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Analysis: ‘Target interventions to the most motivated’

Now that most infections are under control, chronic diseases which require behaviour change as main therapeutic intervention are probably the biggest challenges facing the NHS.

It is primary care that has to deliver this message to the public, but we all know that behaviour change is difficult.

Our trial was taking a generic approach across four risky behaviours: alcohol, smoking, exercise and diet. It is very promising that patients who consulted the trained GPs and practice nurses reported at least that they had greater intention to change their behaviour, and were more likely to have made an attempt to change.  We only found small changes in actual behaviour but there were improvements in healthy eating and activity.  

The reason for only finding small changes could be that patients in the trial were consulting GPs and nurses about other matters, so many of them would have had other things on their mind at the time of the consultation.  Also most of them were only seen once during the trial period.

But GPs see patients around five times a year – and these could be opportunities to ‘make every contact count’ as the Government wants.

We need to be careful and avoid lecturing patients because there is evidence that patients don’t like us going on about smoking and drinking particularly if the consultation is not relevant to those behaviours. So we shouldn’t do behaviour change in every consultation, but we should be considering it at least in every consultation.

GPs and practice nurses have a very important part to play in helping patients lose weight and eat more healthily, but they may struggle as to what advice to actually give. General portion reductions? Eat more fruit and veg? Less dairy products? Less alcohol? It is a complicated area.

The skills-based approach we have developed could be used by GPs and nurses in their routine consultations. It would enable them to target the behaviour change counselling to those patients who seem most motivated - or for whom there is greatest clinical need – and to re-enforce the message and provide further support at subsequent consultations.

The secret is to adopt these skills fully into your consultation style. Many GPs may need further training to be really effective, and time is also a challenge, but we had no evidence that training led to GPs having to extend their consultations and the positive outcomes of this trial are very encouraging.  

Professor Paul Kinnersley is a GP and director of teaching at the Cochrane Institute of Primary Care and Public Health, Cardiff University