The PCP should participate more actively in the behavior-modification process by providing feedback about patients’ performance—including ongoing, individualized information on health consequences—and recalibration of goals over time.

“Behavior modification takes reinforcement,” Dr. Sacco affirms. “You can’t get the word out just once; the message has to be repeated.”

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The AHA statement authors note the importance of scheduled follow-up sessions to elicit and maintain behavioral change. It may be useful to augment face-to-face meetings with telephone or Internet communications.

Provider-patient contact should be relatively frequent early in the process and continue for a minimum of six months. Expert opinion cited in the AHA statement suggests a schedule that includes follow-up visits at six weeks and again at three, six, nine, and 12 months. Subsequent maintenance visits might be appropriate every six months when behavior change has been successful and more frequently when adherence is a problem.

Programs in the community (such as those through hospitals, churches, and health organizations) can provide ongoing support to help individuals maintain positive changes. PCPs should be aware of such resources and refer appropriately.

Formats for change

Group-based interventions are demonstrably effective. For example, one meta-analysis found that these programs increased physical activity significantly more than individual-based programs.2

Other studies have involved groups led by both laypersons and professionals. These groups typically included seven to 10 members and met as often as once a week at first and less frequently over time. The most successful programs integrated didactic material, counseling, and such standard behavior-change modalities as goal-setting and self-monitoring.