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• Focus on prevention •
Why do I knowingly continue a habit that puts my health at risk? A national poll commissioned by the AAFP found that many Americans continue risky health behavior because of a lack of willpower and time, and the pressures of a stressful life. Source: American Academy of Family Physicians/2002 Wirthlin Worldwide poll. |
by Cindy McCanse Borgmeyer
Think about it: When's the last time you fell victim to the siren's song of that second (or third) slice of cheesecake? Or, forced to choose between hitting the walking trail after dinner or playing couch potato in front of the TV, opted for the latter? Well, your patients are no different.
This is not to say that a little self-indulgence every now and then doesn't have its place. But these examples illustrate the fact that people make choices affecting their health each and every day, often without considering the consequences.
"Our patients are constantly bombarded with health information," said AAFP President-elect Michael Fleming, M.D., of Shreveport, La. "Some of that information -- like what they hear from their family doctors -- is reliable. Some of it is not.
"To be able to work effectively with our patients to achieve their health goals, we need solid evidence showing us what they know about maintaining and improving their health and how that information translates into behavior."
A recent AAFP survey provides exactly that insight.
As part of last fall's kickoff of the 2003 Annual Clinical Focus on prevention, the AAFP commissioned a poll by Wirthlin Worldwide to determine what patients know about safeguarding their health and how they make use of that information. Survey results and related materials have been posted to the AAFP Web site at http://www.aafp.org/members/acfpresskit.xml.
Findings from the telephone survey, which included 1,000 adults living in the United States, showed a consistent -- if disappointing -- trend: Although most Americans have a strong grasp of the importance of healthy behaviors, a good many of them still don't do what they know they should be doing.
The survey shows that 98 percent of Americans admit that they have at least one of nine unhealthy habits such as tobacco use, sedentary lifestyle, poor stress management or inadequate sleep. The largest portion, 24 percent, say they lack the willpower or self-control to overcome their unhealthy habits.
By and large, demographically defined population groups tended to respond as one might suspect they would. For example, denial that one's health would be affected by negative consequences was most frequently seen in survey respondents under 35 years of age. Those most likely to blame unhealthy behaviors on a lack of self-discipline included people between ages 35 and 54 -- particularly women, college grads and those with the highest incomes. And a disproportionate number of men in the under-35 age group, along with those for whom high-school graduation was the highest educational level achieved, tended to say risky behaviors are enjoyable.
In many cases, the rationales for specific behaviors also followed expected patterns. Most smokers and people with poor nutritional habits, for example, attributed their continued unhealthy behavior to a lack of willpower.
Other cases were not so clear, however. Those who reported not getting enough sleep, for example, most often attributed that fact to lack of time rather than to excessive stress. And of those who said they failed to exercise as much as they knew they should, most blamed their actions on time constraints rather than on not having sufficient willpower.
So, those are some of the numbers -- now what to do with them? How can family physicians help their patients achieve better health -- especially when some patients seem intent on pursuing the opposite course?
"You have to reach for it whenever you can," said AAFP Past President Richard Roberts, M.D., J.D., of Madison, Wis., who has served as an AAFP spokesperson on motivating patient lifestyle improvements. "From working with these patients over time, you develop a sense of when it's reasonable to bring up certain topics.
"There are some things -- smoking, for example -- I continue to bang the drum about every time I see a patient."
Granted, "selling" prevention to patients can be a challenge.FPs may see some patients quite rarely and only when the patients are in dire health straits. Under those circumstances, "It's hard to get much traction on many prevention issues. I think we do this better than anybody else, but it still ain't great," Roberts quipped.
The key is to customize your approach.
Take exercise, for example. For a patient with a significant health problem, Roberts said, that may mean devising a unique physical activity plan.
Other times, it can mean recognizing an individual as part of a larger population and making best use of that identity. With women, for example, it's often helpful to suggest participation in an exercise group because then it becomes a social activity, he said. Women's sense of interdependence can lead them to engage and support one another in exercise, thus keeping the cycle going.
"Men, on the other hand, tend to prefer to exercise alone," Roberts said. "When men come together in exercise, it's typically for competitive reasons. So you need to keep that in mind."
And learn to see the big picture, Roberts advised. "If you're actually going to move the needle, you have to think beyond the individual. You have to think about the whole community and change the community's way of looking at things."
To reach writer Cindy McCanse Borgmeyer, e-mail cborgmey@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.