Core elements of the Positive Health dialogue during patient consultations: a qualitative study exploring expert and user opinions in the Netherlands

Objectives: The Alternative Dialogue (PHD), a dialogue technique which is based on Positive Health, is considered a potential method to improve patient-centred care within the Netherlands. This study aims to provide clarity on the core elements of the PHD and aims to assess to what extent the practical application of the PHD aligns with these core elements. Design: An exploratory qualitative study using semi-structured interviews. Setting: The study was conducted among health professionals working in primary and secondary care in the Netherlands. Participants: Thirteen experts were purposely sampled and included based on their involvement in the development, implementation or research of the PHD. Additionally, seven users, who applied the PHD in patient consultations and worked as a primary or secondary health professional participated, both self-selected and purposively sampled. They were included if they participated in a Positive Health training. Results: The analysis revealed consensus among experts and users about prioritizing the patient's perspective, adopting a holistic health view, and promoting self-management and empowerment as main guiding principles. Consensus was also found regarding professional attitude, goals and outcomes and implementation conditions. Variability was observed in the role of behaviour change support as a guiding principle. Further, the PHD as intended by its developers seems more structured and comprehensive than often applied in practice. Discrepancies also emerged regarding target patient groups and applicable settings, highlighting the need for customization and tailored guidance within diverse contexts. Conclusions: While there is alignment on the main guiding principles of PHD, there are varying opinions regarding its specific tools and techniques. Clarity in terminology and delineation of the PHD, along with customization for diverse contexts, is crucial to address these challenges and to determine its effectiveness. This study provides initial insights to inform future research and practice in PHD implementation.