Journal Article

Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial

Cohen, David, Spanou, Clio, Simpson, Sharon A, Rollnick, Stephen, Randell, Elizabeth, Kinnersley, Paul, Butler, Christopher C, Edwards, Adrian, Pickles, Tim, McCambridge, Jim, Alam, M Fasihul, Smith, Christine, Hood, Kerenza, Moore, Laurence

2013

Overview

Objectives To evaluate the effect of training primary care health professionals in behaviour change counselling on the proportion of patients self reporting change in four risk behaviours (smoking, alcohol use, exercise, and healthy eating).Design Cluster randomised trial with general practices as the unit of randomisation.Setting General practices in Wales.Participants 53 general practitioners and practice nurses from 27 general practices (one each at all but one practice) recruited 1827 patients who screened positive for at least one risky behaviour.Intervention Behaviour change counselling was developed from motivational interviewing to enable clinicians to enhance patients’ motivation to change health related behaviour. Clinicians were trained using a blended learning programme called Talking Lifestyles.Main outcome measures Proportion of patients who reported making beneficial changes in at least one of the four risky behaviours at three months.Results 1308 patients from 13 intervention and 1496 from 14 control practices were approached: 76% and 72% respectively agreed to participate, with 831 (84%) and 996 (92%) respectively screening eligible for an intervention. There was no effect on the primary outcome (beneficial change in behaviour) at three months (362 (44%) v 404 (41%), odds ratio 1.12 (95% CI 0.90 to 1.39)) or on biochemical or biometric measures at 12 months. More patients who had consulted with trained clinicians recalled consultation discussion about a health behaviour (724/795 (91%) v 531/966 (55%), odds ratio 12.44 (5.85 to 26.46)) and intended to change (599/831 (72%) v 491/996 (49%), odds ratio 2.88 (2.05 to 4.05)). More intervention practice patients reported making an attempt to change (328 (39%) v 317 (32%), odds ratio 1.40 (1.15 to 1.70)), a sustained behaviour change at three months (288 (35%) v 280 (28%), odds ratio 1.36 (1.11 to 1.65)), and reported slightly greater improvements in healthy eating at three and 12 months, plus improved activity at 12 months. Training cost £1597 per practice.Discussion Training primary care clinicians in behaviour change counselling using a brief blended learning programme did not increase patients reported beneficial behaviour change at three months or improve biometric and a biochemical measure at 12 months, but it did increase patients’ recollection of discussing behaviour change with their clinicians, intentions to change, attempts to change, and perceptions of having made a lasting change at three months. Enduring behaviour change and improvements in biometric measures are unlikely after a single routine consultation with a clinician trained in behaviour change counselling without additional intervention.Trial registration ISRCTN 22495456

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group Ltd
• Subject: Addictive behaviors / Adult / Adult learning / Alcohol / Attitude to Health / Behavior / Behavior modification / Biochemistry / Biometrics / Cardiovascular disease / Cluster Analysis / Confidence Intervals / Counseling / Diet / Evidence-based medicine / Experimentation / Female / General practice / General Practice - organization & administration / General Practitioners - education / Health Behavior / Health care policy / Health outcomes / Humans / Hypertension / Intervention / Life Style / Lifestyle / Lifestyles / Male / Medical personnel / Middle Aged / Mortality / Motivation / Nurse Practitioners - education / Odds Ratio / Opportunistic behavior / Patient Compliance - statistics & numerical data / Patients / Physician-Patient Relations / Prevention / Primary care / Primary health care / Primary Health Care - organization & administration / Program Evaluation / Psychoeducational intervention / Risk Assessment / Risk factors / Smoke curing / Smoking / Time Factors / Treatment Outcome / Wales