Evaluating Primary Care Behavioral Counseling Interventions: An Evidence-based Approach. Background Article

Oregon Health and Science University, Portland, Oregon, United States
American Journal of Preventive Medicine (Impact Factor: 4.53). 06/2002; 22(4):267-84. DOI: 10.1016/S0749-3797(02)00415-4
Source: PubMed

ABSTRACT Risky behaviors are a leading cause of preventable morbidity and mortality, yet behavioral counseling interventions to address them are underutilized in healthcare settings. Research on such interventions has grown steadily, but the systematic review of this research is complicated by wide variations in the organization, content, and delivery of behavioral interventions and the lack of a consistent language and framework to describe these differences. The Counseling and Behavioral Interventions Work Group of the United States Preventive Services Task Force (USPSTF) was convened to address adapting existing USPSTF methods to issues and challenges raised by behavioral counseling intervention topical reviews. The systematic review of behavioral counseling interventions seeks to establish whether such interventions addressing individual behaviors improve health outcomes. Few studies directly address this question, so evidence addressing whether changing individual behavior improves health outcomes and whether behavioral counseling interventions in clinical settings help people change those behaviors must be linked. To illustrate this process, we present two separate analytic frameworks derived from screening topic tools that we developed to guide USPSTF behavioral topic reviews. No simple empirically validated model captures the broad range of intervention components across risk behaviors, but the Five A's construct-assess, advise, agree, assist, and arrange-adapted from tobacco cessation interventions in clinical care provides a workable framework to report behavioral counseling intervention review findings. We illustrate the use of this framework with general findings from recent behavioral counseling intervention studies. Readers are referred to the USPSTF ( or 1-800-358-9295) for systematic evidence reviews and USPSTF recommendations based on these reviews for specific behaviors.

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Available from: Carole Tracy Orleans, Sep 28, 2015
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    • "This model provides a framework from which to explore the different levels and components of a SMS intervention and has been successfully applied in the context of LTCs (Whitlock et al, 2002; Glasgow et al, 2003). The model describes fi ve clinical behaviours, each beginning with ' A ' , that have been shown to support health behaviour change (Whitlock et al, 2002; McGowan, 2013). The aim is to ' activate ' the patient to take action and change their behaviour; a central aim of SMS (Pearson et al, 2007). "
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    ABSTRACT: To assess consensus amongst stakeholders in adult auditory rehabilitation on what processes might support self-management. A three-round Delphi review was conducted online. Participants responded to five questions relating to living well with a hearing loss and the clinical processes that might support living well. Responses were analysed using thematic analysis. In further rounds, statements arising from the analysis were scored using a nine-point Likert scale, independently and then in the light of the collated panel responses. Statements reaching pre-defined criteria for consensus were identified. A panel of 26 stakeholders in adult auditory rehabilitation were consulted, including people with hearing loss and researchers and professionals who design and implement process change. There was consensus on clinical skills and behaviours that might help individuals live well, including processes that inform and involve the individual with the hearing loss (e.g. providing information about hearing and collaborative goal setting, respectively). The panel identified potential emotional, cognitive, and behavioural markers for living well with a hearing loss. The results of this review provide a rationale for the development and evaluation of interventions that include collaborative clinical behaviours as part of self-management support.
    International journal of audiology 05/2015; DOI:10.3109/14992027.2015.1037019 · 1.84 Impact Factor
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    • "Although primary care providers recognize the importance of physical activity counselling (Bock et al., 2012; Orrow et al., 2012), numerous barriers need to be addressed. The Five A's model (Assess, Advise, Agree, Assist and Arrange) is a counselling protocol that could be helpful in supporting self-management in a primary care setting (Whitlock et al., 2002; Glasgow et al., 2006). In the Five A's specified model for physical activity promotion, the care provider first assesses the patient's current physical activity level, as well as any contraindications to physical activity and the patient's readiness to change, followed by providing a tailored counselling message and an agreement with the patient by collaborating on a plan of action. "
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    ABSTRACT: The systematic development of a counselling protocol in primary care combined with a monitoring and feedback tool to support chronically ill patients to achieve a more active lifestyle. An iterative user-centred design method was used to develop a counselling protocol: the Self-management Support Programme (SSP). The needs and preferences of future users of this protocol were identified by analysing the literature, through qualitative research, and by consulting an expert panel. The counselling protocol is based on the Five A's model. Practice nurses apply motivational interviewing, risk communication and goal setting to support self-management of patients in planning how to achieve a more active lifestyle. The protocol consists of a limited number of behaviour change consultations intertwined with interaction with and responses from the It's LiFe! monitoring and feedback tool. This tool provides feedback on patients' physical activity levels via an app on their smartphone. A summary of these levels is automatically sent to the general practice so that practice nurses can respond to this information. A SSP to stimulate physical activity was defined based on user requirements of care providers and patients, followed by a review by a panel of experts. By following this user-centred approach, the organization of care was carefully taken into account, which has led to a practical and affordable protocol for physical activity counselling combined with mobile technology. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email:
    Health Promotion International 12/2014; DOI:10.1093/heapro/dau107 · 1.94 Impact Factor
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    • "Across diverse populations and health behaviors, use of the 5As is associated with change in health behaviors and determinants thereof [24] [25] [26]. Because the 5As model covers the key elements of self-management support, it presents a unifying conceptual framework for evaluating and implementing behavioral change counseling interventions in primary care [27], including diabetes care [23] [28]. Our purpose is to use the 5As model as a tool for evaluating the quality of practice nurse communication. "
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    ABSTRACT: Nurse self-management support for type 2 diabetes patients may benefit from applying theory-based behavior change counseling. The 5As Model was used to assess if, and how, nurses applied the five key elements of self-management support in standard care.Methods Seven practice nurses audio-recorded consultations with 66 patients. An existing instrument for assessing counseling quality was used to determine if the 5As were applied. Applied As were compared with quality criteria, to provide an in-depth assessment.ResultsIn almost every consultation, nurses assessed health behaviors, and arranged a follow-up meeting. However, nurses advised behavior change in less than half of the consultations, while setting goals and assisting patients to overcome barriers were used even less. Comparing applied As with quality criteria revealed several issues that could be improved.Conclusion Nurses consistently discussed health behaviors with patients, but important elements of self-management support were not applied.Practice implicationsSelf-management support may benefit from training nurses in performing assessments that form the base for specific advice, setting goals, and addressing barriers to behavior change. Nurses also have to learn how to combine being medical expert and behavioral counselor. Clarifying both roles to patients may facilitate communication and establishing a collaborative relationship.
    Patient Education and Counseling 11/2014; 98(2). DOI:10.1016/j.pec.2014.11.006 · 2.20 Impact Factor
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