چکیده (انگلیسی):

Background:The global epidemic of non-communicable disease (NCDs) has been linked with four modifiable risky
lifestyle behaviours, namely smoking, unhealthy diet, physical inactivity and alcohol abuse. Primary care providers
(PCPs) can play an important role in changing patient’s risky behaviours. It is recommended that PCPs provide
individual brief behaviour change counselling (BBCC) as part of everyday primary care. This study is part of a
larger project that re-designed the current training for PCPs in South Africa, to offer a standardized approach to BBCC
based on the 5 As and a guiding style. This article reports on a qualitative sub-study, which explored whether
the training intervention changed PCPs perception of their confidence in their ability to offer BBCC, whether
they believed that the new approach could overcome the barriers to implementation in clinical practice and
be sustained, and their recommendations on future training and integration of BBCC into curricula and clinical practice.
Methods:This was a qualitative study that used verbal feedback from participants at the beginning and end of
the training course, and twelve individual in-depth interviews with participants once they had returned to their
clinical practice.
Results:Although PCP’s confidence in their ability to counselling improved, and some thought that time
constraints could be overcome, they still reported that understaffing, lack of support from within the facility
and poor continuity of care were barriers to counselling. However, the current organisational culture was not
congruent with the patient-centred guiding style of BBCC. Training should be incorporated into undergraduate
curricula of PCPs for both nurses and doctors, to ensure that counselling skills are embedded from the start. Existing
PCPs should be offered training as part of continued professional development programmes.
Conclusions:This study showed that although training changed PCPs perception of their ability to offer BBCC, and
increased their confidence to overcome certain barriers to implementation, significant barriers remained. It is clear that
to incorporate BBCC into everyday care, not only training, but also a whole systems approach is needed, that involves
the patient, provider, and service organisation at different levels