How younger adults with psychosocial problems experienced person-centered health consultations

摘要

Much attention is focused on the social determinants of health. Family medicine is challenged with a growing number of vulnerable persons with psychosocial or lifestyle related problems. The objective of this work was to explore how vulnerable younger adults experience person-centered preventive health consultations with their general practitioner. The design and setting for this work were a secondary qualitative analysis of a randomized controlled trial (RCT) in Danish general practices. Younger adults (20-45) were consecutively invited to answer a screening questionnaire about psychosocial and lifestyle-related problems when visiting general practice (28 general practitioners (GPs)) for ordinary consultations. The 30% most vulnerable persons were invited to participate in a randomized controlled study. Intervention participants (n = 209) received a structured 1- hour ‘health consultation’ with their general practitioner focusing on resources and self-chosen goals and a 20-min follow-up after 3 months; control participants (n = 255) received usual care. At 1 year, 180 participants answered a follow-up postal questionnaire, of whom 135 answered the open-ended question: “Do you think the health consultation was worthwhile?”. This question was analyzed using qualitative content analysis. Six themes were prevalent: ‘Meeting the doctor in a different way’, ‘Supporting dialogue’, ‘Food for thought’, ‘Feeling better’, ‘Opportunity for change’, and the health consultations were ‘Not worthwhile’. Offering vulnerable younger adults a structured, person-centered preventive health consultation strengthened the doctor-patient relationship, allowed patients to reflect on their life situation, enhanced their perceived ability to cope with their problems and their belief in and ability to initiate wanted changes, thereby enhancing self-efficacy.