Table 2-4.

Evidence-Based Individual Approaches for Improving Health Behaviors and Health Factors in the Clinic Setting

• Set specific, shared, proximal goals (Class I; Level of Evidence A). Set specific, proximal goals with the patient, including a personalized plan to achieve the goals (eg, over the next 3 mo, increase fruits by 1 serving/d, reduce smoking by half a pack/d, or walk 30 min 3 times/wk).
• Establish self-monitoring (Class I; Level of Evidence A). Develop a strategy for self-monitoring, such as a dietary or physical activity diary or Web-based or mobile applications.
• Schedule regular follow-up (Class I; Level of Evidence A). Schedule regular follow-up (in-person, telephone, written, and/or electronic), with clear frequency and duration of contacts, to assess success, reinforce progress, and set new goals as necessary.
• Provide feedback (Class I; Level of Evidence A). Provide feedback on progress toward goals, including using in-person, telephone, and/or electronic feedback.
• Increase self-efficacy (Class I; Level of Evidence A). Increase the patient’s perception that they can successfully change their behavior.*
• Use motivational interviewing (Class I; Level of Evidence A). Use motivational interviewing when patients are resistant or ambivalent about behavior change.
• Provide long-term support (Class I; Level of Evidence B). Arrange long-term support from family, friends, or peers for behavior change, such as in other workplace, school, or community-based programs.
• Use a multicomponent approach (Class I; Level of Evidence A). Combine ≥2 of the above strategies into the behavior change efforts.
  • * Examples of approaches include mastery experiences (set a reasonable, proximal goal that the person can successfully achieve); vicarious experiences (have the person see someone with similar capabilities performing the behavior, such as walking on a treadmill or preparing a healthy meal); physiological feedback (explain to the patient when a change in their symptoms is related to worse or improved behaviors); and verbal persuasion (persuade the person that you believe in their capability to perform the behavior).

  • Motivational interviewing represents use of individual counseling to explore and resolve ambivalence toward changing behavior. Major principles include fostering the person’s own awareness and resolution of their ambivalence, as well as their own self-motivation to change, in a partnership with the counselor or provider.

  • Modified from Artinian et al27 with permission. Copyright © 2010, American Heart Association, Inc.