Susan J. Curry, PhD; David C. Grossman, MD, MPH; Evelyn P. Whitlock, MD, MPH; Adelita Cantu, PhD, RN
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2128.
Requests for Single Reprints: Susan J. Curry, PhD, College of Public Health, University of Iowa, 105 River Street, S153A CPHB, Iowa City, IA 52242; e-mail, Suefirstname.lastname@example.org.
Current Author Addresses: Dr. Curry: College of Public Health, University of Iowa, 105 River Street, S153A CPHB, Iowa City, IA 52242.
Dr. Grossman: Group Health Cooperative, Group Health Research Institute, Metropolitan Park East Building, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.
Dr. Whitlock: Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227.
Dr. Cantu: University of Texas Health Science Center at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78228.
Author Contributions: Conception and design: S.J. Curry, D.C. Grossman, E.P. Whitlock.
Drafting of the article: S.J. Curry, D.C. Grossman, E.P. Whitlock, A. Cantu.
Critical revision of the article for important intellectual content: S.J. Curry, D.C. Grossman, E.P. Whitlock.
Final approval of the article: S.J. Curry, D.C. Grossman, E.P. Whitlock.
Collection and assembly of data: D.C. Grossman, E.P. Whitlock.
The U.S. Preventive Services Task Force (USPSTF) makes recommendations on which preventive services to routinely incorporate into primary care for specific populations. Behavioral counseling interventions are preventive services designed to help persons engage in healthy behaviors and limit unhealthy ones. The USPSTF's evaluation of behavioral counseling interventions asks 2 primary questions: Do interventions in the clinical setting influence persons to change their behavior, and does changing health behavior improve health outcomes with minimal harms?
This article discusses challenges encountered by the USPSTF in aggregating the behavioral counseling intervention literature to develop guidelines. The challenges relate broadly to study populations, intervention protocols, assessment of outcomes, and linking behavior changes to health outcomes. Recommendations to address these challenges include use of the PRECIS (Pragmatic-Explanatory Continuum Indicator Summary) tool as a guide for the development of feasible, replicable, and generalizable behavioral counseling interventions; improved reporting of study methods and results; consensus measures for key behavioral outcomes; and use of existing data sets to link behavior change and clinical outcomes.
Analytic framework for behavioral counseling interventions.
Key questions: 1. Do changes in patients’ health behavior improve health or reduce risk factors? 2. What is the relationship between duration of health behavior change and health improvement (i.e., minimum duration, minimum level of change, and change–response relationship)? 3. What are the adverse effects of health behavior change? 4. Does health behavior change produce other positive outcomes (e.g., patient satisfaction, changes in other health care behaviors, improved function, and decreased use of health care resources)? 5. Is risk factor reduction or measured health improvement associated with reduced morbidity or mortality? 6. Is sustained health behavior change related directly to reduced morbidity or mortality? 7. Are behavioral counseling interventions in clinical care related directly to improved health or risk factor reduction? 8. Are behavioral counseling interventions in clinical care related directly to reduced morbidity or mortality? (Reproduced with permission of Elsevier from the American Journal of Preventive Medicine. 2002;22:267-84.)
Pragmatic-Explanatory Continuum Indicator Summary wheel.
E = explanatory. (Reproduced with permission of Elsevier from the Journal of Clinical Epidemiology. 2009;62:464-75.)
Table. Possible Definitions of Intensity for Primary Care–Feasible and Primary Care–Referable Interventions
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Curry SJ, Grossman DC, Whitlock EP, Cantu A. Behavioral Counseling Research and Evidence-Based Practice Recommendations: U.S. Preventive Services Task Force Perspectives. Ann Intern Med. 2014;160:407-413. doi: 10.7326/M13-2128
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Published: Ann Intern Med. 2014;160(6):407-413.
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