Objective To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease. Design Cluster randomised controlled trial. Participants 883 men and women selected for the presence of one or more modifiable risk factors: regular cigarette smoking, high serum cholesterol concentration (6.5-9.0 mmol/l), and high body mass index (25-35) combined with low physical activity. Intervention Brief behavioural counselling, on the basis of the stage of change model, carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity. Main outcome measures Questionnaire measures of diet, exercise, and smoking habits, and blood pressure, serum total cholesterol concentration, weight, body mass index, and smoking cessation (with biochemical validation) at 4 and 12 months. Results Favourable differences were recorded in the intervention group for dietary fat intake, regular exercise, and cigarettes smoked per day at 4 and 12 months. Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months. No differences were found between groups in changes in total serum cholesterol concentration, weight, body mass index, diastolic pressure, or smoking cessation. Conclusions Brief behavioural counselling by practice nurses led to improvements in healthy behaviour. More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge.

It is recognized that health promotion involves more than the provision of simple information and advice, but GPs and practice nurses lack confidence in lifestyle counselling skills. The attitudes of health professionals are crucial to the implementation of prevention strategies and require regular review.

The stages-of-change model developed by Prochaska and DiClemente was applied to readiness for dietary fat reduction in a postal survey of adults in South London (N = 366). The percentage of respondents falling into each stage was as follows: precontemplation 35.1, contemplation 12.7, preparation 4.1, action 5.5, and maintenance 42.5. More men than women were precontemplators, while more women were in the maintenance stage. Significant associations with dietary fat consumption were observed, but there was no relationship with fibre intake. Cognitive and motivational correlates of healthy eating were associated with stage of change. However, the stage model was of only moderate value in accounting for current dietary habits. Implications for health education are discussed.

Previous attempts to influence individuals' behaviour in order to lessen cardiovas cular risk have met with limited success. We report on the way in which the Stages of Change model was used by trained practice nurses in a randomised controlled trial. Patients with one or more modifiable risk factors (regular smoking, high choles terol, or the combination of high body mass index and low physical activity) were recruited during routine care at 20 group general practices in inner city to rural areas over 18 months. Baseline measurements on 883 people show that the control and intervention groups were reasonably matched, with one, two and three risk factors found among approximately 43, 48 and 9 per cent, respectively. Some differences between groups in readiness to modify behaviour as assessed by stage of change were observed. This trial will evaluate systematically the impact of brief behav ioural counselling in general practice.

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