title: Identifying teachable moments for health behavior counseling in primary care.
abstract: OBJECTIVE
  Situations with potential to motivate positive change in unhealthy behavior have been called 'teachable moments'. Little is known about how they occur in the primary care setting.
  
  
  METHODS
  Cross-sectional observational design. Audio-recordings collected during 811 physician-patient interactions for 28 physicians and their adult patients were analyzed using conversation analysis.
  
  
  RESULTS
  Teachable moments were observed in 9.8% of the cases, and share three features: (1) the presence of a concern that is salient to the patient that is either obviously relevant to an unhealthy behavior, or through conversation comes to be seen as relevant; (2) a link that is made between the patient's salient concern and a health behavior that attempts to motivate the patient toward change; and (3) a patient response indicating a willingness to discuss and commit to behavior change. Additionally, we describe phenomena related to, but not teachable moments, including teachable moment attempts, missed opportunities, and health behavior advice.
  
  
  CONCLUSIONS
  Success of the teachable moment rests on the physician's ability to identify and explore the salience of patient concerns and recognize opportunities to link them with unhealthy behaviors.
  
  
  CONCLUSIONS
  The skills necessary for accomplishing teachable moments are well within the grasp of primary care physicians.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. cohendj@ohsu.edu
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Clark
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lawson
authors.forename: Brad A
authors.initials: BA
authors.lastname: Casucci
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D004032:Diet; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011320:Primary Health Care; D000074606:Smoking Prevention; D013663:Teaching / Q000379:methods*