Patient priorities for behavioral change
- 34 Downloads
When a physician advises a patient to modify unhealthy behaviors, the physician may be tempted to prescribe a target for change by selecting the single “risk factor” that poses the greatest threat to health. The present study was conducted to determine how frequently a statistical approach to health risk appraisal would conflict with a patient’s priorities for lifestyle change, even when the patient was fully informed of the rationale for the advice. Coronary artery disease (CAD) risk factor assessment was performed using the American Heart Association’s RISKO scale, a validated health risk appraisal instrument. Two hundred forty-one patients were seen in an ambulatory clinic that specialized in heart disease prevention. Risk of CAD was estimated based on age, sex, smoking status, blood pressure, body weight, and serum cholesterol. Using RISKO, patients were told which single risk factor posed the greatest threat to health; patients then selected a personal priority for risk factor intervention. The overall rate of agreement between the patients’ priorities and RISKO targets was 63%. If weight loss is considered a nonpharmacologic “target” for controlling hypertension, then the agreement rate rises to 70%. Disagreement was observed even though patients were fully informed of the relative importances of all possible risk factor choices. Since risk factor intervention efforts are less successful unless the target of the intervention is negotiated with the patient, these data should be of clinical importance in devising plans for behavioral change interventions by practitioners.
Key wordshealth promotion risk factor modification coronary disease prevention
Unable to display preview. Download preview PDF.
- 3.Preventive Health Care Committee, Society for Research and Education in Primary Care Internal Medicine. Preventive medicine in general internal medical residency training. Ann Intern Med 1985;102:859–61Google Scholar
- 4.National Institutes of Health. Clinical opportunities for smoking intervention: a guide for the busy physician. U.S. Public Health Service, Publication No. (NIH) 86-2178, 1986Google Scholar
- 5.American Heart Association. Counseling the patient with hyperlipidemia. Dallas, TX: AHA, 1986Google Scholar
- 6.The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984;144:1045Google Scholar
- 7.Kaplan NM, Stamler, J. Prevention of coronary heart disease: practical management of the risk factors. Philadelphia: W. B. Saunders, 1983Google Scholar
- 8.Currie BF, Beasley JW. Health promotion in the medical encounter. In: Taylor RB, Ureda KR, Denham JW (eds). Health promotion: principles and clinical applications. Norwalk, CT: Appleton-Century-Crofts, 1982:143–60Google Scholar
- 9.Fraser GE. Preventive cardiology (chapter 21, pp 319–345). New York: Oxford University Press, 1986Google Scholar
- 10.Marlatt GA, Gordon JR, eds. Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press, 1985Google Scholar
- 12.American Heart Association. RISKO: a heart hazard appraisal. Dallas, TX: AHA, 1981Google Scholar
- 14.McKinlay SM. Development of one scientifically valid health risk appraisal: the case of RISKO. Presented at the 8th Annual Scientific Session of the Society of Behavioral Medicine, Washington, DC, March 19–22, 1987Google Scholar
- 15.Thoresen CE, Mahoney MJ. Behavioral self-control. New York: Holt, Rinehart and Winston, 1974Google Scholar