Helping Patients Adopt Healthier Behaviors

A ssisting patients to improve health-related behaviors is an important responsibility of caregivers, including physicians, nurses, health educators, and counselors. From 1992 to 2000, diet and physical activity counseling took place in < 45 and 30%, respectively, of primary care physician visits by adults with coronary heart disease risk factors.1 Physicians in primary care seldom have time to engage in such discussions and may be unsure how to discuss behavior change with their patients;1-3 nonphysicians are generally the appropriate caregivers to assist patients in adopting healthy behaviors. This article describes a goal-setting method for discussing behavior change with patients in the primary care setting and provides a training guide for clinicians and nonprofessional practice staff. To address the barrier of insufficient time, each primary care practice needs to decide which caregivers—clinicians, nursing personnel, medical assistants, health educators, community health workers, or other patients—can realistically engage patients in goal-setting discussions and whether the activity is best conducted with patients individually or in groups. Goal setting is a collaborative process in which patients choose a behavior-change goal. Goal setting takes place after the clinician has assessed the patient's problem, provided necessary information, and engaged the patient in decision making regarding medical or surgical management of the patient's condition. Most patients with chronic conditions or adverse risk factors would benefit from behavior change to implement an evidence-based management plan. Goal setting is a technique to assist patients in working toward healthier behaviors. One excellent way to initiate a goalsetting discussion is to ask the question used by Stanford Medical School's Dr. Kate Lorig, an international leader in helping patients cope with chronic disease: “Is there anything you would like to do this week to improve your health?” This question allows patients to choose which behavior they are motivated to …