Encouraging Health Behavior Change: Eight Evidence-Based Strategies

 

Using these brief interventions, you can help your patients make healthy behavior changes.

Fam Pract Manag. 2018 Mar-Apr;25(2):31-36.

Author disclosures: no relevant financial affiliations disclosed.

Effectively encouraging patients to change their health behavior is a critical skill for primary care physicians. Modifiable health behaviors contribute to an estimated 40 percent of deaths in the United States.1 Tobacco use, poor diet, physical inactivity, poor sleep, poor adherence to medication, and similar behaviors are prevalent and can diminish the quality and length of patients' lives. Research has found an inverse relationship between the risk of all-cause mortality and the number of healthy lifestyle behaviors a patient follows.2

Family physicians regularly encounter patients who engage in unhealthy behaviors; evidence-based interventions may help patients succeed in making lasting changes. This article will describe brief, evidence-based techniques that family physicians can use to help patients make selected health behavior changes. (See “Brief evidence-based interventions for health behavior change.”)

KEY POINTS

  • Modifiable health behaviors, such as poor diet or smoking, are significant contributors to poor outcomes.

  • Family physicians can use brief, evidence-based techniques to encourage patients to change their unhealthy behaviors.

  • Working with patients to develop health goals, eliminate barriers, and track their own behavior can be beneficial.

  • Interventions that target specific behaviors, such as prescribing physical activity for patients who don't get enough exercise or providing patient education for better medication adherence, can help patients to improve their health.

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BRIEF EVIDENCE-BASED INTERVENTIONS FOR HEALTH BEHAVIOR CHANGE

BehaviorTechniqueDescription

All

SMART goal setting

Ensure that goals are specific, measurable, attainable, relevant, and timely.

Problem-solving barriers

Identify possible barriers to change and develop solutions.

Self-monitoring

Have patients keep a record of the behavior they are trying to change.

Physical inactivity

Physical activity prescription

Collaboratively work with the patient to pick an activity type, amount, and frequency.

Unhealthy eating

Small changes

Have patients choose small, attainable goals to change their diets, such as reducing the frequency of desserts or soda intake or increasing daily fruit and vegetable consumption.

Plate Method

Encourage patients to design their plates to include 50 percent fruits and vegetables, 25 percent lean protein, and 25 percent grains or starches.

Lack of sleep

Brief behavioral therapy

After patients complete sleep diaries, use sleep restriction (reducing the amount of time in bed) and sleep scheduling (daily bed and wake-up times).

Medication nonadherence

Provide education

Instruct patients on drug therapy: indication, efficacy, safety, and convenience.

Make medication routine

Add taking the medication to an existing habit to increase the likelihood patients will remember (e.g., use inhaler before brushing teeth).

Engage social network

Close family members or friends

ABOUT THE AUTHORS

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Dr. Hooker is a clinical psychology postdoctoral fellow in primary care behavioral health in the Department of Family Medicine and Community Health (DFMCH) at the University of Minnesota in Minneapolis....

Dr. Punjabi is an ambulatory care pharmacy resident at the University of Minnesota College of Pharmacy.

Dr. Justesen is an assistant professor in the DFMCH and medical director of the University of Minnesota Physicians' Broadway Family Medicine Clinic in Minneapolis.

Dr. Boyle is a first-year family medicine resident at the Broadway Family Medicine/North Memorial Family Medicine Residency Program in Minneapolis.

Dr. Sherman is a licensed clinical psychologist and professor in the DFMCH.

Author disclosures: no relevant financial affiliations disclosed.

Send comments to fpmedit@aafp.org, or add your comments to the article online.

References

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1. McGinnis JM. Actual causes of death, 1990–2010. Presentation at the Workshop on Determinants of Premature Mortality, National Research Council; September 18, 2013; Washington, D.C....

2. Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all-cause mortality: a systematic review and meta-analysis. Prev Med. 2012;55(3):163–170.

3. Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report. Patient Educ Couns. 2009;76(2):174–180.

4. Lilly CL, Bryant LL, Leary JM, et al. Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in three underserved populations: Colorado, North Carolina, West Virginia, 2009. Prev Chronic Dis. 2014;11:E32.

5. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans (7th Ed). Washington, D.C: U.S. Government Printing Office; 2010.

6. Sreedhara M, Siljee VJ, Rosal MC, Waring ME, Lemon SC. Does provider advice to increase physical activity differ by activity level among U.S. adults with cardiovascular disease risk factors [published ahead of print January 30, 2018]? Fam Pract.

7. Pinto BM, Lynn H, Marcus BH, DePue J, Goldstein MG. Physician-based activity counseling: intervention effects on mediators of motivational readiness for physical activity. Ann Behav Med. 2001;23(1):2–10.

8. Hechanova RL, Wegler JL, Forest CP. Exercise: a vitally important prescription. JAAPA. 2017;30(4):17–22.

9. Guo H, Pavek M, Loth K. Management of childhood obesity and overweight in primary care visits: gaps between recommended care and typical practice. Curr Nutr Rep. 2017;6(4):307–314.

10. Perkins-Porras L, Cappuccio FP, Rink E, Hilton S, McKay C, Steptoe A. Does the effect of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change? Prev Med. 2005; 40(3):314–320.

11. Kahan S, Manson JE. Nutrition counseling in clinical practice: how clinicians can do better. JAMA. 2017;318(12):1101–1102.

12. Choose My Plate. U.S. Department of Agriculture website. https://www.choosemyplate.gov/. Updated January 31, 2018. Accessed February 1, 2018.

13. Ford ES, Cunningham TJ, Giles WH, Croff JB. Trends in insomnia and excessive daytime sleepiness among U.S. adults from 2002 to 2012. Sleep Med. 2015;16(3):372–378.

14. Edinger JD, Sampson WS. A primary care “friendly” cognitive behavioral insomnia therapy. Sleep. 2003;26(2):177–182.

15. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157(11):785–795.

16. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient-centered approach to medication management services. 3rd ed. New York: McGraw-Hill; 2012.

17. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults — United States, 2005–2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1205–1211.

18. Patients not ready to make a quit attempt now (the “5 Rs”). Agency for Healthcare Research and Quality website. http://bit.ly/2jVvpoY. Updated December 2012. Accessed February 2, 2018.

19. Larzelere MM, Williams DE. Promoting smoking cessation. Am Fam Physician. 2012;85(6):591–598.

 
 

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