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

Background: The World Health Organization and German treatment guidelines emphasise integrating physical activity (PA) advice into primary care of patients with coronary heart disease (CHD). However, in general practice in Germany, this is often inadequately implemented. A key barrier may be healthcare professionals’ limited knowledge and skills in providing effective and efficient PA guidance. To address this, 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. Methods: Between March and June 2023, 12 problem-centred one-on-one interviews and six moderated focus group discussions (n=37 participants) with GPs were conducted (total n=49 GPs). Interview and discussion guides were developed and pilot-tested by the multi-professional study team. Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure (deductive and inductive approaches) within a multi-professional team, with active involvement of GPs. Results: In general, GPs recognise the benefits of PA for CHD patients. Their conceptualisations of PA (e.g., definitions of sport and PA, general statements on PA, on types of 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. Conclusion: Building on own previous findings about GPs' experiences, attitudes, and beliefs regarding PA advice, the now identified educational and training needs form a foundation for developing a tailored GP training on supporting CHD patients with regard to PA. This will be implemented and evaluated in a follow-up study.