Using Illness Visits to Provide Health Behavior Advice

描述（由申请人提供）：癌症发病率和死亡率的巨大负担可能通过个人健康行为的改变来预防。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）作为改变癌症相关健康行为和降低发病率和死亡率的策略具有很大的希望。然而，实施有效干预的主要障碍来自于将有效的HBA方法纳入日常实践的竞争需求和提供医疗保健的主要疾病护理模式的可行性。一个潜在的强大的战略，已被推广的是使用疾病访问作为一个'可教的时刻'的健康行为改变。然而，很少有人知道的具体沟通策略至关重要，创造一个可教的时刻或有效性，这种pproach的健康行为改变。了解如何通过沟通和评估这一战略的有效性，构建一个可教的时刻是根本和关键的努力，以促进通过一个可教的时刻健康行为改变的方法。因此，本多方法研究的目标是描述可教时刻的产生方式，并在患者-医生互动中构建，并评估该策略对患者回忆建议，修改行为和改变健康行为的动机的有效性。800名成人患者的音频记录，从分层随机抽样的16个社区家庭医生的临床医生访问将提供丰富的数据进行深入的定性分析。对话分析将用于描述“可教时刻”是如何出现的，它的结构和对话的内容;并确定访问的上下文功能，可能已经启用或阻碍HBA的通信。从定性分析中得出的关键变量，包括可教时刻的元素，建议的内容，线索，竞争需求和以患者为中心的互动将编码为800次访问。通过1个月和6个月的电话随访调查对患者进行纵向随访，以评估改变行为动机和健康行为改变的结果。将使用多变量模型评估可教时刻策略对每种结果的影响，以包括背景协变量，并将使用GEE方法解释聚类数据结构。这项研究的结果将把“可教的时刻”从一个吸引人的想法转变为一种基于实践的策略，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时候传达健康行为建议，并以一种可能对患者结果产生重大影响的方式。

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.