From 2002 to 2004, staff at the Bayer Institute for Health Care Communication explored with health care experts — through the preparation of papers and two meetings — the development of a single intervention tool for treating the "big four" health risk behaviors: sedentary lifestyle, risky drinking, unhealthy diet and smoking.

Key Findings

• Thirty-three percent of primary care populations had one risk factor; 41 percent had two; 14 percent had three; and three percent had four.
• Primary care settings have an array of health risk appraisal instruments available to them, but no single assessment instrument or procedure optimally addresses all risk factors or populations or helps providers to set intervention priorities when multiple risk factors exist.
• Researchers found that large gaps remain in what is known about the efficacy of interventions to address multiple behavioral risk factors in primary care.
• The researchers identified five principles that they believe should guide the design and successful implementation of multiple risk factor interventions and intervention platforms:
  • Greater use of the 5 A's (ask, advise, assess, assist, arrange) model of behavior change counseling.
  • A collaborative approach that supports the patient's role as the key decision maker.
  • Use of the unique strengths of community-based primary care, such as longitudinality (knowing patients over time), therapeutic alliance (positive relationship between physician and patient), and knowledge of the patient and his/her social environment.
  • Using the same model of behavior change to affect changes at the practice and health system level (that is, ongoing assessment, collaborative goal setting, feedback, problem solving, follow-up assessment and support.
  • Redesigning the office environment and patient visits to provide behavior change support across multiple behaviors.

Key Recommendations

In a "synthesis" paper published in the August 2004 supplement to the American Journal of Preventive Medicine, project staff offered the following recommendations:

• Create multiple stakeholder dialogues.
• Create a policy agenda organized around key public issues in multiple risk factor interventions.
• Support the translation of research findings into practical multiple risk factor interventions.
• Initiate a series of demonstration projects to identify the methods of successful multiple risk factor interventions.
• Support a broader research agenda focused on multiple behavioral risk factor interventions.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $366,966.