Identify potential barriers
Think about the potential barriers that may be encountered along the way and prepare your reaction to these barriers.
From the perspective of health care professionals, there are several challenges to learning more about physical activity and incorporating counseling into office visits, including:
- short duration of time during visit
- lack of organizational support
- lack of training for physicians, administrators and support staff
- limited availability of educational materials
- lack of information about local community resources (e.g., places, programs, and services)
- perceived lack of patient motivation to change their behavior
- the best content and frequency of information delivery is undetermined
- inconsistent or inadequate frequency of visits
- lack of external incentives or reinforcement (e.g., financial reimbursement, administrative support, licensing, accreditation)
- health care providers may not believe in self-management
- cultural differences between health care providers and patients or clients
- may be incomplete implementation of the intervention activities due to physician resistance or few incentives to change practices and behaviors.
- hesitation of physicians to deliver advice due to the inability to bill for services and maintain clinic productivity.
- may be uneconomical to educate health care providers one on one, and could better be done with groups of providers or students during their medical school years.
- physicians may not be willing to change their consultation pattern with patients.
- considerable financial and human resources are required to produce clinical practice guidelines and continuing medical education programs.
- providing nutrition training for medical students in clinical years can be difficult due to the numerous clinical sites in which they receive training.
- collaborative effort is the most important component in encouraging providers to truly commit to improved quality of care.
- time is an issue, with lack of time to provide multiple messages in a brief visit, especially in patients with other medical issues to address.
- many physicians work independently (with no one to mandate or reward change) and without computer support for data organization and reminders.
- unique problems associated with the delivery of care to individuals in long-term care facilities since the level of care provided to these patients has not been carefully evaluated.
- clinics, provider offices, hospitals and other health care facilities may not be ready or willing to engage in provider education.
- support staff and system is needed to ensure consistent delivery of advice and can be challenging in a health care setting due to time restrictions and staff turnover.
- some providers are not likely to change their own nutrition or physical activity behaviors.
- may be a history of insufficient record keeping to document incidences of counseling.
- nurses or health educators may not have the same perceived authority as a physician when it comes to providing education.
- Provider education interventions are often brief (few educational sessions) with little reinforcement over time.
From the perspective of the patients or clients receiving the provider education, challenges may include:
- lack of support from family and friends to follow provider’s recommendations
- inability to schedule time for doctor’s appointments
- lack of transportation to visits
- cost of visit with health care professional
- lack of health insurance
- distrust health care professionals
- language or cultural barriers
- generalizability of findings from the healthcare setting may be limited to individuals who have health insurance or those who receive regular care.
All of these factors should be considered and discussed as part of the provider education.