Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa
Open accessAbstract
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.
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All studies reported improvements in knowledge and adoption of BIs.
“All studies reported improvements in knowledge and adoption of BIs [109–112].”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [110]
The Results (no page supplied) report that providers changed their understanding of counselling and described changes in their counselling style after training. The Conclusion (no page supplied) says significant barriers to implementation remained. This supports changes in learning and some use of brief counselling, but not an unqualified improvement in its adoption; this paper also cannot establish what all the other cited studies reported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn all studies, participants reported that the training was useful and improved their capacity to offer SBI.
“In all studies, the participants reported that the training was useful and improved their capacity to offer SBI [41,42,110].”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [110]
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- Authors
- Malan, Z., Mash, R., & Everett-Murphy, K.
- Affiliations
- Stellenbosch University (ZA)
- Corresponding author
- Malan, Zelra
- Venue
- BMC Family Practice
- Published
- 2015-08-19
- Volume
- 16
- Issue
- 1
- Pages
- 101-101
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC4545565
- OpenAlex
- W2151460121
- Cited by
- 27
- References
- 29
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 5 · 2021: 1 · 2020: 2 · 2019: 5 · 2018: 2 · 2017: 1
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- SUNScholar (Stellenbosch University) (submittedVersion)
- Funders
- Cancer Association of South Africa
- Universiteit Stellenbosch
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- non-communicable diseases, primary care providers, provider training, provider confidence, implementation barriers, organizational culture, continuity of care, understaffing, patient-centered care, health professions education, South Africa
- MeSH terms
- Attitude of Health Personnel, Clinical Competence, Education, Medical, Continuing, Education, Nursing, Continuing, Health Promotion, Humans, Interviews as Topic, Life Style, Primary Health Care, Risk Factors, Risk-Taking, South Africa, Program Evaluation, Health Behavior, Qualitative Research, Directive Counseling
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