What makes physicians implement climate change and heat adaptation measures in outpatient practices? A mixed-methods...

Health impacts of climate change are becoming increasingly apparent and require adaptation in the healthcare sector. We aimed to identify behavioural determinants among physicians in outpatient practices for the implementation of climate change adaptation measures with a focus on heat.

We employed a sequential explanatory mixed-methods design with an online cross-sectional survey and focus group discussions (FGD).

Data were collected in a physician network in Germany, from April to May 2023. We used Protection Motivation Theory (PMT) as a theoretical model to assess behavioural determinants for the implementation of eight climate change adaptation measures in outpatient practices. Data were analysed using descriptive statistics and logistic regressions and qualitative content analysis for the FGDs.

67 physicians participated in the survey (62.6 % response rate). On average, physicians reported implementing three out of eight proposed adaptation measures, 91.0 % implemented at least one. In the regression analyses, self-efficacy was a significant predictor for adjusting medication, adjusting schedules, and protecting buildings from heat. Response-efficacy was a significant predictor for educating oneself and the team, informing patients, and advising on active cooling. The FGDs with 18 physicians provided insights into aspects influencing self-efficacy, i.e. lack of time, and response efficacy, i.e. patients' adherence to physicians' recommendations. They also revealed that perceived responsibility for a measure was another determinant outside of PMT.

This study highlights the need to improve physicians' self-efficacy to implement measures, for example by offering clear guidelines. Moreover, it stresses the need to further investigate the effectiveness of single adaptation measures.