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

C. C. Butler, S. A. Simpson, K. Hood, D. Cohen, T. Pickles, C. Spanou, J. McCambridge, L. Moore, E. Randell, M. F. Alam, P. Kinnersley, A. Edwards, C. Smith, S. Rollnick, Fasihul Alam

BMJ, Volume: 346, Issue: mar19 3, Pages: f1191 - f1191

Swansea University Author: Fasihul Alam

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DOI (Published version): 10.1136/bmj.f1191

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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...

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Published in: BMJ
Published: 2013
URI: https://cronfa.swan.ac.uk/Record/cronfa20829
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2015-04-21T17:26:25.1887061</datestamp><bib-version>v2</bib-version><id>20829</id><entry>2015-04-21</entry><title>Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial</title><swanseaauthors><author><sid>642c9290a11352cb60741fc2b1004f6d</sid><ORCID/><firstname>Fasihul</firstname><surname>Alam</surname><name>Fasihul Alam</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2015-04-21</date><deptcode>HHE</deptcode><abstract>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 &#xA3;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.</abstract><type>Journal Article</type><journal>BMJ</journal><volume>346</volume><journalNumber>mar19 3</journalNumber><paginationStart>f1191</paginationStart><paginationEnd>f1191</paginationEnd><publisher/><keywords/><publishedDay>31</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2013</publishedYear><publishedDate>2013-03-31</publishedDate><doi>10.1136/bmj.f1191</doi><url/><notes/><college>COLLEGE NANME</college><department>Swansea Centre for Health Economics</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HHE</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2015-04-21T17:26:25.1887061</lastEdited><Created>2015-04-21T17:26:25.1887061</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care</level></path><authors><author><firstname>C. C.</firstname><surname>Butler</surname><order>1</order></author><author><firstname>S. A.</firstname><surname>Simpson</surname><order>2</order></author><author><firstname>K.</firstname><surname>Hood</surname><order>3</order></author><author><firstname>D.</firstname><surname>Cohen</surname><order>4</order></author><author><firstname>T.</firstname><surname>Pickles</surname><order>5</order></author><author><firstname>C.</firstname><surname>Spanou</surname><order>6</order></author><author><firstname>J.</firstname><surname>McCambridge</surname><order>7</order></author><author><firstname>L.</firstname><surname>Moore</surname><order>8</order></author><author><firstname>E.</firstname><surname>Randell</surname><order>9</order></author><author><firstname>M. F.</firstname><surname>Alam</surname><order>10</order></author><author><firstname>P.</firstname><surname>Kinnersley</surname><order>11</order></author><author><firstname>A.</firstname><surname>Edwards</surname><order>12</order></author><author><firstname>C.</firstname><surname>Smith</surname><order>13</order></author><author><firstname>S.</firstname><surname>Rollnick</surname><order>14</order></author><author><firstname>Fasihul</firstname><surname>Alam</surname><orcid/><order>15</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2015-04-21T17:26:25.1887061 v2 20829 2015-04-21 Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial 642c9290a11352cb60741fc2b1004f6d Fasihul Alam Fasihul Alam true false 2015-04-21 HHE 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. Journal Article BMJ 346 mar19 3 f1191 f1191 31 3 2013 2013-03-31 10.1136/bmj.f1191 COLLEGE NANME Swansea Centre for Health Economics COLLEGE CODE HHE Swansea University 2015-04-21T17:26:25.1887061 2015-04-21T17:26:25.1887061 Faculty of Medicine, Health and Life Sciences School of Health and Social Care C. C. Butler 1 S. A. Simpson 2 K. Hood 3 D. Cohen 4 T. Pickles 5 C. Spanou 6 J. McCambridge 7 L. Moore 8 E. Randell 9 M. F. Alam 10 P. Kinnersley 11 A. Edwards 12 C. Smith 13 S. Rollnick 14 Fasihul Alam 15
title Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
spellingShingle Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
Fasihul Alam
title_short Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
title_full Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
title_fullStr Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
title_full_unstemmed Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
title_sort Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial
author_id_str_mv 642c9290a11352cb60741fc2b1004f6d
author_id_fullname_str_mv 642c9290a11352cb60741fc2b1004f6d_***_Fasihul Alam
author Fasihul Alam
author2 C. C. Butler
S. A. Simpson
K. Hood
D. Cohen
T. Pickles
C. Spanou
J. McCambridge
L. Moore
E. Randell
M. F. Alam
P. Kinnersley
A. Edwards
C. Smith
S. Rollnick
Fasihul Alam
format Journal article
container_title BMJ
container_volume 346
container_issue mar19 3
container_start_page f1191
publishDate 2013
institution Swansea University
doi_str_mv 10.1136/bmj.f1191
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 0
active_str 0
description 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.
published_date 2013-03-31T03:24:40Z
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