Implementing climate-sensitive health counselling: a qualitative study with physicians in Germany

To protect human health, it is important to improve climate-resilience and mitigate climate change and environmental degradation. Health systems can contribute to this by providing climate-resilient and sustainable health services. One example of such a health service is climate-sensitive health counselling (CSHC), which is defined as communication with patients about climate change and health issues within clinical settings. In this study, we explore how physicians in Germany conduct CSHC and what supports them in doing so with the purpose to better conceptualize CSHC and give recommendations on how to support its implementation. We conducted semi-structured qualitative interviews in 2021 with 18 German physicians mainly working in the outpatient sector, who were already conducting CSHC or thought about doing so. The interviews were audio-recorded and transcribed verbatim. A mixed deductive and inductive approach of qualitative content analysis was used for the analysis, supported by NVivo software. The deductive analysis part was guided by the framework on CSHC, and by work on factors that influence the implementation of patient-centered communication. The way in which participants conducted CSHC was broadly aligned with the existing framework for CSHC. With regard to the frameworks’ three content areas (’health impacts and adaptation’, ‘healthy and sustainable lifestyles’ and ‘climate action and policy’), there was an emphasis on lifestyle counselling in this sample. Furthermore, a fourth content area on clinical-decision making was discussed. The most important communication strategies mentioned fitted to principles of patient-centered communication. Enabling factors for implementing CSHC were mentioned on all pre-defined levels (physician, patient, relationship and health system factors). Developing an inner attitude, positive experienced patient response and being aware of touchpoints for CSHC were mentioned as physician factors supporting implementation of CSHC by participants. This study demonstrates that participating physicians already implement CSHC as a sustainable healthcare service. As physician factors seem to be important enabling factors for implementing CSHC, we argue that training physicians in medical curricula and continued medical education are important to support implementation of CSHC. Reflections about the own attitude towards climate change and health and teaching about patient-centered communication strategies could be important elements of such trainings. Future research should consider the expansion of the CSHC framework with regard to clinical decision-making and validate or expand the framework for different medical specializations.