Using Illness Visits to Provide Health Behavior Advice

利用疾病就诊提供健康行为建议

• 批准号: 6934668
• 负责人: SUSAN A. FLOCKE
• 金额: $ 42.14万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6934668
• 关键词: behavior modification; behavioral /social science research tag; cancer prevention; clinical research; communication; counseling; cues; health behavior; health care service evaluation; health education; health services research tag; human subject; longitudinal human study; motivation; neoplasm /cancer education; patient care personnel relations; primary care physician; self help; teaching

DESCRIPTION (provided by applicant): A large burden of cancer morbidity and mortality is potentially preventable by changes in personal health behaviors. Health behavior advice (HBA) by primary care physicians, who provide basic health care to most Americans, holds great promise as a strategy to alter cancer-related health behaviors and reduce morbidity and mortality. However, major barriers to implementing effective intervention stem from the feasibility of incorporating effective HBA approaches into the competing demands of every day practice and a predominately illness care mode of providing health care. One potentially powerful strategy that has been promoted is the use of illness visits as a 'teachable moment' for health behavior change. However, little is known about the specific communication strategies essential to creating a teachable moment or the effectiveness of this pproach for health behavior change. Understanding the way a teachable moment is constructed through communication and evaluation of the effectiveness of this strategy is both fundamental and crucial to efforts to promote adoption of a teachable moment approach for health behavior change. Therefore, the goal of this multimethod study is to characterize the way a teachable moment arises and is constructed within the patient-physician interaction, and to evaluate the effectiveness of this strategy on patient recall of advice, motivation to modify behavior and change in health behavior. Audio recordings of 800 adult patient-clinician visits from a stratified random sample of 16 community family physicians will provide the rich data for the in-depth qualitative analysis. Conversation analysis will be used to characterize how the 'teachable moment' arises, its structure and the content of the dialogue; and identify contextual features of the visit that may have enabled or impeded the communication of HBA. Key variables derived from the qualitative analysis including elements of the teachable moment, the content of the advice, cues, competing demands and the patient centeredness of the interaction will coded for each of the 800 visits. Longitudinal follow-up of patients with one- and six-month phone follow-up surveys will be used to assess the outcomes of change in motivation to modify behavior and change in health behavior. The effect of a teachable moment strategy on each of the outcomes will be evaluated using multivariable models to include contextual covariates and will use GEE methods to account for the clustered data structure. The findings from this study will move 'teachable moments' from the realm of an appealing idea into an empirically-based strategy for affecting health behavior change and will guide physicians to communicate health behavior advice when it is likely to have the most impact and in a way that is likely to have a significant impact on patient outcomes.

描述（由申请人提供）：个人健康行为的变化可以预防癌症发病率和死亡率的很大负担。为大多数美国人提供基本医疗保健的初级保健医生的健康行为建议（HBA），作为改变与癌症相关的健康行为并降低发病率和死亡率的策略的巨大希望。但是，实施有效干预的主要障碍源于将有效的HBA方法纳入每天练习的竞争需求以及提供医疗保健的主要疾病护理模式的可行性。已提倡的一种潜在强大的策略是将疾病探访用作“可教导时刻”的“健康行为”改变。但是，对于创建可教学时刻或这种对健康行为改变的效力至关重要的特定交流策略知之甚少。了解通过沟通和评估该策略的有效性来构建可教会时刻的方式是基本和至关重要的，这对于促进采用可教会时刻的方法来改变了健康行为的改变。因此，这项多方法研究的目的是表征可教会时刻的出现方式并在患者 - 物理学互动中构建的方式，并评估该策略对患者召回建议的有效性，改变行为的动机和健康行为的变化。从16个社区家庭医师分层的随机样本中进行800名成年患者访问的录音将为深入的定性分析提供丰富的数据。对话分析将用于表征“可教的时刻”如何出现，其结构和对话的内容；并确定访问的上下文特征，这些功能可能启用或阻碍了HBA的通信。从定性分析中得出的关键变量，包括可教会时刻的要素，建议的内容，提示，竞争要求和与患者相互作用的以互动为中心，将为800个访问中的每个访问中的每一个编码。对一月和六个月的随访调查的患者进行纵向随访，以评估改变行为和健康行为变化的动机变化结果。将使用多变量模型来评估可教学力矩策略对每个结果的影响，以包括上下文协变量，并将使用GEE方法来说明群集数据结构。这项研究的发现将使“可教的时刻”从一个吸引人的思想的领域转变为一种基于经验的策略，以影响健康行为的改变，并将指导医生在可能产生最大影响的情况下传达健康行为建议，并且以一种可能对患者成果产生重大影响的方式。