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


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
    • "The Self-management Support Programme The Self-management Support Programme consisted of four consultations with the practice nurse spread over a period of four to six months: in the first week, after two weeks, after two to three months and after four to six months. The consultations were based on the 'Five A's cycle' counselling technique (Assess–Advise–Agree–Assist–Arrange ) (Glasgow et al., 2006; Whitlock et al., 2002 "
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    ABSTRACT: Background: A monitoring-and-feedback tool was developed to stimulate physical activity by giving feedback on physical activity performance to patients and practice nurses. The tool consists of an activity monitor (accelerometer), wirelessly connected to a Smartphone and a web application. Use of this tool is combined with a behaviour change counselling protocol (the Self-management Support Programme) based on the Five A's model (Assess-Advise-Agree-Assist-Arrange). Objectives: To examine the reach, implementation and satisfaction with the counselling protocol and the tool. Design: A process evaluation was conducted in two intervention groups of a three-armed cluster randomised controlled trial, in which the counselling protocol was evaluated with (group 1, n=65) and without (group 2, n=66) the use of the tool using a mixed methods design. Settings: Sixteen family practices in the South of the Netherlands. Participants: Practice nurses (n=20) and their associated physically inactive patients (n=131), diagnosed with Chronic Obstructive Pulmonary Disease or Type 2 Diabetes, aged between 40 and 70 years old, and having access to a computer with an Internet connection. Methods: Semi structured interviews about the receipt of the intervention were conducted with the nurses and log files were kept regarding the consultations. After the intervention, questionnaires were presented to patients and nurses regarding compliance to and satisfaction with the interventions. Functioning and use of the tool were also evaluated by system and helpdesk logging. Results: Eighty-six percent of patients (group 1: n=57 and group 2: n=56) and 90% of nurses (group 1: n=10 and group 2: n=9) responded to the questionnaires. The execution of the Self-management Support Programme was adequate; in 83% (group 1: n=52, group 2: n=57) of the patients, the number and planning of the consultations were carried out as intended. Eighty-eight percent (n=50) of the patients in group 1 used the tool until the end of the intervention period. Technical problems occurred in 58% (n=33). Participants from group 1 were significantly more positive: patients: χ(2)(2, N=113)=11.17, p=0.004, and nurses: χ(2)(2, N=19)=6.37, p=0.040. Use of the tool led to greater awareness of the importance of physical activity, more discipline in carrying it out and more enjoyment. Conclusions: The interventions were adequately executed and received as planned. Patients from both groups appreciated the focus on physical activity and personal attention given by the nurse. The most appreciated aspect of the combined intervention was the tool, although technical problems frequently occurred. Patients with the tool estimated more improvement of physical activity than patients without the tool.
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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.
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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:
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