Tuesday, January 1, 2019

Approaches to behavior change that work

- Jennifer Middleton, MD, MPH

It's time for New Year's resolutions, and many of our patients will ask us for help implementing them. The December 15 issue of AFP includes the timely article on "Counseling Patients in Primary Care: Evidence-Based Strategies" which reviews several useful counseling techniques. This article adds to the growing literature of simple methods that can help our patients make healthy changes.

The AFP authors review key tenets of FRAMES, motivational interviewing, BATHE, the stages of change, and the 5A's, providing recommendations about choosing techniques and examples of phrasing to use with patients. All techniques share an emphasis on empathetic patient engagement. The authors also advocate for addressing multiple issues within a visit (such as tobacco use, weight loss, and hazardous alcohol use) and cite data demonstrating that doing so leads to increased change for all of the behaviors addressed.

A 2016 study examined which physician techniques best increased patients' activation scores, a proxy measure for behavior change. More successful physicians used an average of 4 out of the 5 following strategies: "emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients." Less successful physicians reported instead "telling patients the negative health outcomes they can expect if they do not change their unhealthy behaviors." In this same study, more successful physicians also reported spending more time counseling and had higher interest in behavior change than those physicians whose patients had lower activation scores. 

Additional studies' findings are along similar lines. Spending more time counseling patients correlates with higher rates of behavior change regarding weight loss and tobacco cessation. Patients are more willing to engage in counseling related to behavior change with tobacco and alcohol use when their overall health, and not their undesirable habit, is emphasized. Although leveraging our longitudinal relationships with patients is valuable, it's encouraging to note that just one motivational interviewing session can result in meaningful change, too.

You can read more in the AFP By Topic on Health Maintenance and Counseling. I'm adding this new AFP article to my AFP Favorites page for easy reference. Which of these techniques are you adding to your repertoire for 2019?