What are the barriers and facilitators to effective health promotion in urgent and emergency care? A systematic review

Background: There are potential health gains such as reducing early deaths, years spent in ill-health and costs to society and the health and care system by encouraging NHS staf to use encounters with patients to help individuals signifcantly reduce their risk of disease. Emergency department staf and paramedics are in a unique position to engage with a wide range of the population and to use these contacts as opportunities to help people improve their health. The aim of this research was to examine barriers and facilitators to efective health promotion by urgent and emergency care staf. Methods: A systematic search of the literature was performed to review and synthesise published evidence relating to barriers and facilitators to efective health promotion by urgent and emergency care staf. Medical and social science databases were searched for articles published between January 2000 and December 2021 and the reference lists of included articles were hand searched. Two reviewers independently screened the studies and assessed risk of bias. Data was extracted using a bespoke form created for the study. Results: A total of 19 papers were included in the study. Four themes capture the narratives of the included research papers: 1) should it be part of our job?; 2) staf comfort in broaching the topic; 3) format of health education; 4) competency and training needs. Whilst urgent and emergency care staf view health promotion as part of their job, time restraints and a lack of knowledge and experience are identifed as barriers to undertaking health promotion interventions. Staf and patients have diferent priorities in terms of the health topics they feel should be addressed. Patients reported receiving books and leafets as well as speaking with a knowledgeable person as their preferred health promotion approach. Staf often stated the need for more training. Conclusions: Few studies have investigated the barriers to health promotion interventions in urgent and emergency care settings and there is a lack of evidence about the acceptability of health promotion activity. Additional research is needed to determine whether extending the role of paramedics and emergency nurses to include health promotion interventions will be acceptable to staf and patients