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Fam Pract. 2018 Jul 23;35(4):383-398. doi: 10.1093/fampra/cmx137.

Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review.

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Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden.
Julius Center for Health Sciences and Primary Care, University medical Center, Utrecht, The Netherlands.
Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
University Library, Karolinska Institutet, Stockholm, Sweden.
Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece.
Research Unit for General Practice, Institute of Public Health, University of Southern, Odense, Denmark.
Department of General Practice, Charles University, First Faculty of Medicine, Prague, Czech Republic.
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.


The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies.

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