Malan Zelra, Mash Bob, Everett-Murphy Katherine
Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg 7505, South Africa.
Chronic Diseases Initiative in Africa (CDIA), Faculty of Health Sciences, University of Cape Town, P/Bag X 3, Observatory, Cape Town 7935, South Africa.
Patient Educ Couns. 2016 Jan;99(1):125-31. doi: 10.1016/j.pec.2015.08.008. Epub 2015 Aug 14.
To evaluate the effect on clinical practice of training primary care providers (PCPs) in an approach to brief behaviour change counselling (BBCC), integrating the 5As (ask, alert, assess, assist, arrange) with a guiding style derived from motivational interviewing in the South African context. BBCC was focused on the four risky behaviours (unhealthy eating, tobacco smoking, physical inactivity, harmful alcohol use) for non-communicable diseases.
It was a before-and-after design, recording BBCC skills at baseline, directly after training and 6-weeks later. We evaluated each recording for adherence to the guiding style and delivery of the 5As using the Motivational Interviewing Treatment Integrity 3.1.1. tool, and a tool based on the 5As training design.
123 recordings were collected from 41 PCPs. Results showed a significant improvement in adoption of the guiding style (e.g. global score at baseline 2.0 (2.0-2.6) and in clinical practice 3.0 (2.7-3.3) p<0.001) and completion of the 5A steps (e.g. assist score at baseline 1.26 (1.12-1.4) and in clinical practice 1.75 (1.61-1.89) p<0.001).
Training PCPs in this approach to BBCC is effective at changing their clinical practice in the short term.
The training programme should be integrated into the curricula of PCPs, and used in continuing professional development.
在南非背景下，评估对初级保健提供者（PCP）进行简短行为改变咨询（BBCC）培训的效果，该培训将5A法（询问、提醒、评估、协助、安排）与源自动机性访谈的指导风格相结合。BBCC聚焦于非传染性疾病的四种风险行为（不健康饮食、吸烟、缺乏身体活动、有害饮酒）。
采用前后设计，在基线、培训刚结束后及6周后记录BBCC技能。我们使用动机性访谈治疗完整性3.1.1工具以及基于5A培训设计的工具，评估每份记录对指导风格的遵循情况和5A法的实施情况。
从41名初级保健提供者处收集了123份记录。结果显示，在采用指导风格方面有显著改善（例如，基线时的总体评分为2.0（2.0 - 2.6），临床实践中为3.0（2.7 - 3.3），p<0.001），在完成5A步骤方面也有显著改善（例如，基线时协助步骤的评分为1.26（1.12 - 1.4），临床实践中为1.75（1.61 - 1.89），p<0.001）。
以这种方式对初级保健提供者进行BBCC培训在短期内能有效改变他们的临床实践。
该培训项目应纳入初级保健提供者的课程体系，并用于持续专业发展。
