Multiple behavioral risk factor interventions in primary care. Summary of research evidence.
BACKGROUND
An important barrier to the delivery of health behavior change interventions in primary care settings is the lack of an integrated screening and intervention approach that can cut across multiple risk factors and help clinicians and patients to address these risks in an efficient and productive manner.


METHODS
We review the evidence for interventions that separately address lack of physical activity, an unhealthy diet, obesity, cigarette smoking, and risky/harmful alcohol use, and evidence for interventions that address multiple behavioral risks drawn primarily from the cardiovascular and diabetes literature.


RESULTS
There is evidence for the efficacy of interventions to reduce smoking and risky/harmful alcohol use in unselected patients, and evidence for the efficacy of medium- to high-intensity dietary counseling by specially trained clinicians in high-risk patients. There is fair to good evidence for moderate, sustained weight loss in obese patients receiving high-intensity counseling, but insufficient evidence regarding weight loss interventions in nonobese adults. Evidence for the efficacy of physical activity interventions is limited. Large gaps remain in our knowledge about the efficacy of interventions to address multiple behavioral risk factors in primary care.


CONCLUSIONS
We derive several principles and strategies for delivering behavioral risk factor interventions in primary care from the research literature. These principles can be linked to the "5A's" construct (assess, advise, agree, assist, and arrange-follow up) to provide a unifying conceptual framework for describing, delivering, and evaluating health behavioral counseling interventions in primary healthcare settings. We also provide recommendations for future research.
Bayer Institute for Health Care Communication, West Haven, Connecticut, USA. michael.goldstein.b@bayer.com
Michael G
MG
Goldstein
Evelyn P
EP
Whitlock
Judith
J
DePue
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003376:Counseling; D004032:Diet; D019317:Evidence-Based Medicine; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000178:diet therapy / Q000517:prevention & control; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D000074606:Smoking Prevention