Improving diet, physical activity and other lifestyle behaviours using computer-tailored advice in general practice: a randomised controlled trial

International Journal of Behavioral Nutrition and Physical Activity

Frances M Boyle³  David King¹  Corneel Vandelanotte⁴  Sanjoti Parekh² 

[1] School of Medicine, The University of Queensland, Herston, Queensland 4006, Australia;School of Population Health & Healthy Communities Research Centre, The University of Queensland Herston, Queensland 4006, Australia;The University of Queensland, School of Population Health, Qld, 4006, Australia;Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Queensland Australia

关键词: Health behaviours.;    Physical activity;    Diet;    Primary prevention;    Intervention studies;    General practitioners;    Health promotion;   

Others  :  811868
DOI  :  10.1186/1479-5868-9-108

 received in 2011-12-09, accepted in 2012-08-30,  发布年份 2012

【 摘 要 】

Background

The adoption and maintenance of healthy behaviours is essential in the primary prevention of chronic non-communicable diseases. This study evaluated the effectiveness of a minimal intervention on multiple lifestyle factors such as diet, physical activity, smoking and alcohol, delivered through general practice, using computer-tailored feedback.

Methods

Adult patients visiting 21 general practitioners in Brisbane, Australia, were surveyed about ten health behaviours that are risk factors for chronic, non-communicable diseases. Those who completed the self-administered baseline questionnaire entered a randomised controlled trial, with the intervention group receiving computer-tailored printed advice, targeting those health behaviours for which respondents were not meeting current recommendations. The primary outcome was change in summary lifestyle score (Prudence Score) and individual health behaviours at three months. A repeated measures analysis compared change in these outcomes in intervention and control groups after adjusting for age and education.

Results

2306 patients were randomised into the trial. 1711 (76%) returned the follow-up questionnaire at 3 months. The Prudence Score (10 items) in the intervention group at baseline was 5.88, improving to 6.25 at 3 months (improvement = 0.37), compared with 5.84 to 5.96 (improvement = 0.12) in the control group (F = 13.3, p = 0.01). The intervention group showed improvement in meeting recommendations for all individual health behaviours compared with the control group. However, these differences were significant only for fish intake (OR 1.37, 95% CI 1.11-1.68), salt intake (OR 1.19, 95% CI 1.05-1.38), and type of spread used (OR 1.28, 95% CI 1.06-1.51).

Conclusion

A minimal intervention using computer-tailored feedback to address multiple lifestyle behaviours can facilitate change and improve unhealthy behaviours. Although individual behaviour changes were modest, when implemented on a large scale through general practice, this intervention appears to be an effective and practical tool for population-wide primary prevention.

Trial Registration

The Australian New Zealand Clinical Trials Registry: ACTRN12611001213932

【 授权许可】

   
2012 Parekh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Australian Institute of Health and Welfare: Chronic Disease and Associated Risk Factors. AIHW2002, Canberra; 2001.
• [2]Kromhout D, Menotti A, Kesteloot H, Sans S: Prevention of coronary heart disease by diet and lifestyle: evidence from prospective cross-cultural, cohort, and intervention studies. Circulation 2002, 105(7):893-898.
• [3]Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA: Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006, 24(2):215-233.
• [4]Prochaska JO, Velicer WF, Redding C, Rossi JS, Goldstein M, DePue J, Greene GW, Rossi SR, Sun X, Fava JL, Laforge R, Rakowski W, Plummer BA: Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Prev Med 2005, 41(2):406-416.
• [5]Key TJ, Allen NE, Spencer EA, Travis RC: The effect of diet on risk of cancer. Lancet 2002, 360(9336):861-868.
• [6]Australian Institute of Health and Welfare: Australia's Health. AIHW 2008, Canberra; 2008.
• [7]Australian Institute of Health and Welfare: Chronic diseases and associated risk factors. AIHW 2006, Canberra; 2005.
• [8]Pronk NP, Anderson LH, Crain AL, Martinson BC, O'Connor PJ, Sherwood NE, Whitebird RR: Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med 2004, 27(2 Suppl):25-33.
• [9]Ma J, Betts NM, Hampl JS: Clustering of lifestyle behaviors: the relationship between cigarette smoking, alcohol consumption, and dietary intake. Am J Health Promot 2000, 15(2):107-117.
• [10]Prochaska JJ, Sallis JF: A randomized controlled trial of single versus multiple health behavior change: promoting physical activity and nutrition among adolescents. Health Psychol 2004, 23(3):314-318.
• [11]Vohs KD, Baumeister RF, Schmeichel BJ, Twenge JM, Nelson NM, Tice DM: Making choices impairs subsequent self-control: a limited-resource account of decision making, self-regulation, and active initiative. J Pers Soc Psychol 2008, 94(5):883-898.
• [12]Daubenmier JJ, Weidner G, Sumner MD, Mendell N, Merritt-Worden T, Studley J, Ornish D: The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program. Ann Behav Med 2007, 33(1):57-68.
• [13]De Vries H, Kremers SP, Smeets T, Brug J, Eijmael K: The effectiveness of tailored feedback and action plans in an intervention addressing multiple health behaviors. Am J Health Promot 2008, 22(6):417-425.
• [14]Yancey AK, McCarthy WJ, Harrison GG, Wong WK, Siegel JM, Leslie J: Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention. J Womens Health (Larchmt) 2006, 15(4):412-429.
• [15]Sciamanna CN, Marcus BH, Goldstein MG, Lawrence K, Swartz S, Bock B, Graham AL, Ahern DK: Feasibility of incorporating computer-tailored health behaviour communications in primary care settings. Inform Prim Care 2004, 12(1):40-48.
• [16]Prochaska JO, Velicer WF, Rossi JS, Redding CA, Greene GW, Rossi SR, Sun X, Fava JL, Laforge R, Plummer BA: Multiple risk expert systems interventions: impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of parents. Health Psychol 2004, 23(5):503-516.
• [17]Glasgow RE, Goldstein MG, Ockene JK, Pronk NP: Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care. Am J Prev Med 2004, 27(2 Suppl):88-101.
• [18]Goldstein MG, Whitlock EP, DePue J: Multiple behavioral risk factor interventions in primary care. Summary of research evidence. Am J Prev Med 2004, 27(2 Suppl):61-79.
• [19]Fine LJ, Philogene GS, Gramling R, Coups EJ, Sinha S: Prevalence of multiple chronic disease risk factors. 2001 national health interview survey. Am J Prev Med 2004, 27(2 Suppl):18-24.
• [20]Coups EJ, Gaba A, Orleans CT: Physician screening for multiple behavioral health risk factors. Am J Prev Med 2004, 27(2 Suppl):34-41.
• [21]Pronk NP, Peek CJ, Goldstein MG: Addressing multiple behavioral risk factors in primary care. A synthesis of current knowledge and stakeholder dialogue sessions. Am J Prev Med 2004, 27(2 Suppl):4-17.
• [22]Vandelanotte C, Reeves MM, Brug J, De Bourdeaudhuij I: A randomized trial of sequential and simultaneous multiple behavior change interventions for physical activity and fat intake. Prev Med 2008, 46(3):232-237.
• [23]Glasgow RE, Bull SS, Gillette C, Klesges LM, Dzewaltowski DA: Behavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity. Am J Prev Med 2002, 23(1):62-69.
• [24]Kreuter MW, Chheda SG, Bull FC: How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med 2000, 9(5):426-433.
• [25]Reiff-Hekking S, Ockene JK, Hurley TG, Reed GW: Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up. J Gen Intern Med 2005, 20(1):7-13.
• [26]Denney-Wilson E, Fanaian M, Wan Q, Vagholkar S, Schutze H, Mark M: Lifestyle risk factors in general practice - routine assessment and management. Aust Fam Physician 2010, 39(12):950-953.
• [27]Carlfjord S, Nilsen P, Leijon M, Andersson A, Johansson K, Bendtsen P: Computerized lifestyle intervention in routine primary health care: evaluation of usage on provider and responder levels. Patient Educ Couns 2009, 75(2):238-243.
• [28]Vandelanotte C, De Bourdeaudhuij I: Acceptability and feasibility of a computer-tailored physical activity intervention using stages of change: project FAITH. Health Educ Res 2003, 18(3):304-317.
• [29]Haerens L, Deforche B, Vandelanotte C, Maes L, De Bourdeaudhuij I: Acceptability, feasibility and effectiveness of a computer-tailored physical activity intervention in adolescents. Patient Educ Couns 2007, 66(3):303-310.
• [30]Bull FC, Kreuter MW, Scharff DP: Effects of tailored, personalized and general health messages on physical activity. Patient Educ Couns 1999, 36(2):181-192.
• [31]Dutton GR, Provost BC, Tan F, Smith D: A tailored print-based physical activity intervention for patients with type 2 diabetes. Prev Med 2008, 47(4):409-11.
• [32]Neville LM, O'Hara B, Milat A: Computer-tailored physical activity behavior change interventions targeting adults: a systematic review. Int J Behav Nutr Phys Act 2009, 6:30. BioMed Central Full Text
• [33]Strecher V, Wang C, Derry H, Wildenhaus K, Johnson C: Tailored interventions for multiple risk behaviors. Health Educ Res 2002, 17(5):619-626.
• [34]Brug J, Steenhuis I, Van Assema P, De Vries H: The impact of a computer-tailored nutrition intervention. Prev Med 1996, 25(3):236-242.
• [35]Skinner CS, Campbell MK, Rimer BK, Curry S, Prochaska JO: How effective is tailored print communication? Ann Behav Med 1999, 21(4):290-298.
• [36]de Vries H, Brug J: Computer-tailored interventions motivating people to adopt health promoting behaviours: introduction to a new approach. Patient Educ Couns 1999, 36(2):99-105.
• [37]Parekh S, King D, Owen N, Jamrozik K: Spousal concordance and reliability of the 'Prudence Score' as a summary of diet and lifestyle. Aust N Z J Public Health 2009, 33(4):320-324.
• [38]Jiao L, Mitrou PN, Reedy J, Graubard BI, Hollenbeck AR, Schatzkin A, Stolzenberg-Solomon R: A combined healthy lifestyle score and risk of pancreatic cancer in a large cohort study. Arch Intern Med 2009, 169(8):764-770.
• [39]Spencer CA, Jamrozik K, Norman PE, Lawrence-Brown M: A simple lifestyle score predicts survival in healthy elderly men. Prev Med 2005, 40(6):712-717.
• [40]Tamakoshi A, Tamakoshi K, Lin Y, Yagyu K, Kikuchi S: Healthy lifestyle and preventable death: findings from the Japan Collaborative Cohort (JACC) Study. Prev Med 2009, 48(5):486-492.
• [41]Beller EM, Gebski V, Keech AC: Randomisation in clinical trials. Med J Aust 2002, 177(10):565-567.
• [42]Parekh S, Vandelanotte C, King D, Boyle FM: Design and baseline characteristics of the 10 Small Steps Study: a randomised controlled trial of an intervention to promote healthy behaviour using a lifestyle score and personalised feedback. BMC Public Health 2012, 12:179. BioMed Central Full Text
• [43]Craig CL MA, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003, 35(8):1381-1395.
• [44]Kinzie MB: Instructional design strategies for health behavior change. Patient Educ Couns 2005, 56(1):3-15.
• [45]Petty RE, Cacioppo JT: The Elaboration Likelihood Model of persuasion. In Advances in experimental social psychology. Edited by Berkowitz L. Academic, New York; 1986:123-205.
• [46]Brunner EJ, Mosdol A, Witte DR, Martikainen P, Stafford M, Shipley MJ, Marmot MG: Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am J Clin Nutr 2008, 87(5):1414-1421.
• [47]Chiuve SE, Rexrode KM, Spiegelman D, Logroscino G, Manson JE, Rimm EB: Primary prevention of stroke by healthy lifestyle. Circulation 2008, 118(9):947-954.
• [48]Sacerdote C, Fiorini L, Rosato R, Audenino M, Valpreda M, Vineis P: Randomized controlled trial: effect of nutritional counselling in general practice. Int J Epidemiol 2006, 35(2):409-415.
• [49]Ammerman AS, Lindquist CH, Lohr KN, Hersey J: The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med 2002, 35(1):25-41.
• [50]Strecher VJ, DeVellis BM, Becker MH, Rosenstock IM: The role of self-efficacy in achieving health behavior change. Health Educ Q 1986, 13(1):73-92.
• [51]van Sluijs EM, van Poppel MN, Twisk JW, Chin APMJ, Calfas KJ, van Mechelen W: Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial. Am J Public Health 2005, 95(10):1825-1831.
• [52]Nakash RA, Hutton JL, Jorstad-Stein EC, Gates S, Lamb SE: Maximising response to postal questionnaires–a systematic review of randomised trials in health research. BMC Med Res Methodol 2006, 6:5. BioMed Central Full Text
• [53]Liang W, Shediac-Rizkallah MC, Celentano DD, Rohde C: A population-based study of age and gender differences in patterns of health-related behaviors. Am J Prev Med 1999, 17(1):8-17.
• [54]Hjartaker A, Lund E: Relationship between dietary habits, age, lifestyle, and socio-economic status among adult Norwegian women. The Norwegian Women and Cancer Study. Eur J Clin Nutr 1998, 52(8):565-572.
• [55]Bayram C, Britt H, Kelly Z, Valenti L: Male consultations in general practice in Australia 1999–00. Cat No GEP 11 2003, 15.
• [56]Courtenay WH: Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Soc Sci Med 2000, 50(10):1385-1401.
• [57]Spencer CA, Jamrozik K, Lawrence-Brown M, Norman PE: Lifestyle still predicts mortality in older men with established vascular disease. Prev Med 2005, 41(2):583-588.
• [58]Britt H, Miller GC, Charles J, Bayram C, et al.: General practice activity in Australia 2006–07. In AIHW2008 Report No.: General Practice Series no 21 Cat. no. GEP 21, Canberra;
• [59]Rose G: Sick individuals and sick populations. Int J Epidemiol 1985, 14(1):32-38.