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

Nieder J, Quitmann C, Hueber S, Stark S, Klanke M, Shimada D, Lindenthal J, Wambach V, Kaspar-Ott I, Alverez FJ, Hertig E, Herrmann A (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Public Health WB Saunders

Book Volume: 249

Article Number: 106046

DOI: 10.1016/j.puhe.2025.106046

Abstract

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

Authors with CRIS profile

Susann Hueber Institute of General Practice Stefanie Stark Institute of General Practice

Involved external institutions

Universitätsklinikum Heidelberg DE Germany (DE) Universität Augsburg DE Germany (DE) Qualität und Effizienz eG (Gesundheitsnetz) DE Germany (DE)

How to cite

APA:

Nieder, J., Quitmann, C., Hueber, S., Stark, S., Klanke, M., Shimada, D.,... Herrmann, A. (2025). What makes physicians implement climate change and heat adaptation measures in outpatient practices? A mixed-methods study. Public Health, 249. https://doi.org/10.1016/j.puhe.2025.106046

MLA:

Nieder, J., et al. "What makes physicians implement climate change and heat adaptation measures in outpatient practices? A mixed-methods study." Public Health 249 (2025).

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