Guidance on changing health behaviours – what is the evidence, what’s recommended, and do I agree?News - Mar. 30, 2017
Professor Christi Deaton - University of Cambridge, United Kingdom
Guidance on changing health behaviours – what is the evidence, what’s recommended, and do I agree?
In her presentation, prof. Deaton emphasised the important role primary care physicians can play in primary prevention of CVD; it is of great importance that GPs and practice nurses are truly engaged. Not all strategies are alike, thus it is important to consider how health behaviours can be changed
Among others, cognitive behavioural strategies to induce behavioural changes can be used and have been shown to be effective. In general, effective techniques focus on helping people to develop skills to set goals, to achieve those, and on how to overcome barriers to make changes.
Remaining questions in the field include how different techniques may be used. Moreover, it is important to be precise when publishing studies, so that it is clear what people do when they use behavioural techniques. This way, the information will be more valuable to other physicians.
The ESC CV Prevention Guidelines recommend that primary care professionals deliver CVD prevention for high-risk patients. More specifically, recommendations for facilitating changes in behaviour include established cognitive behavioural strategies, involvement of multidisciplinary healthcare professionals and applying multimodal interventions. Principles of effective communication and ten strategic steps to facilitate behavioural change are given. Having sufficient time to follow the guidance is a challenge in many busy practices. This may be overcome by involving other people, by setting up multidisciplinary groups. Nurse-led programmes can be very effective. Involving a nurse in stimulating health behaviour changes, does not mean that the GP is no longer responsible. The GP has a role in asking about the behaviours and to give feedback on the behaviour, possibly supported by for instance repeated BP measurements.
It is important to consider whether GPs have the needed skills to stimulate patients in the right way; practices should be equipped to regard this as just as important as pharmacotherapy. Few GPs in the audience were, however, trained in motivational interview techniques. It may be easily underestimated how patients can be helped to set goals, and many GPs are likely not as skilled as they good be if they had received proper training. Often, we tend to want to persuade patients by sharing the evidence that specific behaviour is good for them. At the same time, we know that this rarely works.
Currently, a big gap exists between what the guidelines recommend and what actually happens in practice. Existing gaps in skills, available time and resources raise the question who is responsible. The guidelines recommend that different parties should act together. The doctor has a responsibility, the patient is ultimately responsible for his/her own health, but there is also a role for society. Even though it is a shared responsibility, GPs should not forget what they can do.