Promoting and inhibiting factors influencing general practitioners’ referral of overweight patients to combined lifestyle interventions. A qualitative study in Dutch primary healthcare
Bente van Aken, Geerke Duijzer, Ellen J.I. van Dongen, Gerrit Jan Hiddink, Annemien Haveman-NiesAbstract
Aim:
To investigate the barriers and facilitators experienced by general practitioners (GPs) as primary referrers of patients to combined lifestyle interventions (CLIs).
Background:
In the Netherlands, evidence-based CLIs are implemented as a possible strategy to tackle overweight and obesity, with GPs authorized as the primary referrer. However, certain target groups are underrepresented in CLI participation and dropout remains a challenge, highlighting the opportunity to strengthen referral practices. Insight into factors influencing GP referral is needed to improve implementation of CLIs.
Methods:
This qualitative study was conducted within general practices in Dutch primary healthcare, using semi-structured interviews. Interviews were conducted with GPs ( n = 16) who had at least one year of experience with referral to CLIs. The interview guide and analyses were guided by the COM-B model and the Theoretical Domains Framework. Interviews were audio recorded and transcribed verbatim. A reflexive thematic analysis was performed by two independent coders, combining deductive and inductive coding.
Findings:
Three referral behaviours to CLIs were identified: 1) extensive, 2) critical, and 3) limited. GPs’ referral behaviour to CLIs was influenced by an interaction between their capability, opportunity, and motivation to refer. Perceived facilitators were GPs’ awareness and knowledge of CLIs, beliefs about effectiveness, beliefs about capabilities, and ease of use of referral systems. Perceived barriers were GPs’ doubts about effectiveness, habits, role identity, lack of knowledge, limited collaboration and communication with CLI providers, and unmotivated patients. These insights may optimize referral and thereby intervention reach and equitable access to CLIs, with potential public health benefits.