Lifestyle counseling in primary care: opportunities and challenges for changing practice

Joan Sargeant Associate Professora*, Michel Vallia, Suzanne Ferriera & Heather MacLeodaa Dalhousie University, Halifax, CanadaJOAN SARGEANT, PhD, is Associate Professor, Division of Medical Education and Director Program Development and Evaluation, Continuing Medical Education, Dalhousie University, Halifax, NS and CME Coordinator, Communication Skills Program, Division of Medical Education. She is responsible for providing communication skills instruction for physicians and conducting research related to its effectiveness.MICHAEL VALLIS, PhD, is a Health Psychologist, Queen Elizabeth II Health Sciences and Associate Professor, Psychiatry, and Adjunct Professor, Psychology, Dalhousie University, Halifax, NS. He specializes in behaviour change, motivational enhancement and emotion management.SUZANNE FERRIER, MSc, is a research associate in the Office of Continuing Medical Education at Dalhousie University, Halifax, NS and a PhD student in the Dalhousie Interdisciplinary PhD Programme. Her research interests are in physical activity counseling, chronic disease prevention, health behaviour change and physician learning.HEATHER MACLEOD, MA, is a research associate in the Division of Medicine Education at Dalhousie University, Halifax, NS whose research interests focus on communication skills in medicine.† Correspondence: Joan Sargeant, Associate Professor, Associate Professor, Division of Medical Education, Director Program Development and Evaluation, Continuing Medical Education, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Halifax NS, B3H 4H7, (902)494-1995, (902)494-1479 joan.sargeant@dal.caBackground: Many patients today have health concerns related to lifestyle factors. This has created a situation where physicians are regularly confronted with the challenge of how to conduct lifestyle counseling with patients. Specific strategies can enable physicians to more effectively navigate this complex area of communication with patients, improving patient response in adopting healthy behaviours and increasing physician satisfaction with this task.Aim: To evaluate the impact of a lifestyle counseling workshop incorporating the motivational enhancement and transtheoretical models upon primary care clinicians’ counseling practice patterns, especially communication and counseling skills, and attitudes toward lifestyle counseling.Method: This study used a mixed method research design. Forty-three clinicians completed a post-workshop evaluation and identified intended changes to practice following the workshop. Twelve participated in interviews several months later to explore the kinds of changes made and influences upon them.Results: Forty-one (95.3%) questionnaire respondents reported an intention to change their practice. Main changes reported were: asking more questions, listening more, assessing patients’ readiness to change, tailoring counseling to patients’ readiness to change. They seemed to have acquired and retained new knowledge and most were able to apply the new skills in their practices. Many reported feeling more comfortable and/or confident when interacting with patients in need of lifestyle change. But, time constraints, comfort with current skills, lack of self-efficacy, and fears of missing opportunities to influence patients, moderated participants’ ability to adopt and maintain new approaches.Conclusions: While primary care clinicians can successfully learn specific lifestyle counseling skills and incorporate them into their practice following a two-hour evidence-based workshop, individual, educational and system factors can interfere.

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