Interactive behavior change technology a partial solution to the competing demands of primary care

Background: Primary care practices are faced with the challenge of having too much to do in too little time. As a result, behavioral counseling is often overlooked, especially for patients with multiple health behaviors in need of change. Methods: This paper describes recent examples of the application of interactive behavior change technologies (IBCTs) to deliver health behavior change counseling before, during, and after the office visit to inform and enhance patient-clinician interactions around these issues. The 5A's framework (assess, advise, agree, assist, arrange follow-up) is used to consider how interactive technology can be used to implement behavior change counseling more consistently. Results: A variety of IBCTs, including the Internet, clinic-based CD-ROMs, and interactive voice-response telephone calls have been shown to be feasible and potentially valuable adjuncts to clinic-based behavioral counseling. These technologies can both increase the effectiveness of behavioral counseling and extend the reach of these services to patients with barriers to face-to-face interactions. Conclusions: If appropriately developed with the context of primary care in mind and integrated as part of a systems approach to intervention, IBCT can be a feasible and appropriate aid for primary care. Recommendations are made for the types of IBCT aids and research that are needed to realize this potential. (C) 2004 American journal of Preventive Medicine.