Assisting patients with modifying health behaviours — what works?
By Dr Peter Adkins, General Practitioner
Health interventions, risk reduction and modifying health behaviours can be complex aspects of working in general practice. The experiences of general practitioners (GPs) in supporting health behaviour change can often range from challenging to rewarding.
Working to strike a balance between the healthy behaviours we know are good for us and limiting (or giving up) enjoyable-though-less-than-healthy things is a universal human experience.
During your career in general practice, you will meet (or already have met) patients working to achieve and maintain this balance. A simple example might be a patient with type 1 diabetes who has a sweet tooth and loves to bake in their spare time.
For GPs, finding an effective way to support these patients to reduce their health risk while allowing them to maintain habits that matter to them can be the challenge.
A good relationship between GPs and patients is foundational to supporting behaviour change. Building trust is key to enhanced patient motivation, shared decision making and improved continuity of care.
How can GPs enable patients to successfully reduce health risks?
Different approaches work with different patients, and success with risk reduction behaviours usually involves a combination of influences (and influencers) over time.
These influences and influencers include health professionals, family members, colleagues, friends, social media trends and social media personalities (a profession now commonly referred to as being an ‘influencer’).
Health prevention activities work best when GPs, practice nurses and allied health professionals work together as a practice team to get involved in the process and share the successes of health improvement. There are a range of tools and resources to assist you in becoming a positive influence in empowering your patients to modify their health behaviours.
The first step for GPs (and for the patients themselves), is identifying the risk and what needs to change. This may involve some health-related myth busting e.g., “my daily walking routine eliminates my smoking risk”. Identifying health risk can be done through:
participation in health prevention and education programs (community based and/or practice-based)
opportunistic screening (e.g., AUSDRISK tool)
a clinical audit to identify patients at high risk of cardiovascular disease (e.g., Primary Sense audit tool).
The next steps involve assessing readiness to change, motivational factors and barriers and realistic goals to reduce health risk.
A range of effective interventions that assist with behaviour modification can be done opportunistically during a standard consultation, such as:
referral to a dietician for weight management.
Other interventions require additional consultation time(s), like:
Digital tools such as mobile phone applications (e.g., Healthy Habits or Food Switch), wearables and gamified (competitive or fun) platforms have been shown to increase engagement and lead to behaviour change.
Social prescribing such as a referral to health and fitness programs can lead to a successful reduction of health risk. Patients who have improved their health will also have information to share on what worked for them.
Helping patients lower their health risks can be challenging, and many times feels like playing a game of snakes and ladders. There are strong individual, social and environmental influences in play which negatively affect both physical and mental health. Persistence is key and as GPs we are trusted sources of health information, know our patients well, and are skilled at motivating patients to practice healthy behaviours. Sometimes there are unintended consequences of health advice e.g., recommending more exercise and subsequently a patient is knocked off their bike by a stray dog and falls and breaks their arm. Putting this unfortunate incident aside where the dog and not the doctor was blamed, assisting with reducing health risk has been a rewarding endeavour.
About the author
Dr Peter Adkins is a Brisbane-based GP with over 30 years of experience in community medicine. He has a particular interest in digital health innovation, health literacy and patient communication, and contributes regularly to professional development and mentoring for early-career GPs.
Dr Adkins is also a Clinical Consultant for Brisbane South PHN, contributing to the development of evidence-based health programs for the local community.