Counselling patients about behaviour change: the challenge of talking about diet

Background
As obesity levels increase, opportunistic
behaviour change counselling fromprimary
care clinicians in consultations about healthy
eating is evermore important. However, little is
known about the approaches clinicians take
with patients.
Aim
To describe the content of simulated
consultations on healthy eating in primary care,
and compare this with the content of smoking
cessation consultations.
Design and setting
Qualitative study of 23 audiotaped simulated
healthy eating and smoking cessation
consultations between an actor and primary
care clinicians (GPs and nurses) within a
randomised controlled trial looking at
behaviour change counselling.
Method
Consultations were audiotaped and transcribed
verbatim, then analysed inductively using
thematic analysis. A thematic framework was
developed by all authors and applied to the
data. The content of healthy eating
consultations was contrasted with that given for
smoking cessation.
Results
There was a lack of consistency and clarity
when clinicians discussed healthy eating
compared with smoking; in smoking cessation
consultations, the content was clearer to both
the clinician and patient. There was a lack of
specificity about what dietary changes should
bemade, how changes could be achieved, and
how progress could bemonitored. Barriers to
change were addressed inmore depth within
the smoking cessation consultations than
within the healthy eating encounters.
Conclusion
At present, dietary counselling by clinicians in
primary care does not typically contain
consistent, clear suggestions for specific
change, how these could be achieved, and how
progress would bemonitored. Thismay
contribute to limited uptake and efficacy of
dietary counselling in primary care.
Keywords
communication, behaviour change counselling;
commnication; healthy eating; primary care.