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Cited by 467Health Promotion and Cardiovascular PreventionBehavioral Health and InterventionsObesity and Health Practices

Multiple behavioral risk factor interventions in primary care

Goldstein, Michael G, Whitlock, Evelyn P, DePue, Judith·2004·American Journal of Preventive Medicine
DOI 10.1016/j.amepre.2004.04.023
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Abstract

Background An important barrier to the delivery of health behavior change interventions in primary care settings is the lack of an integrated screening and intervention approach that can cut across multiple risk factors and help clinicians and patients to address these risks in an efficient and productive manner.Methods We review the evidence for interventions that separately address lack of physical activity, an unhealthy diet, obesity, cigarette smoking, and risky/harmful alcohol use, and evidence for interventions that address multiple behavioral risks drawn primarily from the cardiovascular and diabetes literature.Results There is evidence for the efficacy of interventions to reduce smoking and risky/harmful alcohol use in unselected patients, and evidence for the efficacy of medium- to high-intensity dietary counseling by specially trained clinicians in high-risk patients. There is fair to good evidence for moderate, sustained weight loss in obese patients receiving high-intensity counseling, but insufficient evidence regarding weight loss interventions in nonobese adults. Evidence for the efficacy of physical activity interventions is limited. Large gaps remain in our knowledge about the efficacy of interventions to address multiple behavioral risk factors in primary care.Conclusions We derive several principles and strategies for delivering behavioral risk factor interventions in primary care from the research literature. These principles can be linked to the "5A's" construct (assess, advise, agree, assist, and arrange-follow up) to provide a unifying conceptual framework for describing, delivering, and evaluating health behavioral counseling interventions in primary healthcare settings. We also provide recommendations for future research.

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Authors
Goldstein, M. G., Whitlock, E. P., & DePue, J.
Affiliations
  • Brown University (US)
  • Kaiser Permanente Center for Health Research (US)
Corresponding author
Goldstein, Michael G
ORCID
Whitlock, Evelyn P
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2004-08
Volume
27
Issue
2
Pages
61-79
ISSN
0749-3797 (ISSN-L)
DOI
10.1016/j.amepre.2004.04.023
OpenAlex
W2017125969
Cited by
467
References
166
Citations by year
2026: 3 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 5 · 2021: 6 · 2020: 23 · 2019: 16 · 2018: 18 · 2017: 24 · 2016: 26 · 2015: 22 · 2014: 28 · 2013: 36 · 2012: 35
FWCI
3.94
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • American Journal of Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
primary care, health behavior change, smoking cessation, risky alcohol use, physical activity promotion, nutrition counseling, obesity, weight loss, cardiovascular risk, diabetes risk, intervention efficacy
MeSH terms
Smoking Prevention, Adult, Alcohol Drinking, Cardiovascular Diseases, Counseling, Diet, Humans, Middle Aged, Obesity, Primary Health Care, Risk Factors, Smoking, Health Behavior, Exercise, Evidence-Based Medicine

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