A systematic review of the effectiveness of promoting lifestyle change in general practice

Background. There is increasing evidence that particular lifestyle behaviours increase the risk of disease and it is widely argued that GPs are ideally placed to encourage patients to modify their behaviour in these areas and thereby reduce their disease risk. There is therefore a need for evidence that GP-based lifestyle interventions are effective in eliciting behaviour change. As there has been no comprehensive attempt to review the literature on this subject, we chose to conduct a systematic review, incorporating meta-analytic techniques where possible, to address this need. Objectives. This study aimed to examine how effective lifestyle advice provided by GPs is in changing patient behaviour. The following four areas of behaviour were examined: smoking, alcohol consumption, diet, and exercise. Method. The review was restricted to English-language reports of trials which investigated the effectiveness of lifestyle advice provided in a general practice setting. Studies were included where it could be established that subjects were randomly allocated to experimental groups and where a comparison was made between either a 'no intervention' or 'usual care' control group, or between advice of differing intensities. Six electronic databases were searched and a total of 37 trials were selected for inclusion in the review. Meta-analytic techniques were employed to analyse the data from the smoking advice trials. The results from the trials concerned with the other three behaviours did not lend themselves to this form of analysis. Outcome data were extracted from these trials and summarized in tabular form. Results. The results of this review suggest that whilst many of the general practice-based lifestyle interventions show promise in effecting small changes in behaviour, none appears to produce substantial changes. Conclusion. There is a need for more extensive and rigorous research in this area before substantial public funds are committed to general practice-based health promotion. Furthermore, it is clear that if general practice-based interventions are to be effective in a public health sense, a greater number of GPs will need to become involved in promoting behaviour change than the literature suggests is currently occurring.