Multiple behavioral risk factor interventions in primary care summary of research evidence

被引:369
作者
Goldstein, MG
Whitlock, EP
DePue, J
机构
[1] Bayer Inst Hlth Care Commun, West Haven, CT 06516 USA
[2] Oregon Hlth & Sci Univ, Evidence Based Practice Ctr, Kaiser Permanente Ctr Hlth Res, Portland, OR USA
[3] Brown Med Sch, Ctr Behav & Prevent Med, Providence, RI USA
[4] Miriam Hosp, Providence, RI 02906 USA
关键词
D O I
10.1016/j.amepre.2004.04.023
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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 tip) 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. (C) 2004 American Journal of Preventive Medicine.
引用
收藏
页码:61 / 79
页数:19
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