Introduction: Lifestyle diseases are considered to be one of the main causes of morbidity and mortality among people with a psychiatric diseases compared to the general population. Since 2011 patient targeted prevention of lifestyle risk factors has been initiated in psychiatric hospital settings, but experiences of former inpatients suggest that the prevention is not fully introduced in all hospitalizations. Thus, there seems to be a discrepancy between the intentions among health care leaders and performance in clinical practice by health staff.
Objective: To explore the relations that are important for the health prevention initiatives change shape when it is performed or not performed in clinical practice, and how this interconnection can be changed in order to bring coherence to the agents’ understanding.
Method: The field has been studied in a comparative case study with two cases where health prevention, in a quantitative perspective, has been more or less implemented. Norman Fairclough's critical discourse analysis and Richard Freeman’s perspective of translation have formed a framework for the data generation and the analysis. The cases included section S1 and S7 in the psychiatric Clinic South in the North Denmark Region.
Quantitative and qualitative methods were triangulated. The quantitative method includes an audit with 119 records of patients discharged in the period from March 2nd 2015 to October 19th 2015. The empirical basis for the qualitative method is documents prepared by health care leaders and focus group interviews of the health staff. Additionally, two field observations were performed. The critical discourse analysis and Pierre Bourdieu's concepts of capital, habitus and doxa clarified discursive practices and non-discursive practices and their dialectical relationship to the broad social practices.
Results: Screening among 75% and 77% of the inpatients was documented in sections S1 and S7, respectively. Intervention (including when intervention was rejected) was documented among 50% and 71% of the inpatients, respectively. In section S7 selected interventions occurred among 6%. Critical discourse analysis showed that the agents draw on a welfare discourse, a systemic discourse, an individualization discourse and a priority discourse in their articulation of health prevention. Creative use of language and interdiscursivity changed the construction of the health prevention in clinical practice. Based on the analysis the following proposals are made: The structured intervention should not be part of hospitalizations; Focus on the individual must be increased through everyday life interventions; Efforts of intersectorial collaboration must be improved and communication skills must be implemented in the production of documents.
Conclusion: The health prevention initiatives was translated through discursive practices which clarifies that preventive approaches cannot be implemented as a structured approach in its original form, but will constitute and be constituted by social structures.