health behavior. Conclusion Overall, our findings point to a discrepancy between a biomedical action perspective and the temporality of prevention, with the former lessening the dialogue and interaction between GP and patient.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center.Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients.Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between GP and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues.Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Guidance Information ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center.Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients.Results We found that the health dialogues occurred as one-way communication characterized by biomedically based guidance, information, suggestions, and advice on risk factors passed on from the general practitioner to the patient. Further, contextual factors relating to the intervention framework, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues.Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background: The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center.Methods: The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients.Results: While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between GP and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues.Conclusion: The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

'…but I just prefer to treat everyone the same…': general practice receptionists talking about health inequities

2019 ◽  
Vol 25 (5) ◽  
pp. 430
Author(s):  
Rowan Manhire-Heath ◽  
Donna Cormack ◽  
Emma Wyeth
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Social Constructionism ◽  
Health Inequities ◽  
Cultural Safety ◽  
Limited Data ◽  
Structured Interviews ◽  
Health Determinant ◽  
The Social ◽  
Patient’S Experience

General practice receptionists are positioned at the beginning of a patient’s journey within the healthcare system, yet their influence on a patient’s experience is unknown. The limited data on, and research involving, general practice receptionists both in New Zealand and internationally is evidence of this. This research undertook an exploration of the discourses used by a group of general practice receptionists in Wellington, New Zealand to discover how they talk about, and represent, health inequities. Eight in-depth semi-structured interviews were conducted, guided by Social Constructionism and Decolonising Theory. Three reoccurring patterns of discourse were identified: discourses about the social determinants of health; discourses about Māori culture and behaviour; and discourses about egalitarianism. Further, narratives that could be seen as deficit-focussed or victim-blaming were identified. Racism was not directly discussed by participants as a health determinant. The findings support the need for training guided by cultural safety and anti-racism principles to be available for all general practice receptionists.

“We Speak the Truth!”

2019 ◽  
Vol 12 (2) ◽  
pp. 53-80
Author(s):  
Sari Hanafi
Keyword(s):  
Social Sciences ◽  
Content Analysis ◽  
Social Science ◽  
The Political ◽  
Structured Interviews ◽  
Social Phenomena ◽  
The Social ◽  
Academic Qualifications

This study investigates the preachers and their Friday sermons in Lebanon, raising the following questions: What are the profiles of preachers in Lebanon and their academic qualifications? What are the topics evoked in their sermons? In instances where they diagnosis and analyze the political and the social, what kind of arguments are used to persuade their audiences? What kind of contact do they have with the social sciences? It draws on forty-two semi-structured interviews with preachers and content analysis of 210 preachers’ Friday sermons, all conducted between 2012 and 2015 among Sunni and Shia mosques. Drawing from Max Weber’s typology, the analysis of Friday sermons shows that most of the preachers represent both the saint and the traditional, but rarely the scholar. While they are dealing extensively with political and social phenomena, rarely do they have knowledge of social science

WORK-BASED LEARNING IN HIGHER EDUCATION: EXPERIENCE AND CHALLENGES OF LEARNERS, WORKPLACES AND INSTITUTIONS OF HIGHER EDUCATION

2020 ◽  
Author(s):  
Anne Roosipõld ◽  
Krista Loogma ◽  
Mare Kurvits ◽  
Kristina Murtazin
Keyword(s):  
Higher Education ◽  
University Education ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Constructivist Learning Theory ◽  
Education Experience ◽  
Restaurant Management ◽  
The Social ◽  
The University ◽  
Social Constructivist Learning

In recent years, providing higher education in the form of work-based learning has become more important in the higher education (HE) policy and practice almost in all EU countries. Work-based learning (WBL) in HE should support the development of competences of self-guided learners and adjust the university education better to the needs of the workplace. The study is based on two pilot projects of WBL in HE in Estonia: Tourism and Restaurant Management professional HE programme and the master’s programme in Business Information Technology. The model of integrative pedagogy, based on the social-constructivist learning theory, is taken as a theoretical foundation for the study. A qualitative study based on semi-structured interviews with the target groups. The data analysis used a horizontal analysis to find cross-cutting themes and identify patterns of actions and connections. It appears, that the challenge for HE is to create better cooperation among stakeholders; the challenge for workplaces is connected with better involvement of students; the challenge for students is to take more initiative and responsibility in communication with workplaces.

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

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