Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study

• Published in: PloS one 2024-06, Vol.19 (6), p.e0304053
• Main Authors: Te Loo, Leonie M, Holla, Jasmijn F M, Vrijsen, Joyce, Driessen, Anouk, van Dijk, Marlinde L, Linders, Lilian, van den Akker-Scheek, Inge, Bouma, Adrie, Schans, Leah, Schouten, Linda, Rijnbeek, Patrick, Dekker, Rienk, de Bruijne, Martine, van der Ploeg, Hidde P, van Mechelen, Willem, Jelsma, Judith G M
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Biology and Life Sciences; Collaboration; Community health services; Content analysis; Cooperation; Diet; Exercise; Female; Health aspects; Health behavior; Health care policy; Health Personnel; Hospitals; Humans; Interviews; Life Style; Lifestyles; Male; Management; Medical personnel; Medical referral; Medical referrals; Medicine and Health Sciences; Methods; Middle Aged; Patients; People and places; Qualitative Research; Referral and Consultation; Rehabilitation; Social Sciences; Transitional care; Workflow
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0304053

A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers. We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC). Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow. In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.