BackgroundHealth related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients.MethodsOur new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques—such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors’ communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the “Health Coaching” programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients’ self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues.ResultsIn total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8–22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the “Health Coaching” programme were consistently high.ConclusionsOur innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.
Gesundheitsförderung und (Krankheits-)Prävention gehören zu den zentralen Themenbereichen von Public Health. Beide haben die Stärkung der Gesundheit der Menschen zum Ziel. Während bei der Gesundheitsförderung die Zunahme und Mobilisierung von Gesundheitsressourcen im Vordergrund stehen, soll bei der Prävention die Krankheitslast zurückgedrängt werden. In diesem Kapitel gehen wir zu Beginn auf die Grundlagen von Gesundheitsförderung und Prävention ein. Nachdem wir uns verschiedene Erklärungsmodelle des Gesundheitsverhaltens angeschaut haben, betrachten wir jeweils kurz die wichtigsten Gesundheitsverhaltensweisen, die sich negativ auf unsere Gesundheit auswirken: Bewegungsmangel, ungesunde Ernährung, Alkoholmissbrauch, Rauchen und Stress. Sie sind meist Teil eines gesundheitsrelevanten Lebensstils und können erheblichen Einfluss auf die Gesundheit der Menschen haben. Zur Umsetzung von Lebensstiländerungen bedarf es einer entsprechenden Gesundheitskompetenz. Aufgabe von Public-Health-Fachleuten ist es, die Gesundheit der Bevölkerung oder von Bevölkerungsgruppe z. B. mit Hilfe von Projekten in der Gesundheitsförderung zu verbessern. Ärztinnen und Ärzte können das Gesundheitsverhalten ihrer PatientInnen in der Arztpraxis ansprechen und neben der Gesundheitsberatung auch periodische Gesundheitsuntersuchungen anbieten. Mit Hilfe von bevölkerungsweit durchgeführten Screening-Programmen sollen schließlich bestimmte Erkrankungen, die mit einer erheblichen Krankheitslast verbunden sind, frühzeitig erkannt werden, um das Risiko einer zukünftigen Gesundheitsbeeinträchtigung zu reduzieren.
Health related behaviour is a main determinant of chronic disease. Family physicians have an important role in the support of patients to improve their health behaviour, but relevant barriers should be addressed. In the new "Health Coaching KHM" program, patients and physicians are working as a team in four steps (sensitize -create motivation -plan -act). In this process, physicians' communication skills (which are trained within the program) are of utmost importance. In a pilot study with 20 family physicians and 1045 patients acceptance and feasibility were excellent: Every second participant improved her or his behaviour in the area of choice by at least one (of two possible) categories. For dissemination improving framework is crucial.
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