What Is The First Step In Trying To Change A Health-related Behavior

Encouraging Health Behavior Change: Eight Evidence-Based Strategies

Using these brief interventions, y'all tin can assist your patients make healthy behavior changes.

Stephanie A. Hooker, PhD, MPH, Anjoli Panjabi, PharmD, MPH, Kacey Justesen, Md, Lucas Boyle, MD, and Michelle D. Sherman, PhD, ABPP

Fam Pract Manag. 2018 Mar-Apr;25(2):31-36.

Author disclosures: no relevant fiscal affiliations disclosed.

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Article Sections

Introduction
CROSS-BEHAVIOR TECHNIQUES
BEHAVIOR-SPECIFIC TECHNIQUES
GETTING STARTED
References

Finer encouraging patients to change their health behavior is a critical skill for primary care physicians. Modifiable health behaviors contribute to an estimated 40 pct of deaths in the The states.one Tobacco utilize, poor diet, physical inactivity, poor sleep, poor adherence to medication, and similar behaviors are prevalent and can diminish the quality and length of patients' lives. Research has plant an inverse relationship between the risk of all-cause bloodshed and the number of healthy lifestyle behaviors a patient follows.2

Family unit physicians regularly encounter patients who engage in unhealthy behaviors; evidence-based interventions may help patients succeed in making lasting changes. This article will describe brief, evidence-based techniques that family physicians can use to help patients make selected health beliefs changes. (See "Brief evidence-based interventions for health beliefs change.")

KEY POINTS

Modifiable health behaviors, such every bit poor nutrition or smoking, are significant contributors to poor outcomes.
Family unit physicians can employ cursory, show-based techniques to encourage patients to modify their unhealthy behaviors.
Working with patients to develop health goals, eliminate barriers, and rail their own behavior can be beneficial.
Interventions that target specific behaviors, such as prescribing physical activeness for patients who don't get enough practise or providing patient education for improve medication adherence, tin can assist patients to improve their health.

BRIEF EVIDENCE-BASED INTERVENTIONS FOR HEALTH Beliefs Alter

Behavior	Technique	Description
All	SMART goal setting	Ensure that goals are specific, measurable, attainable, relevant, and timely.
	Trouble-solving barriers	Place possible barriers to change and develop solutions.
	Cocky-monitoring	Have patients go along a tape of the behavior they are trying to alter.
Concrete inactivity	Physical activity prescription	Collaboratively work with the patient to pick an activity type, amount, and frequency.
Unhealthy eating	Small changes	Take patients cull small, attainable goals to change their diets, such as reducing the frequency of desserts or soda intake or increasing daily fruit and vegetable consumption.
Unhealthy eating	Plate Method	Encourage patients to blueprint their plates to include 50 percent fruits and vegetables, 25 percent lean protein, and 25 pct grains or starches.
Lack of sleep	Cursory behavioral therapy	Later patients consummate sleep diaries, apply sleep restriction (reducing the corporeality of time in bed) and slumber scheduling (daily bed and wake-up times).
Medication nonadherence	Provide education	Instruct patients on drug therapy: indication, efficacy, condom, and convenience.
	Brand medication routine	Add taking the medication to an existing habit to increase the likelihood patients volition remember (e.g., use inhaler before brushing teeth).
	Engage social network	Shut family members or friends tin can help fill pillboxes or remind patients to take their medications.
Smoking	Accost the 5 Rs	Hash out the relevance to the patient, risks of smoking, rewards of quitting, roadblocks, and echo the discussion.
Smoking	Prepare a quit date	Patients who gear up a quit appointment are more likely to stop smoking and remain abstinent.

Cross-Beliefs TECHNIQUES

Abstract
Cantankerous-BEHAVIOR TECHNIQUES
Beliefs-SPECIFIC TECHNIQUES
GETTING STARTED
References

Although many interventions target specific behaviors, three techniques can exist useful beyond a multifariousness of behavioral change endeavors.

"SMART" goal setting. Goal setting is a primal intervention for patients looking to make behavioral changes.3 Helping patients visualize what they need to do to accomplish their goals may brand it more than likely that they will succeed. The acronym SMART tin be used to guide patients through the goal-setting procedure:

Specific. Encourage patients to get equally specific equally possible virtually their goals. If patients want to be more active or lose weight, how agile practise they want to be and how much weight do they want to lose?
Measurable. Ensure that the goal is measurable. For how many minutes will they exercise and how many times a week?
Attainable. Make sure patients tin reasonably reach their goals. If patients commit to going to the gym daily, how realistic is this goal given their schedule? What would exist a more attainable goal?
Relevant. Ensure that the goal is relevant to the patient. Why does the person want to make this change? How will this change improve his or her life?
Timely. Help patients define a specific timeline for the goal. When exercise they want to attain their goal? When volition you follow-upwards with them? Proximal, rather than distal, goals are preferred. Helping patients set up a goal to lose five pounds in the side by side month may feel less overwhelming than a goal of losing 50 pounds in the next year.

Problem-solving barriers. Physicians may eagerly talk with patients nearly making changes — only to go disillusioned when patients do not follow through. Both physicians and patients may grow frustrated and less motivated to work on the problem. Ane manner to preclude this mutual phenomenon and set patients upwards for success is to begin possible obstacles to behavior modify during visits.

Later offering a suggestion or co-creating a plan, physicians can ask simple, respectful questions such as, "What might get in the way of your [insert beliefs modify]?" or "What might make it difficult to [insert specific step]?" Physicians may conceptualize some common barriers raised by patients just be surprised by others. Once the barriers are defined, the physician and patient tin can develop potential solutions, or if a detail bulwark cannot exist overcome, reevaluate or change the goal. This approach tin improve clinical outcomes for numerous medical weather and for patients of various income levels.four

For case, a patient wanting to lose weight may commit to regular short walks around the block. Upon farther give-and-take, the patient shares that the common cold Minnesota winters and the violence in her neighborhood brand walking in her area difficult. The physician and patient may consider other options such as walking around a local mall or walking with a family member instead. Anticipating every barrier may be impossible, and the problem-solving process may unfold over several sessions; however, exploring potential challenges during the initial goal setting can be helpful.

Cocky-monitoring. Some other effective strategy for facilitating a variety of behavioral changes involves self-monitoring, defined equally regularly tracking some specific element of behavior (e.g., minutes of practice, number of cigarettes smoked) or a more distal outcome (e.thousand., weight). Having patients go on diaries of their behavior over a short period rather than asking them to call up it at a visit can provide more accurate and valuable data, likewise as provide a baseline from which to track change.

When patients agree to self-monitor their behavior, physicians tin can increase the take a chance of success by discussing the specifics of the plan. For example, at what time of day will the patient log his or her behavior? How will the patient retrieve to observe and record the behavior? What will the patient write on the log? Logging the beliefs shortly after information technology occurs will provide the near accurate information. Although patients may be tempted to omit unhealthy behaviors or exaggerate healthy ones, physicians should encourage patients to exist completely honest to maximize their records' usefulness. For self-monitoring to be most effective, physicians should ask patients to bring their tracking forms to follow-up visits, review them together, celebrate successes, discuss challenges, and co-create plans for adjacent steps. (Several diary forms are available in the Patient Handouts section of the FPM Toolbox.)

A variety of digital tracking tools exist, including online programs, smart-phone apps, and smart-picket functions. Physicians can aid patients select which method is most convenient for daily use. Most online programs can nowadays data in charts or graphs, allowing patients and physicians to easily rails modify over time. SuperTracker, a free online plan created by the U.S. Department of Agriculture, helps patients track nutrition and concrete activity plans, set goals, and work with a grouping leader or coach. Apps like Lose It! or MyFitnessPal can also aid.

The procedure of consistently tracking one's behavior is sometimes an intervention itself, with patients frequently sharing that it created cocky-reflection and resulted in some changes. Research shows self-monitoring is effective across several wellness behaviors, peculiarly using food intake monitoring to produce weight loss.5

Behavior-SPECIFIC TECHNIQUES

Abstract
CROSS-Beliefs TECHNIQUES
Behavior-SPECIFIC TECHNIQUES
GETTING STARTED
References

The following evidence-based approaches can be useful in encouraging patients to adopt specific health behaviors.

Physical activity prescriptions. Many Americans do non engage in the recommended amounts of physical activity, which can affect their physical and psychological health. Physicians, even so, rarely talk over physical action with their patients.6 Clinicians ought to human action every bit guides and work with patients to develop personalized concrete activity prescriptions, which have the potential to increment patients' activity levels.vii These prescriptions should list creative options for exercise based on the patient'southward experiences, strengths, values, and goals and be adapted to a patient's condition and treatment goals over fourth dimension. For example, a physician working with a patient who has asthma could prescribe tai chi to assist the patient with breathing control too as residuum and anxiety.

In creating these prescriptions, physicians should help the patient recognize the personal benefits of physical activity; place barriers to concrete activity and how to overcome them; set small, achievable goals; and give patients the confidence to attempt their chosen activeness. Physicians should also put the prescriptions in writing, requite patients logs to track their activity, and ask them to bring those logs to follow-upwards appointments for further word and coaching.eight More information about practise prescriptions and sample forms are available online.

Healthy eating goals. Persuading patients to change their diets is daunting plenty without unrealistic expectations and the constant bombardment of fad diets, cleanses, fasts, and other food trends that often leave both patients and physicians uncertain well-nigh which nutrient options are actually good for you. Moreover, physicians in grooming receive piffling pedagogy on what constitutes audio eating communication and ideal diet.9 This confusion can prevent physicians from broaching the topic with patients. Even if they identify healthy options, mutual setbacks can leave both patients and physicians less motivated to readdress the issue. However, physicians tin can help patients set realistic healthy eating goals using ii simple methods:

Small steps. Studies have shown that one way to combat the inertia of unhealthy eating is to help patients commit to small-scale, actionable, and measurable steps.x Commencement, inquire the patient what pocket-size change he or she would similar to make — for instance, decrease the number of desserts per week by i, swallow 1 more fruit or vegetable serving per mean solar day, or swap one fast food meal per week with a homemade sandwich or salad.eleven Hold on these small changes to empower patients to take control of their diets.
The Plate Method. This model of repast design encourages patients to visualize their plates carve up into the post-obit components: 50 percent fruits and non-starchy vegetables, 25 percent protein, and 25 pct grains or starchy foods.12 Discuss healthy options that would fit in each of the categories, or combine this method with the small steps described higher up. By providing a standard approach that patients can adapt to many forms of cuisine, the model helps physicians empower their patients to assess their food options and adopt good for you eating behaviors.

Brief behavioral therapy for insomnia. Many adults struggle with insufficient or unrestful sleep, and approximately 18.viii pct of adults in the United States meet the criteria for an indisposition disorder.xiii The first-line handling for insomnia is Cognitive Behavioral Therapy for Indisposition (CBT-I), which involves irresolute patients' behaviors and thoughts related to their sleep and is delivered past a trained mental wellness professional. A doc in a clinic visit tin hands administer shorter versions of CBT-I, such as Brief Behavioral Therapy for Indisposition (BBT-I).14 BBT-I is a structured therapy that includes restricting the amount of time spent in bed just not asleep and maintaining a regular sleep schedule from nighttime to night. Here's how it works:

Sleep diary. Take patients maintain a sleep diary for two weeks before starting the treatment. Patients should track when they got in bed, how long it took to fall asleep, how oft they woke up and for how long, what time they woke up for the day, and what time they got out of bed. Many different slumber diaries exist, but the American Academy of Sleep Medicine's version is especially user-friendly.
Educational activity. In the next dispensary appointment, briefly explicate how the body regulates sleep. This includes the sleep drive (how the pressure to sleep is based on how long the person has been awake) and cyclic rhythms (the 24-hour biological clock that regulates the sleep-wake cycle).
Set a wake-up time. Take patients choice a wake-up fourth dimension that will work for them every day. Encourage them to set an alert for that time and get up at that fourth dimension every day, no matter how the previous night went.
Limit "total time in bed." Review the patient's sleep diary and calculate the average number of hours per nighttime the patient slept in the past two weeks. Add together 30 minutes to that average and explain that the patient should be in bed simply for that amount of time per night until your side by side appointment.
Set a target bedtime. Subtract the full time in bed from the chosen wake-upwardly time, and encourage patients to go to bed at that "target" fourth dimension simply if they are sleepy and definitely non any earlier.

For example, if a patient brings in a slumber diary with an boilerplate of vi hours of slumber per night for the by 2 weeks, her recommended total time in bed will be six.five hours. If she picks a wake-up time of 7 a.m., her target bedtime would be 12:xxx a.grand. It usually takes up to three weeks of regular sleep scheduling and sleep restriction for patients to get-go seeing improvements in their sleep. As patients' slumber routines go more solid (i.e., they are falling asleep chop-chop and sleeping more than ninety percent of the fourth dimension they are in bed), slowly increase the full time in bed to peradventure increase time asleep. Physicians should encourage patients to increment time in bed in increments of xv to 30 minutes per week until the ideal amount of sleep is reached. This amount is unlike for each patient, but patients generally have reached their ideal corporeality of sleep when they are sleeping more than 85 percent of the time in bed and feel rested during the day.

Patient teaching to forestall medication nonadherence. Medication adherence tin can be challenging for many patients. In fact, approximately 20 percent to 30 pct of prescriptions are never picked up from the chemist's, and 50 percent of medications for chronic diseases are non taken as prescribed.15 Nonadherence is associated with poor therapeutic outcomes, further progression of disease, and decreased quality of life. To help patients meliorate medication adherence, physicians must determine the reason for nonadherence. The well-nigh common reasons are forgetfulness, fear of side effects, high drug costs, and a perceived lack of efficacy. To help patients alter these beliefs, physicians tin can take several steps:

Brainwash patients on iv key aspects of drug therapy — the reason for taking it (indication), what they should look (efficacy), side effects and interactions (safety), and how it structurally and financially fits into their lifestyle (convenience).sixteen
Aid patients make taking their medication a routine of their daily life. For example, if a patient needs to use a controller inhaler twice daily, recommend using the inhaler earlier brushing his or her teeth each morning and night. Ask patients to describe their day, including morning routines, work hours, and other responsibilities to find optimal opportunities to integrate this new behavior.
Enquire patients, "Who can help you manage your medications?" Social networks, including family members or close friends, tin can help patients set pillboxes or provide medication reminders.

The five Rs to quitting smoking. Despite the well-known consequences of smoking and nationwide efforts to reduce smoking rates, approximately 15 percent of U.Due south. adults yet smoke cigarettes.17 Equally with all kinds of behavioral change, patients present in unlike stages of readiness to quit smoking. Motivational interviewing techniques can be useful to explore a patient'southward ambivalence in a fashion that respects his or her autonomy and bolsters cocky-efficacy. Discussing the five Rs is a helpful approach for exploring ambivalence with patients:xviii

Relevance. Explore why quitting smoking is personally relevant to the patient.
Risks. Propose the patient on negative consequences of standing to smoke.
Rewards. Ask the patient to place the benefits of quitting smoking.
Roadblocks. Help the patient decide obstacles he or she may face when quitting. Mutual barriers include weight gain, stress, fright of withdrawal, fearfulness of failure, and having other smokers such as coworkers or family in close proximity.
Echo. Comprise these aspects into each clinical contact with the patient.

Many patients opt to cut dorsum on the corporeality of tobacco they utilise before their quit date. However, research shows that cutting back on the number of cigarettes is no more constructive than quitting abruptly, and setting a quit engagement is associated with greater long-term success.nineteen

Once the patient sets a quit engagement, repeated doc contact to reinforce smoking abeyance messages is fundamental. Physicians, care coordinators, or clinical staff should consider calling or seeing the patient within ane to 3 days of the quit date to encourage continued efforts to quit, as this time period has the highest take chances for relapse. Prove shows that contacting the patient 4 or more times increases the success charge per unit in staying abstemious.18 Quitting for skilful may take multiple a empts, but continued encouragement and efforts such as setting new quit dates or offering other pharmacologic and behavioral therapies can exist helpful.

GETTING STARTED

Abstruse
Cantankerous-BEHAVIOR TECHNIQUES
Behavior-SPECIFIC TECHNIQUES
GETTING STARTED
References

Family physicians are uniquely positioned to provide encouragement and evidence-based advice to patients to change unhealthy behaviors. The proven techniques described in this article are brief enough to try during clinic visits. They can exist used to encourage concrete activity, healthy eating, meliorate sleep, medication adherence, and smoking abeyance, and they can help patients adapt their lifestyle, improve their quality of life, and, ultimately, lower their risk of early bloodshed.

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Almost THE AUTHORS

prove all writer info

Dr. Hooker is a clinical psychology postdoctoral swain in principal care behavioral health in the Department of Family unit Medicine and Community Wellness (DFMCH) at the University of Minnesota in Minneapolis....

Dr. Punjabi is an ambulatory care pharmacy resident at the University of Minnesota College of Pharmacy.

Dr. Justesen is an assistant professor in the DFMCH and medical director of the University of Minnesota Physicians' Broadway Family Medicine Dispensary in Minneapolis.

Dr. Boyle is a start-yr family unit medicine resident at the Broadway Family Medicine/North Memorial Family Medicine Residency Program in Minneapolis.

Dr. Sherman is a licensed clinical psychologist and professor in the DFMCH.

Writer disclosures: no relevant financial affiliations disclosed.

References

show all references

one. McGinnis JM. Actual causes of expiry, 1990–2010. Presentation at the Workshop on Determinants of Premature Mortality, National Enquiry Quango; September 18, 2013; Washington, D.C. ...

2. Loef Chiliad, Walach H. The combined effects of healthy lifestyle behaviors on all-crusade mortality: a systematic review and meta-assay. Prev Med. 2012;55(three):163–170.

3. Bodenheimer T, Handley MA. Goal-setting for beliefs change in primary care: an exploration and status report. Patient Educ Couns. 2009;76(ii):174–180.

4. Lilly CL, Bryant LL, Leary JM, et al. Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in three underserved populations: Colorado, N Carolina, West Virginia, 2009. Prev Chronic Dis. 2014;xi:E32.

5. U.South. Department of Agriculture and U.S. Section of Wellness and Human Services. Dietary Guidelines for Americans (7th Ed). Washington, D.C: U.South. Regime Printing Role; 2010.

six. Sreedhara M, Silfee VJ, Rosal MC, Waring ME, Lemon SC. Does provider advice to increase concrete activity differ by activity level among U.South. adults with cardiovascular disease risk factors? Fam Pract. 2018;35(iv):420-425.

vii. Pinto BM, Lynn H, Marcus BH, DePue J, Goldstein MG. Doctor-based activeness counseling: intervention effects on mediators of motivational readiness for physical activeness. Ann Behav Med. 2001;23(1):two–10.

8. Hechanova RL, Wegler JL, Forest CP. Exercise: a vitally important prescription. JAAPA. 2017;xxx(four):17–22.

nine. Guo H, Pavek G, Loth K. Management of childhood obesity and overweight in primary care visits: gaps between recommended care and typical practice. Curr Nutr Rep. 2017;half dozen(iv):307–314.

10. Perkins-Porras L, Cappuccio FP, Rink Eastward, Hilton Due south, McKay C, Steptoe A. Does the result of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change? Prev Med. 2005; 40(three):314–320.

11. Kahan S, Manson JE. Nutrition counseling in clinical exercise: how clinicians tin exercise better. JAMA. 2017;318(12):1101–1102.

12. Choose My Plate. U.S. Department of Agriculture website. https://world wide web.choosemyplate.gov/. Updated January 31, 2018. Accessed February 1, 2018.

13. Ford ES, Cunningham TJ, Giles WH, Croff JB. Trends in insomnia and excessive daytime sleepiness among U.Southward. adults from 2002 to 2012. Sleep Med. 2015;16(iii):372–378.

14. Edinger JD, Sampson WS. A primary intendance "friendly" cognitive behavioral insomnia therapy. Sleep. 2003;26(2):177–182.

15. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United states of america: a systematic review. Ann Intern Med. 2012;157(eleven):785–795.

16. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical intendance practice: the patient-centered approach to medication management services. 3rd ed. New York: McGraw-Loma; 2012.

17. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking amid adults — United States, 2005–2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1205–1211.

18. Patients not set up to brand a quit endeavor now (the "5 Rs"). Agency for Healthcare Research and Quality website. http://bit.ly/2jVvpoY. Updated December 2012. Accessed Feb 2, 2018.

nineteen. Larzelere MM, Williams DE. Promoting smoking cessation. Am Fam Physician. 2012;85(half dozen):591–598.

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