This study aims to describe barriers and facilitators of the implementation of a combined lifestyle intervention (CLI) in primary care for patients with chronic disease. The aim of CLI to help patients to create a healthy lifestyle and to maintain this healthy lifestyle. During a CLI a patient receives advice and counselling to improve health-related behavior such as physical activity and diet. Special attention was given to the influence of adding a health promoting financial incentive (HPFI) for the participants to the CLI. Twenty-four semi-structured interviews within six care groups were performed between July and October 2017. The interviews were transcribed verbatim and coded by two researchers independently. Respondents mentioned several preferred characteristics of the CLI such as easy accessibility of the intervention site and the presence of health care professionals during exercise sessions. Moreover, factors that could influence implementation (such as attitude of the health care professionals) and preconditions for a successful implementation of a CLI (such as structural funding and good infrastructure) were identified. Overall, positive HPFIs (e.g. a reward) were preferred over negative HPFIs (e.g. a fine). According to the respondents, HPFIs could positively influence the degree of participation, and break down barriers for participating in and finishing the CLI. Multiple barriers and facilitators for successful implementation of a CLI were identified. For successful implementing CLIs, a positive attitude of all stakeholders is essential and specific preconditions should be fulfilled. With regard to adding a HPFI, more research is needed to identify the attitude of specific target groups towards an HPFI.

中文翻译：

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对慢性病患者实施生活方式干预与经济激励相结合的感知障碍和促进因素

这项研究旨在描述在慢性病患者的初级保健中实施综合生活方式干预（CLI）的障碍和促进因素。CLI旨在帮助患者创造健康的生活方式并保持这种健康的生活方式。在CLI期间，患者会接受建议和咨询，以改善与健康有关的行为，例如体育锻炼和饮食。特别注意了为CLI参与者添加健康促进财务奖励（HPFI）的影响。2017年7月至2017年10月，在六个护理小组中进行了二十四次半结构式访谈。访谈被逐字记录并由两名研究人员独立编码。受访者提到了CLI的一些优选特性，例如，易于干预的部位以及锻炼期间卫生保健专业人员的到来。此外，确定了可能影响实施的因素（例如卫生保健专业人员的态度）和成功实施CLI的前提条件（例如结构性资金和良好的基础设施）。总体而言，积极的HPFI（例如奖励）比消极的HPFI（例如罚款）更为可取。受访者表示，HPFI可以对参与程度产生积极影响，并打破参与和完成CLI的障碍。确定了成功实施CLI的多个障碍和促进者。为了成功实施CLI，所有利益相关者的积极态度至关重要，应满足特定的先决条件。关于添加HPFI，需要更多的研究来确定特定目标群体对HPFI的态度。