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

Authors
  • Broholm-Jørgensen, Marie1
  • Langkilde, Siff Monrad2
  • Tjørnhøj-Thomsen, Tine1
  • Pedersen, Pia Vivian1
  • 1 University of Southern Denmark, Studiestræde 6, Copenhagen K, 1455, Denmark , Copenhagen K (Denmark)
  • 2 The Danish Centre for Urban Regeneration and Community Development, Hvidovre, Denmark , Hvidovre (Denmark)
Type
Published Article
Journal
BMC Family Practice
Publisher
BioMed Central
Publication Date
Sep 08, 2020
Volume
21
Issue
1
Identifiers
DOI: 10.1186/s12875-020-01249-z
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe 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.MethodsThe 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.ResultsWhile 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.ConclusionThe 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.

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