Which Of The Following Is The Best Way To Start Changing An Unhealthy Behavior?

Encouraging Health Beliefs Change: Eight Evidence-Based Strategies

Using these cursory interventions, you tin can help your patients brand healthy beliefs changes.

Stephanie A. Hooker, PhD, MPH, Anjoli Punjabi, PharmD, MPH, Kacey Justesen, Physician, Lucas Boyle, Doc, and Michelle D. Sherman, PhD, ABPP

Fam Pract Manag. 2018 Mar-Apr;25(2):31-36.

Author disclosures: no relevant financial affiliations disclosed.

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Commodity Sections

Introduction
CROSS-Beliefs TECHNIQUES
Beliefs-SPECIFIC TECHNIQUES
GETTING STARTED
References

Effectively encouraging patients to alter their wellness behavior is a critical skill for primary care physicians. Modifiable health behaviors contribute to an estimated 40 percent of deaths in the United States.1 Tobacco use, poor diet, concrete inactivity, poor sleep, poor adherence to medication, and similar behaviors are prevalent and can diminish the quality and length of patients' lives. Research has found an inverse relationship between the risk of all-cause mortality and the number of healthy lifestyle behaviors a patient follows.2

Family physicians regularly run into patients who engage in unhealthy behaviors; bear witness-based interventions may help patients succeed in making lasting changes. This commodity will depict cursory, prove-based techniques that family physicians can utilise to assist patients make selected health beliefs changes. (Meet "Cursory testify-based interventions for health behavior change.")

Central POINTS

Modifiable wellness behaviors, such as poor diet or smoking, are significant contributors to poor outcomes.
Family physicians tin can employ cursory, evidence-based techniques to encourage patients to modify their unhealthy behaviors.
Working with patients to develop wellness goals, eliminate barriers, and track their ain behavior can be beneficial.
Interventions that target specific behaviors, such as prescribing concrete activity for patients who don't get enough practice or providing patient education for better medication adherence, can assistance patients to improve their health.

BRIEF Bear witness-BASED INTERVENTIONS FOR Wellness Behavior CHANGE

Behavior	Technique	Description
All	SMART goal setting	Ensure that goals are specific, measurable, attainable, relevant, and timely.
	Problem-solving barriers	Identify possible barriers to change and develop solutions.
	Self-monitoring	Take patients go on a record of the behavior they are trying to change.
Physical inactivity	Physical activity prescription	Collaboratively work with the patient to choice an action type, amount, and frequency.
Unhealthy eating	Small changes	Have patients cull small, attainable goals to change their diets, such as reducing the frequency of desserts or soda intake or increasing daily fruit and vegetable consumption.
Unhealthy eating	Plate Method	Encourage patients to pattern their plates to include 50 percent fruits and vegetables, 25 per centum lean protein, and 25 percent grains or starches.
Lack of sleep	Brief behavioral therapy	Later patients complete sleep diaries, use sleep restriction (reducing the amount of time in bed) and sleep scheduling (daily bed and wake-up times).
Medication nonadherence	Provide education	Instruct patients on drug therapy: indication, efficacy, safety, and convenience.
	Brand medication routine	Add taking the medication to an existing habit to increase the likelihood patients will recollect (e.g., use inhaler before brushing teeth).
	Appoint social network	Close family unit members or friends can help fill up pillboxes or remind patients to accept their medications.
Smoking	Accost the 5 Rs	Discuss the relevance to the patient, risks of smoking, rewards of quitting, roadblocks, and repeat the give-and-take.
Smoking	Set a quit appointment	Patients who set a quit date are more likely to stop smoking and remain abstinent.

Cantankerous-BEHAVIOR TECHNIQUES

Abstract
CROSS-Beliefs TECHNIQUES
Beliefs-SPECIFIC TECHNIQUES
GETTING STARTED
References

Although many interventions target specific behaviors, three techniques can be useful across a variety of behavioral alter endeavors.

"SMART" goal setting. Goal setting is a key intervention for patients looking to make behavioral changes.three Helping patients visualize what they demand to practise to reach their goals may make it more probable that they will succeed. The acronym SMART can exist used to guide patients through the goal-setting process:

Specific. Encourage patients to get as specific as possible about their goals. If patients want to be more agile or lose weight, how active do they want to be and how much weight do they desire to lose?
Measurable. Ensure that the goal is measurable. For how many minutes will they exercise and how many times a week?
Accessible. Make sure patients can reasonably accomplish their goals. If patients commit to going to the gym daily, how realistic is this goal given their schedule? What would exist a more than attainable goal?
Relevant. Ensure that the goal is relevant to the patient. Why does the person want to make this change? How will this change improve his or her life?
Timely. Aid patients ascertain a specific timeline for the goal. When do they want to accomplish their goal? When volition you follow-up with them? Proximal, rather than distal, goals are preferred. Helping patients set a goal to lose v pounds in the side by side month may feel less overwhelming than a goal of losing fifty pounds in the next year.

Problem-solving barriers. Physicians may eagerly talk with patients nigh making changes — simply to get disillusioned when patients do not follow through. Both physicians and patients may abound frustrated and less motivated to work on the problem. One way to prevent this common miracle and set patients up for success is to begin possible obstacles to behavior change during visits.

After offer a proposition or co-creating a plan, physicians can ask uncomplicated, respectful questions such as, "What might arrive the fashion of your [insert behavior modify]?" or "What might arrive difficult to [insert specific step]?" Physicians may anticipate some common barriers raised by patients but be surprised by others. Once the barriers are defined, the doc and patient can develop potential solutions, or if a item barrier cannot exist overcome, reevaluate or change the goal. This arroyo tin improve clinical outcomes for numerous medical conditions and for patients of diverse income levels.four

For example, a patient wanting to lose weight may commit to regular brusque walks effectually the block. Upon further word, the patient shares that the cold Minnesota winters and the violence in her neighborhood make walking in her expanse hard. The physician and patient may consider other options such as walking around a local mall or walking with a family member instead. Anticipating every barrier may exist impossible, and the problem-solving process may unfold over several sessions; withal, exploring potential challenges during the initial goal setting can be helpful.

Cocky-monitoring. Another effective strategy for facilitating a variety of behavioral changes involves self-monitoring, divers as regularly tracking some specific element of behavior (e.1000., minutes of practice, number of cigarettes smoked) or a more distal upshot (e.g., weight). Having patients proceed diaries of their behavior over a short period rather than asking them to recollect information technology at a visit can provide more accurate and valuable data, equally well equally provide a baseline from which to track change.

When patients concord to self-monitor their behavior, physicians can increase the chance of success by discussing the specifics of the program. For example, at what time of 24-hour interval will the patient log his or her behavior? How will the patient retrieve to find and record the behavior? What volition the patient write on the log? Logging the behavior soon afterward it occurs will provide the nearly accurate data. Although patients may be tempted to omit unhealthy behaviors or exaggerate healthy ones, physicians should encourage patients to be completely honest to maximize their records' usefulness. For self-monitoring to be most constructive, physicians should ask patients to bring their tracking forms to follow-up visits, review them together, celebrate successes, discuss challenges, and co-create plans for adjacent steps. (Several diary forms are available in the Patient Handouts section of the FPM Toolbox.)

A variety of digital tracking tools exist, including online programs, smart-phone apps, and smart-watch functions. Physicians can assist patients select which method is about convenient for daily use. About online programs tin can present data in charts or graphs, assuasive patients and physicians to hands track alter over time. SuperTracker, a costless online program created by the U.S. Department of Agronomics, helps patients track nutrition and physical activity plans, prepare goals, and work with a group leader or coach. Apps like Lose It! or MyFitnessPal can likewise aid.

The process of consistently tracking i'south behavior is sometimes an intervention itself, with patients often sharing that it created self-reflection and resulted in some changes. Inquiry shows cocky-monitoring is constructive across several health behaviors, especially using nutrient intake monitoring to produce weight loss.v

BEHAVIOR-SPECIFIC TECHNIQUES

Abstract
CROSS-BEHAVIOR TECHNIQUES
BEHAVIOR-SPECIFIC TECHNIQUES
GETTING STARTED
References

The following evidence-based approaches can exist useful in encouraging patients to adopt specific health behaviors.

Concrete activity prescriptions. Many Americans practice not engage in the recommended amounts of physical action, which can affect their concrete and psychological health. Physicians, nonetheless, rarely discuss physical activity with their patients.6 Clinicians ought to act as guides and work with patients to develop personalized concrete activity prescriptions, which accept the potential to increment patients' activeness levels.7 These prescriptions should list creative options for exercise based on the patient's experiences, strengths, values, and goals and exist adapted to a patient's status and treatment goals over time. For instance, a dr. working with a patient who has asthma could prescribe tai chi to help the patient with animate control too as balance and anxiety.

In creating these prescriptions, physicians should help the patient recognize the personal benefits of concrete activeness; identify barriers to physical activity and how to overcome them; ready small, achievable goals; and give patients the confidence to attempt their chosen action. Physicians should likewise put the prescriptions in writing, give patients logs to track their activity, and enquire them to bring those logs to follow-upward appointments for further discussion and coaching.8 More information almost practice prescriptions and sample forms are bachelor online.

Healthy eating goals. Persuading patients to change their diets is daunting enough without unrealistic expectations and the constant bombardment of fad diets, cleanses, fasts, and other food trends that oftentimes go out both patients and physicians uncertain almost which food options are actually salubrious. Moreover, physicians in preparation receive piddling instruction on what constitutes sound eating advice and ideal nutrition.9 This confusion can prevent physicians from broaching the topic with patients. Even if they identify healthy options, common setbacks can leave both patients and physicians less motivated to readdress the issue. Withal, physicians can help patients set up realistic healthy eating goals using ii uncomplicated methods:

Small steps. Studies have shown that 1 way to combat the inertia of unhealthy eating is to help patients commit to small, actionable, and measurable steps.10 Get-go, ask the patient what minor change he or she would like to brand — for case, subtract the number of desserts per calendar week by one, eat one more fruit or vegetable serving per day, or bandy one fast nutrient repast per week with a homemade sandwich or salad.11 Concord on these small changes to empower patients to take control of their diets.
The Plate Method. This model of meal pattern encourages patients to visualize their plates separate into the following components: l pct fruits and non-starchy vegetables, 25 pct protein, and 25 percentage grains or starchy foods.12 Discuss healthy options that would fit in each of the categories, or combine this method with the small steps described above. By providing a standard approach that patients can suit to many forms of cuisine, the model helps physicians empower their patients to assess their nutrient options and prefer healthy eating behaviors.

Brief behavioral therapy for insomnia. Many adults struggle with insufficient or unrestful sleep, and approximately 18.8 percent of adults in the United States meet the criteria for an insomnia disorder.xiii The first-line treatment for insomnia is Cerebral Behavioral Therapy for Insomnia (CBT-I), which involves changing patients' behaviors and thoughts related to their sleep and is delivered past a trained mental wellness professional. A dr. in a clinic visit can easily administer shorter versions of CBT-I, such as Brief Behavioral Therapy for Insomnia (BBT-I).14 BBT-I is a structured therapy that includes restricting the amount of time spent in bed just not asleep and maintaining a regular slumber schedule from night to night. Here's how information technology works:

Sleep diary. Have patients maintain a sleep diary for two weeks before starting the treatment. Patients should runway when they got in bed, how long it took to fall asleep, how frequently they woke up and for how long, what time they woke up for the twenty-four hour period, and what time they got out of bed. Many different sleep diaries exist, merely the American Academy of Slumber Medicine's version is especially convenient.
Teaching. In the side by side clinic appointment, briefly explain how the body regulates sleep. This includes the sleep drive (how the pressure to slumber is based on how long the person has been awake) and cyclic rhythms (the 24-hr biological clock that regulates the slumber-wake cycle).
Gear up a wake-upward fourth dimension. Have patients pick a wake-upwardly time that volition work for them every twenty-four hours. Encourage them to set an alert for that time and get upwardly at that time every 24-hour interval, no matter how the previous night went.
Limit "total time in bed." Review the patient's sleep diary and calculate the average number of hours per night the patient slept in the past ii weeks. Add together 30 minutes to that average and explain that the patient should be in bed only for that amount of time per nighttime until your next engagement.
Set a target bedtime. Decrease the total fourth dimension in bed from the chosen wake-upwardly time, and encourage patients to become to bed at that "target" time only if they are sleepy and definitely not any earlier.

For example, if a patient brings in a slumber diary with an boilerplate of half dozen hours of slumber per night for the past 2 weeks, her recommended full time in bed will be 6.5 hours. If she picks a wake-up time of 7 a.m., her target bedtime would be 12:30 a.yard. It usually takes upward to three weeks of regular sleep scheduling and sleep restriction for patients to start seeing improvements in their sleep. As patients' sleep routines become more solid (i.e., they are falling asleep quickly and sleeping more than ninety percent of the time they are in bed), slowly increment the total time in bed to maybe increase time asleep. Physicians should encourage patients to increment time in bed in increments of xv to xxx minutes per week until the ideal corporeality of sleep is reached. This corporeality is dissimilar for each patient, only patients by and large have reached their ideal amount of sleep when they are sleeping more than than 85 percent of the time in bed and experience rested during the day.

Patient education to prevent medication nonadherence. Medication adherence tin can be challenging for many patients. In fact, approximately 20 percentage to 30 percent of prescriptions are never picked up from the chemist's, and fifty percent of medications for chronic diseases are not taken every bit prescribed.fifteen Nonadherence is associated with poor therapeutic outcomes, further progression of disease, and decreased quality of life. To assist patients improve medication adherence, physicians must decide the reason for nonadherence. The most common reasons are forgetfulness, fear of side effects, high drug costs, and a perceived lack of efficacy. To aid patients modify these behavior, physicians can have several steps:

Educate patients on four key aspects of drug therapy — the reason for taking it (indication), what they should wait (efficacy), side effects and interactions (safety), and how it structurally and financially fits into their lifestyle (convenience).16
Help patients make taking their medication a routine of their daily life. For case, if a patient needs to apply a controller inhaler twice daily, recommend using the inhaler before brushing his or her teeth each morning and dark. Ask patients to describe their day, including morning routines, work hours, and other responsibilities to detect optimal opportunities to integrate this new behavior.
Ask patients, "Who can help you lot manage your medications?" Social networks, including family members or close friends, can help patients ready pillboxes or provide medication reminders.

The five Rs to quitting smoking. Despite the well-known consequences of smoking and nationwide efforts to reduce smoking rates, approximately 15 pct of U.S. adults nonetheless smoke cigarettes.17 Every bit with all kinds of behavioral alter, patients present in different stages of readiness to quit smoking. Motivational interviewing techniques can be useful to explore a patient's ambivalence in a mode that respects his or her autonomy and bolsters self-efficacy. Discussing the five Rs is a helpful arroyo for exploring ambivalence with patients:xviii

Relevance. Explore why quitting smoking is personally relevant to the patient.
Risks. Advise the patient on negative consequences of continuing to smoke.
Rewards. Ask the patient to place the benefits of quitting smoking.
Roadblocks. Help the patient determine obstacles he or she may face when quitting. Common barriers include weight gain, stress, fear of withdrawal, fear of failure, and having other smokers such as coworkers or family in close proximity.
Repeat. Incorporate these aspects into each clinical contact with the patient.

Many patients opt to cutting dorsum on the amount of tobacco they use before their quit date. Yet, research shows that cut back on the number of cigarettes is no more constructive than quitting abruptly, and setting a quit appointment is associated with greater long-term success.19

Once the patient sets a quit date, repeated physician contact to reinforce smoking cessation messages is fundamental. Physicians, care coordinators, or clinical staff should consider calling or seeing the patient within ane to three days of the quit date to encourage continued efforts to quit, as this time catamenia has the highest risk for relapse. Show shows that contacting the patient four or more times increases the success rate in staying abstinent.18 Quitting for good may take multiple a empts, but continued encouragement and efforts such as setting new quit dates or offering other pharmacologic and behavioral therapies can be helpful.

GETTING STARTED

Abstract
CROSS-BEHAVIOR TECHNIQUES
Behavior-SPECIFIC TECHNIQUES
GETTING STARTED
References

Family physicians are uniquely positioned to provide encouragement and show-based advice to patients to change unhealthy behaviors. The proven techniques described in this article are cursory enough to attempt during dispensary visits. They tin be used to encourage physical activity, good for you eating, better sleep, medication adherence, and smoking cessation, and they tin can assistance patients adjust their lifestyle, improve their quality of life, and, ultimately, lower their risk of early mortality.

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ABOUT THE AUTHORS

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Dr. Hooker is a clinical psychology postdoctoral young man in primary care behavioral health in the Section of Family Medicine and Community Health (DFMCH) at the University of Minnesota in Minneapolis....

Dr. Panjabi is an convalescent care chemist's resident at the University of Minnesota College of Pharmacy.

Dr. Justesen is an assistant professor in the DFMCH and medical director of the Academy of Minnesota Physicians' Broadway Family Medicine Dispensary in Minneapolis.

Dr. Boyle is a kickoff-year family medicine resident at the Broadway Family Medicine/North Memorial Family Medicine Residency Plan in Minneapolis.

Dr. Sherman is a licensed clinical psychologist and professor in the DFMCH.

Author disclosures: no relevant fiscal affiliations disclosed.

References

show all references

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17. Jamal A, Rex BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking amidst adults — Usa, 2005–2015. MMWR Morb Mortal Wkly Rep. 2016;65(44):1205–1211.

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