Schalkwijk Annemarie A H, Nijpels Giel, Bot Sandra D M, Elders Petra J M
Department of General Practice and Elderly Care and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
BMC Health Serv Res. 2016 Mar 8;16:83. doi: 10.1186/s12913-016-1324-7.
In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard.
A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'.
Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural funding; task rearrangements; a central care coordinator and structural information feedback from the health care providers involved.
The integrated health care standard stipulate that the care of overweight or obese children be provided using an integrated approach. The barriers and needs identified in this study can be used to define strategies to improve the implementation of the integrated health care standard pertaining to overweight and obese children in the Netherlands.
2010年，荷兰发布并传播了一项（儿童）肥胖症国家综合医疗保健标准。本研究的目的是深入了解医疗保健提供者的需求以及他们在实施该综合医疗保健标准方面所面临的障碍。
采用混合方法，包括焦点小组、半结构化面对面访谈以及基于电子邮件的网络调查。研究参与者包括：全科医生（焦点小组）；不同专业的医疗保健提供者（面对面访谈）以及医疗保健提供者，包括全科医生、青少年保健工作者、儿科医生、营养师、心理学家和物理治疗师（调查）。首先，对焦点小组的记录进行主题分析。然后，将在此过程中确定的主题用于分析访谈。定性数据分析的结果用于构建基于电子邮件的网络调查中使用的陈述。对各项的回答采用5点李克特量表进行衡量，并分为三种结果：“同意”或“重要”（回答类别1和2）、“不同意”或“不重要”。
受邀的27名全科医生（51%）参加了四个焦点小组。受邀的九名医疗保健专业人员中有七名（78%）参加了访谈，222份问卷（17%）被收回并纳入分析。在实施综合医疗保健标准方面确定了以下关键障碍：不愿提及该话题；认为家长缺乏动力和知识；以前在生活方式项目方面的负面经历；资金限制以及缺乏结构化的多学科方法。确定的主要需求包括：医疗保健提供者以及家长/儿童方面知识和意识的提高；有效干预的社会地图；结构性资金；任务重新安排；一名中央护理协调员以及来自相关医疗保健提供者的结构性信息反馈。
综合医疗保健标准规定，应采用综合方法为超重或肥胖儿童提供护理。本研究中确定的障碍和需求可用于确定战略，以改进荷兰超重和肥胖儿童综合医疗保健标准的实施。
