Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care.
BACKGROUND
The evidence base regarding what works in practice for helping patients change multiple risk behaviors is less developed than is the more basic literature on behavior change. Still, there is enough consistency of findings to present testable hypotheses for clinicians and administrators to evaluate and guide practice until more definitive evidence is available.


METHODS
The behavior change principles known as the 5A's outline a sequence of support activities (assess, advise, agree, assist, arrange) that are effective for helping patients to change various health behaviors. These same principles also apply at the clinic level for designing activities to support behavior change.


RESULTS
Successful practices promoting sustainable changes in multiple behaviors are patient centered, tailored, proactive, population based, culturally proficient, multilevel, and ongoing. Often a stepped-care model can be used to provide increasingly intensive (and costly) interventions for patients who are not successful at earlier intervention levels.


CONCLUSIONS
Contextual factors are influential in determining success at both the patient and the office practice level. Therefore, greater attention should be paid to creating supportive family, healthcare system, and community resources and policies. We enumerate 15 hypotheses to be tested for improving patient-clinician interactions and for medical office change.
Kaiser Permanente Colorado, Clinical Research Unit, Denver, Colorado, USA. russg@ris.net
Russell E
RE
Glasgow
Michael G
MG
Goldstein
Judith K
JK
Ockene
Nicolaas P
NP
Pronk
D001521:Behavior Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods*; D015438:Health Behavior; D006801:Humans; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration*