BMJ 1999;319:943-948 ( 9 October )

Papers

Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial

Andrew Steptoe, professor, ^a Sheelagh Doherty, research fellow, ^a Elizabeth Rink, research manager, ^b Sally Kerry, lecturer in statistics, ^b Tony Kendrick, reader, ^b Sean Hilton, professor. ^b

^a Department of Psychology, St George's Hospital Medical School, London SW17 0RE, ^b Department of General Practice and Primary Care, St George's Hospital Medical School

Correspondence to: A Steptoe asteptoe{at}sghms.ac.uk

Objective: To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease.
Design: Cluster randomised controlled trial.
Participants: 883 men and women selected for the presence of one or more modifiable risk factors: regular cigarette smoking, high serum cholesterol concentration (6.5-9.0 mmol/l), and high body mass index (25-35) combined with low physical activity.
Intervention: Brief behavioural counselling, on the basis of the stage of change model, carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity.
Main outcome measures: Questionnaire measures of diet, exercise, and smoking habits, and blood pressure, serum total cholesterol concentration, weight, body mass index, and smoking cessation (with biochemical validation) at 4 and 12 months.
Results: Favourable differences were recorded in the intervention group for dietary fat intake, regular exercise, and cigarettes smoked per day at 4 and 12 months. Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months. No differences were found between groups in changes in total serum cholesterol concentration, weight, body mass index, diastolic pressure, or smoking cessation.
Conclusions: Brief behavioural counselling by practice nurses led to improvements in healthy behaviour. More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge.

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Rapid Responses:

Read all Rapid Responses

Methodological flaws in study

Gary Frost
bmj.com, 22 Oct 1999 [Full text]

Response

Pat Twomey
bmj.com, 4 Nov 1999 [Full text]

Behavioural counselling in general practice for the promotion of healthy behaviour

Robert Bunney
bmj.com, 3 Dec 1999 [Full text]

Paper over-interpretes the data

Richard Hobbs
bmj.com, 13 Dec 1999 [Full text]

Difficulties in evaluating behavourial counselling

Margaret Cupples
bmj.com, 25 Feb 2000 [Full text]

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