Division of Family Medicine, Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg.
S Afr Fam Pract (2004). 2024 Aug 29;66(1):e1-e5. doi: 10.4102/safp.v66i1.5874.
With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.
基层医疗保健（PHC）具有独特的地位，可以提供健康促进和预防服务，包括生活方式行为咨询。在接受 PHC 治疗的患者中，不健康的生活方式行为非常普遍，许多患者不愿意改变或处于考虑阶段。虽然使用动机性访谈咨询的 5A 方法可以更好地管理处于思考阶段的患者，但对于那些不愿意或没有准备好改变的患者，需要采用不同的方法，例如动机性访谈（MI）咨询的 5R 方法。5R MI 方法有望促使不愿意的个人考虑开始行为改变之旅。5R 方法不是单独执行的孤立任务清单，而是最好集成到理论行为改变框架中。在经常使用的四个与健康相关的行为改变理论框架中，改变模型的跨理论阶段是最常用的。这篇持续的专业发展文章对行为改变理论的文献进行了总结回顾，这些理论适用于生活方式健康行为的改变，并提出 5R 方法是管理不愿意改变或处于考虑阶段的患者的可行和实用方法。这为改善基层医疗保健系统中普遍存在的可改变的不健康生活方式行为的患者结果提供了一线希望。
