Matching implementation strategies to barriers and facilitators for a lifestyle front office in the hospital: a qualitative study.

Background: In Dutch hospitals, advice on healthy lifestyle during consultation with healthcare professionals is hindered by limited time, insufficient skills and limited knowledge on referral options. In order to organize a new care pathway in which care related to healthy lifestyle is provided through a dedicated lifestyle front office (LFO) in the hospital, implementation barriers and facilitators were identified and matched to tailored implementation strategies.

Methods: Semi-structured interviews were held between March and August 2021 with healthcare professionals (i.e. specialists, physician assistants, dieticians, physiotherapist, (specialized) nurses) from different clinical departments (n = 33), and with patients (n = 27) diagnosed with a non-communicable disease (NCD) that were treated in out-patient clinics of the hospital and had a body mass index of 25 ≥ kg/m² and/or were current smokers. An inductive thematic analysis was conducted to identify barriers and facilitators for implementation. Barriers were matched to implementation strategies with the CFIR-ERIC Implementation Strategy Matching Tool and further operationalized for use in practice.

Results: Barriers and facilitators were clustered according to different organizational stages of the identified care pathway. Referral to LFO includes six topics: healthcare professionals' beliefs about lifestyle; patient motivation for lifestyle change; referral skills and knowledge of healthcare professionals; digital resource support for referral; feedback after referral; and responsibility for referral. Appointment at LFO was affected by six topics: financial burden of the additional visit; time, skills and knowledge of lifestyle broker; physical location of LFO; efficiency in care planning; fragmentation; and prevention as task of the general practitioner. Regarding referral to community-based lifestyle initiatives four barriers were identified: financial burden of community-based lifestyle initiative; geographical availability; quality assurance of community-based lifestyle initiatives; and collaboration. Implementation strategies included building an infrastructure, creating a learning collaborative, preparing a referral tool, identifying local champions, informing stakeholders, conducting training, building a coalition, collecting testimonials and accessing new funding.

Conclusions: Insights from the current qualitative study were based on a large and diverse stakeholder group and provided important insights for the implementation of an LFO in the hospital. Future research should provide information on effectiveness of actual implementation of the implementation strategies in an LFO in the hospital.