Citation

Fernald DH, Dickinson LM, Froshaug DB, Balasubramanian BA, Holtrop JS, Krist AH, Glasgow RE, Green LA. J. Am. Board Fam. Med. 2012; 25(5): 701-711.

Affiliation

the Department of Family Medicine, University of Colorado, Aurora; the Colorado Foundation for Medical Care, Englewood; the University of Texas Southwestern Medical Center, Dallas; the Department of Family Medicine, Michigan State University, East Lansing; the Virginia Commonwealth University, Department of Family and Community Medicine, Richmond; and the Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD.

Copyright

(Copyright © 2012, American Board of Family Medicine)

DOI

10.3122/jabfm.2012.03.110057

PMID

22956706

Abstract

BACKGROUND: Four health behaviors-smoking, risky drinking, physical inactivity, and unhealthy diets-contribute substantially to health care burden and are common among primary care patients. However, there is insufficient evidence to recommend broadly brief interventions to address all 4 of these in frontline primary care. This study took advantage of a multinetwork initiative to reflect on health behavior outcomes and the challenges of using a common set of measures to assess health behavior-change strategies for multiple health behaviors in routine primary care practice. METHODS: Standardized, brief practical health behavior and quality of life measures used across 7 practice-based research networks (PBRNs) with independent primary care interventions in 54 primary care practices between August 2005 and December 2007 were analyzed. Mixed-effects longitudinal models assessed whether intervention patients improved diet, physical activity, smoking, alcohol consumption, and unhealthy days over time. Separate analyses were conducted for each intervention. RESULTS: Of 4463 adults, 2199 had follow-up data, and all available data were used in longitudinal analyses. Adjusting for age, race/ethnicity, education, and baseline body mass index where available, diet scores improved significantly in 5 of 7 networks (P < .02). Physical activity improved significantly in 2 networks but declined in one network (P < .024). The likelihood of being a current smoker was reduced in 2 of 5 networks (P < .0001), and average alcoholic drinks per day was reduced in 2 network s (P < .02). Participants reported fewer unhealthy days at follow-up in 3 of 7 networks (P < .01). Details of implementation and the limitations in instrumentation help contextualize these modest outcomes. CONCLUSIONS: Although some patients in these 7 PBRNs improved in several health behaviors and quality of life, the strength of evidence for field-ready methods to address multiple health risk behaviors remains elusive. The use of common measures to assess changes in 4 unhealthy behaviors was achieved practically in PBRNs testing diverse strategies to improve behaviors; however, variations in implementation, instrumentation performance, and some features of study design overwhelmed potential cross-PBRN comparisons. For common measures to be useful for comparisons across practices or PBRNs, greater standardization of study designs and careful attention to practicable implementation strategies are necessary.

Language: en