Dynamics of Lifestyle Counseling for Chronic Diseases Within and Between General Practices and Social Work Services Causal Loop Diagram and Points for Improvement.

BACKGROUND: A healthy lifestyle can slow the progression of chronic conditions and improve quality of life. Lifestyle counseling in Dutch general practices can be further optimized, among other factors by improving collaboration with social work services. To achieve this, it is important to map out the system of lifestyle counseling within and between general practices and social work services, as well as to identify opportunities for improvement. METHODS: Semi-structured individual interviews were conducted with 3 general practitioners (GPs) and 6 practice nurses (PNs), as well as 5 group interviews with in total 15 professionals from social work services. Participants were based in the city of Nijmegen, the Netherlands. The interviews were conducted between March and August 2024. A thematic analysis was performed which resulted in themes and subthemes. Hereafter, the interviews were re-read to examine relationships between subthemes. The themes, subthemes, and relationships formed the basis for developing a causal loop diagram (CLD) and identifying areas for improvement. The CLD was subsequently reviewed through a member check with the same professions. RESULTS: The system of lifestyle counseling within and between general practices and social work services consists of the following main themes; addressing lifestyle within general practices, referral to social work services from general practices, GP/PNs' overview and knowledge about social work services, contact between GP/PNs and social work services, and patient status exchange between GP/PNs and social work services. These main themes include interrelated variables which facilitate or impede referrals from general practices to social work services, which is illustrated by the CLD. For example, the more patient status information is shared, the better the GP/PNs' understanding of the available social work services. CONCLUSION: The CLD illustrates multiple factors that influence the system of lifestyle counseling in and between general practices and social work services. The CLD, together with the improvement points identified in the interviews, leads to actionable strategies to enhance collaboration between general practices and social work services. These strategies include increasing GP/PNs' understanding of the role and activities of social work services, exchange information, as well as strengthening mutual familiarity and facilitating personal contact between professionals in both domains.