Strengths and weaknesses in health counseling in Finnish primary health care.

Representative samples of Finnish health centres and of their physicians, nurses and physiotherapists were selected for a comprehensive survey on the professionals' work characteristics, health education attitudes and counseling practices. The main objectives of the study were to study the degree of implementation of patient counseling, with special reference to the national goals in health policy and to analyze the determinants of counseling practices in terms of predisposing, enabling and reinforcing factors. Broadly defined patient counseling was frequent in the contacts with all 3 professional groups and no differences in counseling frequency were found between different sizes of health centres. However, the objective of implementing counseling in every patient contact, with the incorporation of guidance regarding healthy living habits in it, recommended in the national health policy goals, was only partially realized. There were distinct differences between the 3 professional groups in counseling attitudes, topics, methods and purposes. These differences reflect, to a great extent, the differences in the professional tasks and the basic training between the 3 groups and also differences in the characteristics of patient contacts. These findings indicate a need for further in-service training in the methods of patients counseling, as well as restructuring the health care delivery system to allow more time for counseling, better continuity between contacts and more co-work between the members of primary care teams.