Preventing disease through opportunistic, rapid engagement by primary care teams using behaviour change counselling (PRE-EMPT): protocol for a general practice-based cluster randomised trial

Abstract

BackgroundSmoking, excessive alcohol consumption, lack of exercise and an unhealthy diet are the key modifiable factors contributing to premature morbidity and mortality in the developed world. Brief interventions in health care consultations can be effective in changing single health behaviours. General Practice holds considerable potential for primary prevention through modifying patients' multiple risk behaviours, but feasible, acceptable and effective interventions are poorly developed, and uptake by practitioners is low. Through a process of theoretical development, modeling and exploratory trials, we have developed an intervention called Behaviour Change Counselling (BCC) derived from Motivational Interviewing (MI). This paper describes the protocol for an evaluation of a training intervention (the Talking Lifestyles Programme) which will enable practitioners to routinely use BCC during consultations for the above four risk behaviours.Methods/DesignThis cluster randomised controlled efficacy trial (RCT) will evaluate the outcomes and costs of this training intervention for General Practitioners (GPs) and nurses. Training methods will include: a practice-based seminar, online self-directed learning, and reflecting on video recorded and simulated consultations. The intervention will be evaluated in 29 practices in Wales, UK; two clinicians will take part (one GP and one nurse) from each practice. In intervention practices both clinicians will receive training. The aim is to recruit 2000 patients into the study with an expected 30% drop out. The primary outcome will be the proportion of patients making changes in one or more of the four behaviours at three months. Results will be compared for patients seeing clinicians trained in BCC with patients seeing non-BCC trained clinicians. Economic and process evaluations will also be conducted.DiscussionOpportunistic engagement by health professionals potentially represents a cost effective medical intervention. This study integrates an existing, innovative intervention method with an innovative training model to enable clinicians to routinely use BCC, providing them with new tools to encourage and support people to make healthier choices. This trial will evaluate effectiveness in primary care and determine costs of the intervention.Trial RegistrationISRCTN22495456

Counselling patients about behaviour change: the challenge of talking about diet

“…The primary aim was to examine the efficacy of using such counselling during consultations by reporting the proportion of patients making changes in one or more of four behaviours: smoking, alcohol intake, eating, and exercise. 3 Although the emphasis of the PRE-EMPT trial was on how practitioners advised patients through recordings of simulated consultations by clinicians, it also provided an opportunity to study what advice was given. This article reports on an analysis of audiotaped consultations between simulated patients, and GPs and nurses, which enable a contrast between the content of smoking cessation and healthy eating consultations to be made.…”

“…3 Twenty-nine general practices in Wales were recruited and randomised to usual care or to the intervention arm; one doctor and one nurse from each practice participated. The intervention involved clinician training in behaviour change counselling using a blended learning programme.…”

“…3,4 Patients consult their GP on average 5.5 times a year 5 and, if clinicians do not engage in health promotion there is the risk that patients assume there are no concerns. 6 Smoking levels have dropped in the UK over the last decade, whereas obesity rates have risen; 2 talking about healthy diets, physical activity, and other factors relating to obesity are, therefore, a pressing challenge.…”

“…14 To improve how health professionals provide advice, researchers have adapted behaviour change techniques for healthy eating counselling, derived from motivational interviewing. 3,15 Successful use of this technique regarding reducing alcohol intake and quitting smoking suggests this approach could be used for dietary concerns. 16 However, how information is provided is unlikely to lead to significant change if there is a lack of clarity regarding what dietary changes to recommend and implement.…”

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

“…105 This suggested to us that instead of focusing on generic CHD or depression risk factors, the new intervention should enable patients to specify their own goals, for instance stopping smoking or increasing social contact, so that work is directed towards outcomes important to patients.…”