Although resource orientation, as a part of health promotion, should play a major role in general practice, the anchoring and realization of resource-oriented approaches remain small in Germany. The aim of this study was to analyze what resource orientation means to general practitioners (GPs) and develop strategies as to how this can be facilitated in GP practice. Within a qualitative research approach, 19 semi-structured telephone interviews were recorded, transcribed, and analyzed using qualitative content analysis. Within the interviews, the inclusion of the patients’ individual resources is described as core competence of GPs. Supporting the patients’ disease coping strategies and self-help were seen as important by GPs. However, perceptions as to which resources are considered to be fundamental ranged widely across the participant group. The results confirm the important role of resource-oriented approaches in general practice. However, a general definition of resource orientation is needed. In addition, working conditions for GPs need to be taken into account to ensure that these contribute to a healthy work-life balance. The need for GP training was identified to improve communication skills. Further integration of GPs in health promotion and communal structures would be beneficial.
Resource orientation focuses on individual resources (=“inner potentials”) of the patient to maintain and improve personal health. Thereby, it is mainly characterized by the salutogenic perspective stressing on factors that support human health and well-being. In addition, it overlaps or shares common elements with other concepts used in the context of health promotion, and complementary and alternative medicine such as sense of coherence, resilience, patient empowerment, or self-efficacy.
Traditionally, resource orientation has been researched in the psychological and pedagogical context. Increasingly its importance for primary care is recognized, in particular with regard to the management of chronically ill patients [
Nevertheless, resource-oriented approaches are increasingly important for general practitioners (GPs). For the evaluation of a patient’s individual resources, GPs work within an ideal setting to discover and promote the resources of the patient based on their long-lasting relationship with the patient. GPs do not only have medical knowledge regarding diseases and therapies but also build a therapeutic relationship with patients over time. This enables GPs to gain knowledge about the patient’s coping mechanisms, his or her individual resources and additional available resources in the community settings. GPs can potentially anticipate possible causes of pathogenesis from a somatic, psychosomatic, social, and/or human dimension [
Community resources, such as social services, self-help groups but also sports clubs, kindergartens, or schools are essential to facilitate the identification and the leverage effect of individual resources. However, including community resources in a resource-oriented approach requires a well-established cooperation between doctors and local services [
The study is concerned with the position of resource orientation and resource-oriented approaches in GP practice, using a qualitative research approach and focusing on the treatment of chronically ill patients in primary care. The primary aim was to gain a solid understanding of the meaning of resource orientation from the GP perspective. A further aim was to identify possibilities and specific measures to facilitate resource orientation in the primary care setting.
To get a realistic, detailed insight into the individual, personal perception of GPs regarding resource-oriented approaches, a qualitative study design consisting of semi-structured one-to-one interviews was chosen and conducted by telephone [
GPs were recruited via the quality circle “health promotion practices” that took place from 2002 to 2005 (12 invitations) and via a German General Practice E-mail List server (300 invitations). Inclusion criterion was the contact with resource-oriented approaches. We consecutively included all GPs meeting the inclusion criterion and with interest to take part in the study.
Individual appointments for the interviews were arranged. All interviews were carried out in the Department of General Practice and Health Services Research, University Hospital of Heidelberg, Germany, and were conducted by Franziska Prüfer. Each interview was recorded digitally and transcribed verbatim. Anonymity was preserved during data analysis, and participants consented on this understanding. The interviews were based on the following questions: What does resource-orientation mean to you? To what extent are resource-oriented approaches important? How can resource-oriented approaches be facilitated in primary care?
The goal of the interviews was explained prior to commencement to prevent misunderstanding and to allow time for answering possible questions that participants may have had. The term “resource orientation” as understood by the researcher was not explained in prior to every interview, in order to prevent bias as to the meaning of resource orientation in the responses. The study was approved by the Ethics Committee of the University of Heidelberg Medical Faculty (S-154/2011).
The interviews took place from May 2011 to August 2011. Each interview lasted between 20 and 30 minutes. The analysis was carried out according to the principles of Mayring's qualitative content analysis [
Altogether, 19 GPs were recruited for the study. Age ranged from 45 to 67 years (mean 55,7 years). Occupational experience as GP ranged between 1 and 37 years. Eighteen were medical specialists in general practice; one was a medical specialist in physical and rehabilitative medicine (Table
Sociodemographic characteristics of the study sample (
Gender | |
Female | 2 |
Male | 16 |
Age in years (mean, range) | 55.7 (45–67) |
Working experience in general practice in years (mean, range) | 20.4 (1–37) |
Type of practice | |
Sole practitioner | 6 |
Group practice | 10 |
Location of practice | |
City | 5 |
Small town | 4 |
Rural area | 7 |
Two main categories emerged from this analysis: the meaning (abstract ideas) and the facilitation (concrete ideas) of resource orientation in general practice. Table
GPs’ opinions regarding the meaning and facilitation of resource orientation.
Main category | Subcategory | Code |
---|---|---|
Meaning |
Meaning for the GP | Core competence |
Supposed benefits for patients | Accepting direct responsibility | |
Opportunities | Increased job satisfaction | |
| ||
Facilitation |
Communication | Patient-doctor conversation |
Patient orientation | Holistic approach | |
Complementary and alternative medicine | Feldenkrais | |
Lifestyle changes | Target agreement | |
Settings | Communal structures | |
Improvements | Health care system |
The interviews showed a very heterogeneous understanding of resource orientation which will be illustrated subsequently. Although the foundational understanding appeared similar, GPs focused on different aspects. For the GPs, resource orientation also meant orientating themselves towards their own resources.
During the interviews, resource orientation was described as a core competence of GPs. For example, “because these [resource-oriented approaches] are the basics of our [GPs’] actions” (GP 10). Most GPs stated that these approaches were partly carried out intuitively. Moreover, resource orientation was considered to be an attitude that focuses on the inner potentials of every individual. Some of the GPs expressed a strong need for a common definition to further establish resource orientation and make it comprehensible for everybody. During the interviews, resources were amongst other things defined “as sources of a healthy development” (GP 16). Resources represented an inner potential that differs quite individually from one person to another. In addition, assistance towards self-help and coping with illness were also considered to be an integral part of resource orientation by the GPs.
In addition, the interviews showed the importance of establishing awareness regarding resources. According to the GPs, this is a necessary prerequisite to implement and foster resource-oriented approaches.
Furthermore, GPs attach importance to resource orientation also with regard to their own resources for preserving and promoting their own health. Most of the GPs were satisfied with their own living and working situation. However, some of the GPs reported periods of exhaustion or burnout. During the interviews, the desire for a good work-life balance was evident. Satisfactory working conditions were emphasized as a core factor in achieving a healthy work-life balance. An appropriate workload, the possibility to exchange ideas with colleagues, and job satisfaction all contribute to the strengthening of GPs’ resources.
In addition, acceptance by the GP that the patient declines the GP's preferred therapy method also contributes to the effective resource orientation of GPs.
Participant GPs utilized leisure activities to reduce stress. Music, philosophy, and relaxation methods as well as family and friends were mentioned frequently. A healthy diet, physical activity, and weight loss were further factors mentioned in the context of maintaining a healthy lifestyle.
The interviews showed the importance of creating a heightened awareness regarding resources. For example,
For the GPs resource orientation opens the potential for working with chronically ill people to become more satisfying. Interviewees had the impression that patients can increase personal autonomy with the acceptance of direct responsibility for their health and well-being. This can have benefits for both patients and GPs. Patients can improve their satisfaction and awareness of health and in sharing responsibility, GPs can also achieve improved work satisfaction.
Additionally, the interviewees explained that when the self-responsibility for health in a patient increases, medical interventions and medication intake can be reduced. As an additional gain, deleterious effects, complications, and costs can be lowered.
The interviewed GPs did not have a standardized method to stimulate their patients’ resources. Methods were very individual and differed from doctor to doctor. In addition, the patient contributed decisively to the choice of a suitable method of facilitation, as not every patient is receptive to the same treatment. Furthermore, the opinions about which resources are most important differed considerably among GPs.
According to the interviewees, communication is the decisive mean for the facilitation of resource-oriented approaches.
In order to conduct an effective doctor-patient conversation, the interviewees considered a common language to be essential. With respect to this, they pointed out that language barriers may emerge during conversations with patients with a migrant background. Additionally, the importance of using a language that is comprehensible to patients was stressed several times. In the context of relevant methods of communication, the interviewees emphasized that questions asked by doctors should be open, for instance, questions about the patients’ subjective theories about their illness: “
In addition, the interviews showed how rarely questions are actually asked about a patient’s background in a GP’s practice. One of the doctors reported that he had only started doing this within the context of resource orientation.
In addition to the asking of questions, reporting about other patients was identified as a possible method for opening communication channels. Examples of patients in similar situations could help to illustrate the presentation of potential effects of therapy. For example:
Further approaches to put resource orientation into practices were seen in the field of patient orientation, in which it is especially crucial to look at a patient in his entirety. This means that the patient should not be perceived as an object, but as an individual. In the interviews, it was emphasized that the initial task of a doctor is listening to the patient very closely and accepting him in his entirety. For example:
Doing this promotes the creation of a confidential doctor-patient relationship, which enables the cooperation of doctor and patient on the same level. They can then jointly define a resource-oriented treatment based on the individual patient’s quality of life. For example;
According to the respondents specific methods of complementary and alternative medicine offer the opportunity to facilitate resource orientation; explicitly mentioned were Feldenkrais, acoustic bowl therapy, magnetic fields, homeopathy, and kinesiology.
Furthermore kinesiology was mentioned as a possibility for the facilitation of resource orientation within primary care.
Changes of lifestyle can also support the strengthening of patients’ healthcare resources, in the view of participating GPs. First and foremost, those lifestyle changes included physical exercise, a healthy diet, and weight loss.
It was possible to set goals in order to counteract patients’ difficulties in putting plans such as regular exercise into practice. Setting realistic goals could also strengthen a patient’s motivation.
The setting (social entities, e.g., schools, districts, and migrant gatherings) was seen as a further possibility to facilitate resource-oriented approaches throughout the interviews. Doctors especially stressed the integration into local structures which was described as a very positive experience:
Networking between nonmedical and medical professions was perceived as another starting point for the facilitation of resource orientation. According to the GPs interviewed, networking between professions could create a concept for society as a whole which includes doctors and stimulates resources in many fields.
Primarily, the settings of school and kindergarten seemed to have the potential to increase the usage of resources. It was particularly emphasized that children should be exposed to principles of health promotion as early as possible. This could either prevent the future development of a disease or at least delay onset. The early development of self-esteem also was seen to be of great importance.
The role of workplace health promotion in preventing burnout and experiences of excessive demand was pointed out as well. From the participating GPs’ perspectives, the development of resource-oriented workplaces in collaboration with occupational physicians was an important task, especially considering our aging society. For instance, it would be possible to grant additional breaks to older employees and to consider the employees’ age when assigning tasks.
A majority of respondents consider the possibility to spend more time with the patients as well as financial reimbursement for consultation as a foundation for the improvement of resource orientation. Furthermore, the integration of resource orientation in GP care by, for example, establishing resource-oriented consultations was discussed. During the interviews, the question which role a GP plays in regard to resource orientation and health promotion and whether this is part of his or her professional role at all was frequently asked.
Additionally, respondents expressed their wish for better representation of resource orientation in medical education and research. An emphasis was placed on the necessity of offering patient-oriented counselling techniques.
Within this qualitative interview study the importance of resource orientation for primary care was clearly emphasized by GPs; nevertheless there was a heterogeneous understanding of what resource orientation means. Resource orientation is regarded to be essential for the doctor-patient communication and relationship. Furthermore, the interviews demonstrated that resource orientation plays an important role in a double sense: for the GP’s own resources and for the care of patients. In many of our results the close relation between resource orientation and the concept of health promotion became apparent. In contrast to simple resource orientation, this concept concerns all societal elements and consequently an analysis and subsequent strengthening of health resources is in order. A salutogenic perspective is characteristic of both, resource orientation and health promotion.
The interviewees noted that when GPs use resource orientation they do not merely see the patient as a person with an illness, but rather as a subject that is regarded in his or her entirety. Since medical measures are taken based on patient’s individual resources, most GPs see the consideration of individual aspects as a core area within primary care, similar to the GPs within this study. In 2011, the European association WONCA defined six core competences which are required from a GP, which include an individualistic treatment and a holistic model [
The results indicate that resource orientation plays a crucial role in relation to GPs’ own health. Despite the fact that burnout syndrome or exhaustion were only rarely mentioned in interviews, it is now widely known that doctors are paradoxically one of the occupational groups most at risk of health impairment. Due to the fact that a doctor’s state of health may also impact on a patient’s medical care and thereby a patient’s health, it is clearly necessary to promote health and well-being among medical specialists. Despite the high percentage of males in this study, the compatibility of family and career becomes increasingly important given the rising number of women in medicine [
In addition to an increased awareness of their own resources, doctors may also feel relief if patients accept more self-responsibility for their health. In order to do so, resource consciousness as well as watchfulness of one’s own body needs to be facilitated among patients. They may, for instance, become more autonomous, active and assume more responsibility by receiving instructions from their medical practitioner. Thereby, patients can prevent and counteract mild diseases without straining their own health. The provision of information and skilled advisers in self-help can promote confident interaction between doctors and patients. Thereby, this method increases patient competence and contributes to shared-decision making [
In order to be able to implement resource orientation more effectively, doctors were asked for a general definition of the term. Bringing together the existing approaches around resource orientation with the aim to establish a general definition would be an important step for patient care but also for education and further research.
The results also indicate that currently there is no structured advancement in implementing resource orientation. In order to improve this, a working communication between a doctor and his patient is necessary, due to the fact that this exchange can promote compliance as well as significantly increase the exchange of information [
The results also show that teaching communication competence as well as resource-oriented approaches are essential in medical training and further education. Existing competency-based curricula such as the CanMeds are particularly recommended as a guiding manual for undergraduate and postgraduate education. Within the CanMeds concept health promotion and resource-oriented approaches are described in the role of the “Health advocate” [
With regard to facilitation communal resources can offer great potential to treat patients in a resource-oriented manner. Some doctors questioned were already integrated in community activities. However, they reported that integration into communities is largely dependent upon the doctor’s own commitment due to the fact that structures, which could facilitate integration, are generally lacking. In order to improve these conditions a better network of all actors involved is a desirable solution. This should not only include all health-related professions (doctors, nurses, and allied health care professionals), but also other professional groups within the community, for example, in the fields of education and employment. A key element in supplying healthcare for chronically ill patients is an integration of networking as described within the chronic care model, an approach which has currently also been discussed [
In the interviews, the role of GPs was also discussed, and it was mentioned that individual health care is a GP’s primary duty within health promotion. Doctors can introduce patients to health promotion offers, which already exist within the community, or can alternatively offer these in their own practices (e.g., nutrition consultation). Often however, doctors lack knowledge of health care offers already established within their communities. Another approach in further incorporating GPs into the community and fostering their work relief is a possible restructure of ambulant health care by strongly integrating other health care professionals. After all, most patients visiting a GP already show symptoms. Resource orientation should, however, also be applied to healthy individuals.
The results, moreover, suggested that there are further possibilities to accommodate for resource-oriented approaches in health care. A resource-oriented consultation for chronically ill patients could increase the focus on healthy and positive aspects in the patient’s life and improve his quality of life. An integration of resource orientation in existing structures, for example, established medical check-ups also seems promising. Lastly, the use of a resource-oriented questionnaire, which concerns the patients’ different areas of life as well as their capacities, could prove reasonable.
Our study has several limitations. One could, for instance, view the inclusion criterion as a limitation, “experience in resource orientation”, for example, was not further defined. An imbalance of gender representation may also be understood as a limitation. However, our aim was not to draw conclusions on a representative basis, but to explore the respective GPs’ personal insights on resource orientation. The remote interview method has some limitations regarding the creation of an atmosphere of trust. However, this approach was chosen purposefully to be able to include GPs from around Germany, with an awareness of the bias that can arise from this method [
Resource orientation, as a part of health promotion, plays an important role in GPs’ daily work. Therefore it should be increasingly taken into account. Furthermore, resource orientation should be focused in medical curricula as well as in daily work routine of GPs and other health professionals. Resource-oriented skills could, for example, be taught in communication classes or quality circles. Moreover, GPs should be more integrated in communal structures. With regard to the demographic development this can contribute to respond the growing demand of health care and the increasing workload and burden within primary care. Additionally, the duty of the patients is to become aware of their resources. They need to take over direct responsibility for their health and health related problems which could lead to a better quality of life and self-efficacy of patients especially those with chronic conditions. In this way, resource orientation could lead to a reduced demand of medical services and, thus, to a reduction of GPs’ workload.
The authors declare that they have no conflict of interests.
This work was supported by the Baden-Württemberg Ministry of Science, Research and Art, Stuttgart, Germany, within the project “Competence Centre General Practice Baden-Württemberg.” The authors thank Sarah Berger for supporting translation of the paper and all doctors who took part in this study.