Planting the Seed of Lifestyle Change in General Practice: A Grounded Theory

AIM: To develop a grounded theory to explain how rural general practice nurses (GPNs) support lifestyle risk reduction. DESIGN: A constructivist grounded theory approach. METHODS: Twelve GPNs from 10 general practices across the Murrumbidgee Primary Health Network participated in semi-structured interviews. Data were collected in three stages via in-person and telephone interviews. Constant comparative analysis and memos were used to conceptualise data and reach theoretical saturation. RESULTS: The theory of Planting the Seed of Lifestyle Change explains how rural GPNs support lifestyle risk reduction through four key elements. The core concern, cultivating caring connections, emphasised the importance of relational continuity and building rapport. The key antecedents focused on harnessing teachable moments. The six-stage action cycle, of breaking ground, surveying the situation, tilling the soil, feeding and weeding, mapping borders and steps and staking and tending, supported lifestyle change. Finally, making a difference described the participants' perspectives of the benefits for patients and GPNs. CONCLUSIONS: While community ties strengthen engagement, workforce pressures, differing practice cultures, systems and models of care undermine efforts. Secure funding for structured behaviour change programs, evidence-based resources and professional development would enhance capacity. IMPLICATIONS FOR THE PROFESSION: GPNs play a central role in chronic disease prevention. While targeted training and mentoring are needed to build GPNs' knowledge, skills and confidence in leading behaviour change, organisational and systems-level factors must be addressed to optimise their contribution. IMPACT: This study provides a framework for GPN support of lifestyle risk reduction in rural general practice, informing future practice, health care policy and models of team-based primary care. REPORTING METHOD: The COREQ checklist guided the reporting of this research. PATIENT OR PUBLIC INVOLVEMENT: This study did not include patient or public involvement in its design, conduct, or reporting.