Promoting behaviour change in patients with coronary heart disease: A consensus study in two countries with different healthcare systems

Background: Secondary prevention is an effective strategy for reducing coronary heart disease morbidity and mortality. Secondary prevention in primary care has been shown to be suboptimal. Evidence on approaches to behaviour change, suitable for implementation in primary care, is needed. Objective: To identify approaches to behaviour change in patients with coronary heart disease that are relevant to primary care and compare the views of health professionals in two different healthcare systems (United Kingdom and the Republic of Ireland). Methods: Two nominal groups were conducted in Northeast Scotland and the West of Ireland with expert panels representing core and extended primary care teams. Participants were asked to generate ideas, rank them, and then discuss areas of disagreement before a second round of ranking. Results: In both groups, there was good consensus on items relating to individual patient assessment (including motivation and understanding), addressing the practitioner's willingness to change, using established principles of behaviour change, and having adequate resources, staff and time. Priorities were, however, different. Emphasis on items relating to resources, staff and organisation was particularly strong in the Irish group; there was more emphasis on approaches to behaviour change in the Scottish group. Conclusions: When attempting to promote behaviour change and secondary prevention, there are different priorities in different healthcare systems. These should be taken into account in the design of any intervention.