For family physicians to help patients reach their diet and exercise goals more successfully, one group of researchers said it's necessary to first understand the opportunities and obstacles that may be in their path to success.
A study published in the March/April issue of Annals of Family Medicine,(www.annfammed.org) led by Robert Ferrer, M.D., M.P.H., of the department of family and community medicine at the University of Texas Health Science Center at San Antonio, found that an individual's feasible opportunities -- or what he or she is practically able to do as a result of demographics, surroundings or abilities -- had a positive association with the patient's intentions, eating and activity behaviors and predicted lower body mass index (BMI).
"Your personal circumstances and your environment shape your practical opportunities, which then shape the choices that you make, which then shape the outcome -- so there are stages involved," Ferrer told AAFP News. "Unless we get in the exam rooms in health settings and we try to understand what comes before choices, then it's kind of an impoverished fact-finding basis for counseling people."
Ferrer said there are two aspects that determine practical opportunities: the resources available -- whether it's having money to join a gym or access to a nearby walking trail -- as well as conversion factors, or personal circumstances that may impact or limit a patient's ability to convert those resources into achievements.
- A new study in Annals of Family Medicine found that what patients are able to practically do affects their eating and activity behaviors.
- Researchers explored the roles of two factors -- available resources and personal circumstances that affect the use of those resources -- on healthy behaviors and body mass index.
- One researcher said the study suggests that current methods used to change patient health behaviors may not drill down far enough to determine the unique challenges that could be keeping a patient from succeeding.
Conversion factors can include anything from low literacy or a poor social support system to an unsafe neighborhood or being too depressed to shop for food.
For instance, while a patient may have a walking trail near home, he or she may live in a neighborhood that's too unsafe to make walking a viable option.
Key Study Findings
Researchers explored the role resources and conversion factors play on healthy behaviors and on BMI in a study of 746 adults who had visited one of eight large primary care practices in Texas. They measured practical opportunities for diet and physical activity for each patient by using a 25-item survey -- the Capability Assessment for Diet and Activity -- that asked patients about the resources available to them to assist with a healthy diet and activity, as well as any conversion factors.
In addition to establishing each patient's practical opportunities, researchers also surveyed participants about their healthy eating and activity habits and their future intentions. Finally, to establish BMI, height and weight were measured at the participating clinics.
Researchers found that both resources and conversion factors predicted a patient's intention for activity. Conversation factors also predicted the patient's intentions to eat a healthy diet, although resources did not.
When it came to actual behaviors, once again, resources and conversion factors were found to be positively associated with the number of weekly activity minutes a patient reported; however, only conversion factors were positively associated with diet quality. And similar patterns were observed for BMI.
Ferrer said the study suggests that the current methods used in health care to change patient health behaviors, such as motivational interviewing, may not drill down far enough to determine the unique obstacles or challenges that could be preventing a patient from making behavioral change.
"That has a presumption that the motivation and the choice making is the central thing that we have to change and so the study was designed to look at where choices come from...because the choices that you make depend on the choices that you have," he said. "And so if we don't have a profound enough understanding of the context of people's choices then maybe our intervention strategy might be incomplete and not as potent as we'd like it to be."
Using This in Practice
If family physicians can't figure out why their patients aren’t making the changes to diet and exercise that they suggest, it can be frustrating for both physician and patient. Physicians may feel they are giving the same advice over and over without any results, while patients may feel they don't have the resources or ability to make the changes the physician suggests.
However, there are ways that family practices can make a few simple changes to get more detailed information about their patients.
Ferrer said many family medicine practices already use questionnaires to find out more about their patients. They could simply include a few more questions that speak to a patient's feasible opportunities.
"Then the advice giving doesn't happen in a vacuum; it's responding to the patient's actual real-life context and I think everyone is more effective that way," he said.
In his own practice, the physician group assessed patients using the practical opportunities survey and found that 70 percent of the patients reported being food insecure, meaning they ran out of money for food by the end of each month.
As a result, the clinic is pilot testing a targeted intervention by partnering with an area food bank to bring a produce truck with healthy food to the clinic parking lot several times a month.
"It just put it right under our noses with a red blinking light that hey, the food insecurity thing is really big and obviously it has a major importance in how people eat," Ferrer said.
The next stage in the research following this study, he said, is evaluating whether determining the practical opportunities for a patient can impact the effectiveness of how physicians treat their patients.
Related AAFP News Coverage
HHS, USDA Release Final 2015-2020 Dietary Guidelines
AAFP Questions Evidence Supporting Sodium Intake Recommendation