Integrating community-based health promotion programs and primary care: A mixed methods analysis of feasibility

Aaron L. Leppin, Karen Schaepe, Jason Egginton, Sara Dick, Megan Branda, Lori Christiansen, Nicole M. Burow, Charlene Gaw, Victor Manuel Montori

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Implementation of evidence-based programs (EBPs) for disease self-management and prevention is a policy priority. It is challenging to implement EBPs offered in community settings and to integrate them with healthcare. We sought to understand, categorize, and richly describe key challenges and opportunities related to integrating EBPs into routine primary care practice in the United States. Methods: As part of a parent, participatory action research project, we conducted a mixed methods evaluation guided by the PRECEDE implementation planning model in an 11-county region of Southeast Minnesota. Our community-partnered research team interviewed and surveyed 15 and 190 primary care clinicians and 15 and 88 non-clinician stakeholders, respectively. We coded interviews according to pre-defined PRECEDE factors and by participant type and searched for emerging themes. We then categorized survey items - before looking at participant responses - according to their ability to generate further evidence supporting the PRECEDE factors and emerging themes. We statistically summarized data within and across responder groups. When consistent, we merged these with qualitative insight. Results: The themes we found, "Two Systems, Two Worlds," "Not My Job," and "Seeing is Believing," highlighted the disparate nature of prescribed activities that different stakeholders do to contribute to health. For instance, primary care clinicians felt pressured to focus on activities of diagnosis and treatment and did not imagine ways in which EBPs could contribute to either. Quantitative analyses supported aspects of all three themes, highlighting clinicians' limited trust in community-placed activities, and the need for tailored education and system and policy-level changes to support their integration with primary care. Conclusions: Primary care and community-based programs exist in disconnected worlds. Without urgent and intentional efforts to bridge well-care and sick-care, interventions that support people's efforts to be and stay well in their communities will remain outside of - if not at odds with - healthcare.

Original languageEnglish (US)
Article number72
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
StatePublished - Jan 31 2018

Fingerprint

Health Promotion
Primary Health Care
Delivery of Health Care
Aptitude
Health Services Research
Self Care
Disease Management
Interviews
Education
Health
Research
Therapeutics

Keywords

  • CBPR
  • Chronic disease management
  • Chronic disease self-management program
  • Clinic-community linkages
  • Community-based participatory research
  • Evidence-based programs
  • Implementation
  • Mixed methods
  • Primary care

ASJC Scopus subject areas

  • Health Policy

Cite this

Integrating community-based health promotion programs and primary care : A mixed methods analysis of feasibility. / Leppin, Aaron L.; Schaepe, Karen; Egginton, Jason; Dick, Sara; Branda, Megan; Christiansen, Lori; Burow, Nicole M.; Gaw, Charlene; Montori, Victor Manuel.

In: BMC Health Services Research, Vol. 18, No. 1, 72, 31.01.2018.

Research output: Contribution to journalArticle

Leppin, Aaron L. ; Schaepe, Karen ; Egginton, Jason ; Dick, Sara ; Branda, Megan ; Christiansen, Lori ; Burow, Nicole M. ; Gaw, Charlene ; Montori, Victor Manuel. / Integrating community-based health promotion programs and primary care : A mixed methods analysis of feasibility. In: BMC Health Services Research. 2018 ; Vol. 18, No. 1.
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AU - Dick, Sara

AU - Branda, Megan

AU - Christiansen, Lori

AU - Burow, Nicole M.

AU - Gaw, Charlene

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AB - Background: Implementation of evidence-based programs (EBPs) for disease self-management and prevention is a policy priority. It is challenging to implement EBPs offered in community settings and to integrate them with healthcare. We sought to understand, categorize, and richly describe key challenges and opportunities related to integrating EBPs into routine primary care practice in the United States. Methods: As part of a parent, participatory action research project, we conducted a mixed methods evaluation guided by the PRECEDE implementation planning model in an 11-county region of Southeast Minnesota. Our community-partnered research team interviewed and surveyed 15 and 190 primary care clinicians and 15 and 88 non-clinician stakeholders, respectively. We coded interviews according to pre-defined PRECEDE factors and by participant type and searched for emerging themes. We then categorized survey items - before looking at participant responses - according to their ability to generate further evidence supporting the PRECEDE factors and emerging themes. We statistically summarized data within and across responder groups. When consistent, we merged these with qualitative insight. Results: The themes we found, "Two Systems, Two Worlds," "Not My Job," and "Seeing is Believing," highlighted the disparate nature of prescribed activities that different stakeholders do to contribute to health. For instance, primary care clinicians felt pressured to focus on activities of diagnosis and treatment and did not imagine ways in which EBPs could contribute to either. Quantitative analyses supported aspects of all three themes, highlighting clinicians' limited trust in community-placed activities, and the need for tailored education and system and policy-level changes to support their integration with primary care. Conclusions: Primary care and community-based programs exist in disconnected worlds. Without urgent and intentional efforts to bridge well-care and sick-care, interventions that support people's efforts to be and stay well in their communities will remain outside of - if not at odds with - healthcare.

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