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OBJECTIVES

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Objectives

  • Describe the importance of health behavior change counseling in medical settings.

  • Identify barriers and opportunities for promoting behavior change with vulnerable and underserved populations.

  • Review an evidence-based and practical approach to behavior change counseling.

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INTRODUCTION

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Mr. Nguyen is a 34-year-old man, Vietnamese. He lives with his girlfriend and works as a line cook. He drinks six to nine drinks several nights per week but does not meet criteria for an alcohol use disorder.

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The primary goal of health care is to reduce morbidity and mortality through the prevention and treatment of disease. Health-care providers are also charged with promoting behavioral change strategies that support wellness. When thinking of causes of death, diseases such as heart disease, cancer, and respiratory disease come to mind. Underlying these causes of death, however, often lie modifiable behavioral risk factors, such as tobacco use, poor diet and physical activity, and alcohol misuse.1 Termed “actual causes of death,” these preventable behaviors account for about half of all deaths and underscore the importance of prioritizing the promotion of behavior change in health-care settings. Furthermore, psychosocial issues, such as mental illness, substance abuse, trauma, and poverty, when left unaddressed by the health-care system, can cause and exacerbate illness among the world’s most vulnerable populations. Two decades of behavioral research indicate that physicians can successfully promote health behavior change in their patients.2,3 Health-care providers who understand behavior change theory and who practice a patient-centered approach to behavior change counseling achieve the best outcomes.

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MISPERCEPTIONS

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When envisioning the promotion of behavior change, it is common to picture a prototypical counseling setup, which involves a series of long intervention sessions focused on specific psychosocial stressors or mental health disorders. It is no wonder that many providers choose to avoid behavior change counseling altogether, when this is their perception of what promotion of behavior change entails. Providers in medical settings typically have neither the time nor the specialty training to operate using a counseling paradigm. However, empirical evidence suggests that relatively brief interventions can have powerful effects and that a single brief empathic discussion can promote long lasting behavior change.4 For many areas, interventions as short as 5 minutes can change important health behaviors.5

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Another barrier to the promotion of behavior change in medical settings may be perceptions regarding who is appropriate for intervention. For example, when thinking about a patient who would benefit from behavior change around alcohol, many providers picture a patient with a severe alcohol use disorder, many complicating psychosocial stressors, and a history of unsuccessful quit attempts. While such patients are certainly in need of services and their medical providers should address their alcohol use, they are less likely to respond to brief interventions and more likely to benefit from referral to more intensive specialty treatment. When such patients are the first, or ...

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