General practitioners' educational and training needs and requirements for advising patients with coronary heart disease on physical activity: findings from a qualitative study in Germany.

backgroundThe World Health Organization and German treatment guidelines emphasise integrating physical activity (PA) advice into primary care of patients with coronary heart disease (CHD). However, this is often inadequately implemented in German general practice. A key barrier may be healthcare professionals' limited knowledge and skills in providing effective and efficient PA guidance - both in general as well as for patients with CHD. International guidelines recommend targeted training for general practitioners (GPs). Understanding GPs' specific educational and training needs is crucial to developing tailored training programmes for improving implementation of advising CHD patients on PA.

methodsBetween March and June 2023, 12 problem-centred one-on-one interviews and six moderated focus groups (n = 37 participants) with GPs were conducted in-person (total N  = 49 GPs, 37% female, mean age 56 years (36-78 years)). Interview and focus group topic guides were developed and pilot-tested by the multi-professional study team. Transcripts from audio-recorded data were analysed using both deductive and inductive content structuring, within a multi-professional team, with active involvement of GPs. This analysis extends a previous study using the same dataset. 

resultsGPs recognise the benefits of PA for CHD patients. Their conceptualisations of PA (e.g., definitions of sport and PA, general statements on PA) vary and the incorporation of PA in everyday activities (e.g., using stairs) to encourage behaviour change is sometimes recommended. GPs identify the following key training needs for providing PA advice to CHD patients: peer exchange and self-reflection, evidence-based knowledge on PA and CHD, practical tools and support materials to facilitate the integration of PA advice into routine practice. These include low-barrier, time-efficient communication techniques, and role-play simulations. 

conclusionThis qualitative study provides insights into GPs' needs and preferences regarding the content, didactics, and organisation of training on PA advice. To enhance competence and foster deeper learning, training should combine evidence-based knowledge with practical elements such as simulations and reflective peer exchange. Building on previous findings about GPs' attitudes and experiences, the identified educational needs offer a foundation for developing tailored training to support PA counselling in routine primary CHD care. This training will be implemented and evaluated in a subsequent study.