title: Teachable moments for health behavior change and intermediate patient outcomes.
abstract: OBJECTIVE
  Teachable moments (TM) are opportunities created through physician-patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients' recall of advice, motivation to modify behavior, and behavior change.
  
  
  METHODS
  A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit.
  
  
  RESULTS
  Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49-74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change.
  
  
  CONCLUSIONS
  TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice.
  
  
  CONCLUSIONS
  TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively.
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA; Department of Epidemiology & Biostatistics, Case Western Reserve University School of Medicine, Cleveland, USA; Case Comprehensive Cancer Center, Cleveland, USA. Electronic address: Susan.Flocke@case.edu.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
authors.affiliation: Department of Family Medicine, University of Medicine and Dentistry of New Jersey, New Brunswick, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Clark
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Antognoli
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Mason
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lawson
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Smith
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D011795:Surveys and Questionnaires; D013637:Tape Recording
keywords: Communication; Health behavior change; Health promotion; Primary care; Teachable moment