How can “health” become an issue in the GP consultation?

Photo: Family practice Mortsiefer & Breer, Köln

Posted by: Ottomar Bahrs and Natalie Seuken

The ‘Positive Health’ concept (Huber et al., 2022) has gained recognition in the Netherlands, particularly in the primary care sector, and is spreading to other health and social care areas. The spider web graphic (“My positive health“) provides a method for self-assessment of subjective Health, encouraging those concerned – patients, citizens, relatives – to reflect on themselves and serving as a basis for a dialogue going beyond routine care (“alternative dialogue”). According to the available information, many patients appreciate it – “finally it was about me as a person and not just about illness” – and many professionals feel relieved, seeing more significant opportunities for performing the primary task as a helper, which is why many made their career choice and are increasingly unable to implement in everyday practice (Lemmen et al., 2021). The tools associated with “Positive Health” seem suitable for supporting a paradigm shift to primary care, drawing on existing resources and sustainable effectiveness. We understand “Positive Health” as a promising approach for applying the salutogenesis model, especially in primary care.
However, there is a lack of information about the concrete interactions in the “alternative dialogue.” For a “promising intervention” to become a “proven intervention” (Smedley & Syme, 2001), findings are needed about the processing of communication. Such data provide clues as to how this form of conversation differs from others and which influences (qualifications, personal skills, reasons for the conversation, setting, etc.) need to be considered (Bahrs & Matthiessen, 2007).

Therefore, the Salutogenesis umbrella organization (www.dachverband-salutogenese.eu) has initiated a pilot project for the real-life analysis of positive health discussions in different settings based on the assumption that the corresponding research results can promote the implementation of “positive health” and support the further development of target group-specific training. We got financial support from the Chaja Foundation (Frankfurt), the association Positive Gesundheit Deutschland (Berlin), the Institute for General Practice and Outpatient Health Care at the University of Witten and Positive Health International (Utrecht), which are our main cooperation partners. The ongoing study “Contextualization and Structuring of Positive Health Conversations” started on July 1, 2024 (led by Dr. Ottomar Bahrs) and is initially scheduled to last 15 months.

Natalie Seuken’s doctoral thesis (University of Witten) is part of the project. She will evaluate Positive Health dialogues conducted by general practitioners using the Rating Inventory of Solution-Focused Interventions (Schiepek et al., 1997). About five family physicians with initial experience with the positive health concept and its practical implementation take part in the study. The study will document some positive health discussions on video with the consent of those seeking advice.

We are also endeavouring to document and evaluate contrasting conversations with non-physician professionals in the social and healthcare sectors to examine the influence of context and action-guiding professional perspectives. We plan to hold some evaluation meetings with the GPs in the sense of participatory research and report the results to the participants. For more information, please contact natalie.seuken@uni-wh.de.

Natalie Seuken is a research associate at the Institute of General Practice and Primary Care (iamag) at the University of Witten-Herdecke. Contact: natalie.seuken@uni-wh.de.

Dr Ottomar Bahrs is a medical sociologist and freelancer at the Institute for General Practice at the University of Düsseldorf. He has been involved in conversation analyses, focusing on resource orientation in primary care. He is a spokesperson for the umbrella organization Salutogenesis and the editor of the journal “Der Mensch – Zeitschrift für Salutogenese und anthropologische Medizin”. Contact: obahrs@gwdg.de

References:

Bahrs, O. & Matthiessen, P. F. (2007). Gesundheitsfördernde Praxen: die Chancen einer salutogenetischen Orientierung in der hausärztlichen Praxis. Bern: Huber.

Bahrs, O. & Seuken, N. (2024). Forschungsprojekt “Kontextuierung und Strukturierung von Positive Health Gesprächen”. Der Mensch – Zeitschrift für Salutogenese und anthropologische Medizin, 64/65: 56-64.

Huber, M., Jung, H. P., & Dijkstra, K. V. D. B. (2022). Handbook positive health in primary care. Heidelberg: Springer.
Lemmen, C. H., Yaron, G., Gifford, R., & Spreeuwenberg, M. D. (2021). Positive Health and the happy professional: a qualitative case study. BMC Family Practice, 22, 1-12.

Smedley BD, Syme SL; Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public’s Health. Promoting Health: intervention strategies from social and behavioural research. Am J Health Promot. 2001 Jan-Feb;15(3):149-66. Doi: 10.4278/0890-1171-15.3.149. PMID: 11265579.

Schiepek, G., Honermann, H., Müssen, P., & Senkbeil, A. (1997). Ratinginventar Lösungsorientierter Interventionen (RLI) – Die Entwicklung eines Kodierinstruments für ressourcen orientierte Gesprächsführung in der Psychotherapie. Zeitschrift für Klinische Psychologie, 26 (4): 269–277.