Advertisement

Interactive behavior change technology

A partial solution to the competing demands of primary care

      Abstract

      Background

      Primary care practices are faced with the challenge of having too much to do in too little time. As a result, behavioral counseling is often overlooked, especially for patients with multiple health behaviors in need of change.

      Methods

      This paper describes recent examples of the application of interactive behavior change technologies (IBCTs) to deliver health behavior change counseling before, during, and after the office visit to inform and enhance patient–clinician interactions around these issues. The 5A's framework (assess, advise, agree, assist, arrange follow-up) is used to consider how interactive technology can be used to implement behavior change counseling more consistently.

      Results

      A variety of IBCTs, including the Internet, clinic-based CD-ROMs, and interactive voice-response telephone calls have been shown to be feasible and potentially valuable adjuncts to clinic-based behavioral counseling. These technologies can both increase the effectiveness of behavioral counseling and extend the reach of these services to patients with barriers to face-to-face interactions.

      Conclusions

      If appropriately developed with the context of primary care in mind and integrated as part of a systems approach to intervention, IBCT can be a feasible and appropriate aid for primary care. Recommendations are made for the types of IBCT aids and research that are needed to realize this potential.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stange K.C
        • Woolf S.H
        • Gjeltema K
        One minute for prevention.
        Am J Prev Med. 2002; 22: 320-323
      1. U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore MD: Williams & Wilkins, 1996

        • Yarnell K.S
        • Pollack K.I
        • Ostbye T
        • Krause K.M
        • Michener J.L
        Primary care.
        Am J Public Health. 2003; 93: 635-641
      2. Fine LJ, Philogene GS, Grambling R, Coups EJ, Sinha S. Prevalence of multiple behavioral risk factors in the United States: results from the 2001 National Health Interview Survey. Am J Prev Med 2004;27(suppl 1):18–24

      3. Goldstein MG, Whitlock EP, DePue J. Multiple health risk behavior interventions in primary care: summary of research evidence. Am J Prev Med 2004;27(suppl 1):61–79

        • Starfield B.A
        • Lemke K.W
        • Bernhardt T
        • Foldes S.S
        • Forest C.B
        • Weiner J.P
        Comorbidity.
        Ann Fam Med. 2003; 1: 8-14
        • Bayliss E.A
        • Steiner J.F
        • Fernald D.H
        • Crane L.A
        • Main D.S
        Descriptions of barriers to self-care by persons with comorbid chronic conditions.
        Ann Fam Med. 2003; 1: 15-21
        • Dertouzos M.L
        What will be: how the new world of information will change our lives.
        HarperEdge Publishers, New York1997
        • Street Jr, R.L
        • Gold W.R
        • Manning T.E
        Health promotion and interactive technology: theoretical applications and future directions.
        Lawrence Erlbaum Associates, London1997
        • Rice R.E
        • Katz J.E
        The Internet and health communication.
        Sage, Thousand Oaks CA2001
        • Kreuter M
        • Farrell D
        • Olevitch L
        • Brennan L
        Tailoring health messages: Customizing communication with computer technology.
        Lawrence Erlbaum, Mahweh NJ2000
        • Noell J
        • Glasgow R.E
        Interactive technology applications for behavioral counseling.
        Am J Prev Med. 1999; 17: 269-274
      4. Gustafson DF, Hawkins R, Boberg E, et al. Impact of a patient-centered, computer-based health information/support system. Am J Prev Med 1999;16:9–18

        • Gustafson D.H
        • Robinson T.N
        • Ansley D
        • Adler L
        • Brennan P.F
        Consumers and evaluation of interactive health communication applications. The Science Panel on Interactive Communication and Health.
        Am J Prev Med. 1999; 16: 23-29
        • Gustafson D.H
        • Hawkins R
        • Boberg E
        • et al.
        Impact of a patient-centered, computer-based health information/support system.
        Am J Prev Med. 1999; 16: 1-9
      5. Glasgow RE, Goldstein MG, Ockene J, Pronk NP. Translating what we have learned into practice: Principles and hypotheses for addressing multiple behaviors in primary care. Am J Prev Med 2004;27(suppl 1):88–101

        • Whitlock E.P
        • Orleans C.T
        • Pender N
        • Allan J
        Evaluating primary care behavioral counseling interventions.
        Am J Prev Med. 2002; 22: 267-284
        • Glasgow R.E
        • Davis C.L
        • Funnell M.M
        • Beck A
        Implementing practical interventions to support chronic illness self-management in healthcare settings.
        Jt Comm J Qual Saf. 2003; 29: 563-574
        • Orleans C.T
        • Slade J
        Nicotine addiction: principles and management.
        Oxford University Press, New York1993
      6. Rhyne R, Bogue R, Kukulka G, Fulmer H. Community-oriented primary care: health care for the 21st century. Washington DC: American Public Health Association, 1998

        • Starfield B
        Primary care: balancing health needs, services, and technology.
        Oxford University Press, Oxford1998
        • Miller W.R
        • Rollnick S
        Motivational interviewing: preparing people to change addictive behavior.
        Guilford Press, New York1991
        • Goldstein M.R
        • DePue J
        Models for provider–patient interaction: applications to health behavior change.
        in: Shumaker S Schron E.B McBee W.L The handbook of health behavior change. Springer, New York1998: 85-113
        • Glasgow R.E
        • McKay H.G
        • Piette J.D
        • Reynolds K.D
        The RE-AIM framework for evaluating interventions.
        Patient Educ Couns. 2001; 44: 119-127
        • Pronk N.P
        • O'Connor P
        Systems approach to population health improvement.
        J Ambulatory Care Manage. 1997; 20: 24-31
      7. Babor TF, Sciamanna CN, Pronk N. Assessing multiple risk behaviors in primary care: screening issues and related concepts. Am J Prev Med 2004;27(suppl 1):42–53

        • Kreuter M.W
        • Strecher V.J
        Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial.
        Health Educ Res. 1996; 11: 97-105
        • Bental D.S
        • Cawsey A
        • Jones R
        Patient information systems that tailor to the individual.
        Patient Educ Couns. 1999; 2: 171-180
        • Campbell M.K
        • DeVellis B.M
        • Strecher V.J
        • Ammerman A.S
        • DeVellis R.F
        • Sandler R.S
        Improving dietary behavior.
        Am J Public Health. 1994; 84: 783-787
        • De Vries H
        • Brug J
        Computer-tailored interventions motivating people to adopt health promoting behaviors.
        Patient Educ Couns. 1999; 36: 99-105
        • Kreuter M.W
        • Strecher V.J
        Changing inaccurate perceptions of health risk.
        Health Psychol. 1995; 14: 56-63
        • Lipkus I.M
        • Lyna P.R
        • Rimer B.K
        Using tailored interventions to enhance smoking cessation among African-Americans at a community health center.
        Nicotine Tob Res. 1999; 1: 77-85
        • Marcus B.H
        • Emmons K.M
        • Simkin-Silverman L.R
        • et al.
        Evaluation of motivationally tailored vs standard self-help physical activity interventions at the workplace.
        Am J Health Promo. 1998; 12: 246-253
        • Rakowski W
        • Ehrich B
        • Goldstein M.G
        • et al.
        Increasing mammography among women aged 40–74 by use of a stage-matched, tailored intervention.
        Am J Prev Med. 1998; 27: 748-756
        • Skinner C.S
        • Strecher V.J
        • Hospers H
        Physicians' recommendations for mammography.
        Am J Public Health. 1994; 84: 43-49
        • Brug J
        • Campbell M
        • Van Assema P
        The application and impact of computer-generated personalized nutrition education.
        Patient Educ Couns. 1999; 36: 145-156
        • Ryan G.L
        • Skinner C.S
        • Farrell D
        • Champion V.L
        Examining the boundaries of tailoring.
        Health Educ Res. 2001; 16: 555-566
        • Tate D.F
        • Wing R.R
        • Winett R.A
        Using Internet technology to deliver a behavioral weight loss program.
        JAMA. 2001; 285: 1172-1177
        • Strecher V.J
        • Kreuter M
        • Den Boer D.J
        • Kobrin S
        • Hospers H.J
        • Skinner C.S
        The effects of computer-tailored smoking cessation messages in family practice settings.
        J Fam Pract. 1994; 39: 262-268
        • Glasgow R.E
        • Eakin E.G
        Medical office-based interventions.
        in: Snoek F.J Skinner C.S Psychological aspects of diabetes care. John Wiley and Sons, London2000: 142-168
        • Strecher V.J
        • Seijts G.H
        • Kok G.J
        • et al.
        Goal setting as a strategy for health behavior change.
        Health Educ Q. 1995; 22: 190-200
        • Greenfield S
        • Kaplan S.H
        • Ware J.E
        • Yano E.M
        • Frank H
        Patients' participation in medical care.
        J Gen Intern Med. 1988; 3: 448-457
        • Piette J.D
        • McPhee S.J
        • Weinberger M
        • Mah C.A
        • Kraemer F.B
        Use of automated telephone disease management calls in an ethnically diverse sample of low-income patients with diabetes.
        Diabetes Care. 1999; 22: 1302-1309
        • Piette J.D
        Patient education via automated calls.
        Am J Prev Med. 2000; 17: 138-141
        • Glasgow R.E
        • Eakin E.G
        • Fisher E.B
        • Bacak S.J
        • Brownson R.C
        Physician advice and support for physical activity.
        Am J Prev Med. 2001; 21: 189-196
        • Piette J.D
        Interactive voice response systems in the diagnosis and management of chronic disease.
        Am J Manag Care. 2000; 6: 817-827
        • Perrine M.W
        • Mundt J.C
        • Searles J.S
        • Lester L.S
        Validation of daily self-reported alcohol consumption using interactive voice response (IVR) technology.
        J Stud Alcohol. 1995; 56: 487-490
        • Kobak K.A
        • Taylor L.V
        • Dottle S.L
        • et al.
        A computer-administered telephone interview to identify mental disorders.
        JAMA. 1997; 278: 905-910
        • Piette J.D
        • Weinberger M
        • Kraemer F.B
        • McPhee S.J
        The impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Veterans Affairs health care system.
        Diabetes Care. 2001; 24: 202-208
        • Friedman R.H
        • Kazis L.E
        • Jette A
        • et al.
        A telecommunications system for monitoring and counseling patients with hypertension.
        Am J Hypertens. 1996; 9: 285-292
        • Feil E.G
        • Glasgow R.E
        • Boles S.M
        • McKay H.G
        Who participates in Internet-based self-management programs? A study among novice computer users in a primary care setting.
        Diabetes Educ. 2000; 26: 806-811
        • Rost K
        • Carter W
        • Inui T
        Introduction of information during the initial medical visit.
        Soc Sci Med. 1989; 28: 315-321
        • Bertakis K.D
        The communication of information from physician to patient.
        J Fam Pract. 1977; 5: 217-222
        • Schillinger D
        • Piette J.D
        • Bindman A
        Closing the loop.
        Arch Intern Med. 2003; 163: 83-90
      8. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension or diabetes. Arch Intern Med 1998;158

        • Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association
        Health literacy.
        JAMA. 1999; 281: 552-557
        • Schillinger D
        • Grumbach K
        • Piette J.D
        • et al.
        Association of health literacy with diabetes outcomes.
        JAMA. 2002; 288: 475-482
        • Moyer C.A
        • Stern D.T
        • Dobias K.S
        • Cox D.T
        • Katz S.J
        Bridging the electronic divide.
        Am J Manag Care. 2002; 8: 427-433
        • Tate D.F
        • Jackvony E.H
        • Wing R.R
        Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes.
        JAMA. 2003; 289: 1833-1836
        • Haynes B.R
        • McKibbon K
        • Kanani R
        Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications.
        Lancet. 1996; 348: 383-386
        • Linkens R.W
        • Dini E.F
        • Watson G
        • et al.
        A randomized trial of effectiveness of computer-generated telephone messages in increasing immunization visits among preschool children.
        Arch Pediatr Adolesc Med. 1994; 148: 914
        • Stehr-Green P.A
        • Dini E.F
        • Lindegren M.L
        • Patriarca P.A
        Evaluation of telephone computer-generated reminders to improve immunization coverage in inner-city clinics.
        Public Health Rep. 1993; 108: 426-430
        • Leirer V.A
        • Morrow D.G
        • Tanke E.D
        • Pariante G.M
        Elders' non-adherence.
        Gerontologist. 1991; 31: 514-520
        • Tanke E.D
        • Leirer V.O
        Automated telephone reminders in tuberculosis care.
        Med Care. 1994; 32: 380-389
        • Kawachi I
        • Kennedy B.P
        • Lochner K
        • Prothrow-Stith D
        Social capital, income inequality, and mortality.
        Am J Public Health. 1997; 87: 1491-1498
        • Lorig K.R
        • Sobel D.S
        • Ritter P.L
        • Laurent D
        • Hobbs M
        Effect of a self-management program on patients with chronic illness.
        Eff Clin Pract. 2001; 4: 256-262
        • Scott J
        • Gade G
        • McKenzie M
        • Venohor I
        Cooperative health care clinics.
        Geriatrics. 1998; 53: 68-70
        • Davison K.P
        • Pennebaker J.W
        • Dickerson S.S
        Who talks? The social psychology of illness support groups.
        Am Psychol. 2000; 55: 217
        • Lamberg L
        Online empathy for mood disorders.
        JAMA. 2003; 289: 3073-3077
        • Feil E.G
        • Noell J
        • Lichtenstein E
        • Boles S.M
        • McKay H.G
        Evaluation of an Internet-based smoking cessation program.
        Nicotine Tob Res. 2003; 5: 189-194
        • Winzelberg A
        • Eldredge K.L
        • Eppstein D
        • et al.
        Effectiveness of an Internet-based program for reducing risk factors for eating disorders.
        J Consult Clin Psychol. 2000; 68: 346-350
        • Winzelberg A.J
        • Classen C
        • Alpers G.W
        • et al.
        Evaluation of an internet support group for women with primary breast cancer.
        Cancer. 2003; 97: 1164-1173
        • Lorig K.R
        • Laurent D.D
        • Deyo R.A
        • Marnell M.E
        • Minor M.A
        • Ritter P.L
        Can a back pain e-mail discussion group improve health status and lower health care costs? A randomized study.
        Arch Intern Med. 2002; 162: 792-796
        • Barrera Jr, M
        • Glasgow R.E
        • McKay H.G
        • Boles S.M
        • Feil E.G
        Do Internet-based support interventions change perceptions of social support? An experimental trial of approaches for supporting diabetes self-management.
        Am J Comm Psychol. 2002; 30: 637-654
      9. Center for Studying Health System Change. Data bulletins. Available at: www.hschange.org. Accessed June 8, 2004

      10. Institute of Medicine. Primary care: America's health in a new era. Washington DC: National Academy of Sciences, 1996

      11. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press, 2001

        • Pronk N.P
        Designing and evaluating health promotion programs. Simple rules for a complex issue.
        Dis Manage Health Outcomes. 2003; 11: 149-157
        • Tunis S.R
        • Stryer D.B
        • Clancey C.M
        Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy.
        JAMA. 2003; 290: 1624-1632
        • Glasgow R.E
        • Klesges L.M
        • Dzewaltowski D.A
        • Bull S.S
        • Estabrooks P
        The future of health behavior change research.
        Ann Behav Med. 2004; 27: 3-12
        • Glasgow R.E
        • Bull S.S
        Making a difference with interactive technology.
        Diabetes Spectrum. 2001; 14: 99-106
        • Stange K.C
        One size doesn't fit all.
        Multimethod research yields new insights into interventions to increase prevention in family practice. J Fam Pract. 1996; 43: 358-360