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Simultaneous vs sequential counseling for multiple behavior change.

David J Hyman1, Valory N Pavlik, Wendell C Taylor

  • 1Department of Medicine, Baylor College of Medicine, Houston, TX 77098, USA. dhyman@bcm.tmc.edu

Archives of Internal Medicine
|June 15, 2007
PubMed
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Simultaneously addressing multiple health behaviors in primary care is not inferior to sequential counseling and may be more effective for individual goals. Long-term multiple behavior change remains challenging in clinical settings.

Area of Science:

  • Cardiovascular disease prevention
  • Behavioral science
  • Primary care interventions

Background:

  • Patients in primary care often have multiple cardiovascular disease risk factors.
  • Effective counseling strategies for multiple behavior change in clinical settings are not well-established.

Purpose of the Study:

  • To compare the effectiveness of sequential versus simultaneous counseling for multiple behavior change in primary care.
  • To evaluate different approaches to behavioral counseling for cardiovascular disease risk factors.

Main Methods:

  • A randomized trial involving African Americans with hypertension (aged 45-64) was conducted.
  • Participants were randomized to simultaneous counseling, sequential counseling (new behavior every 6 months), or usual care (group classes).

Related Experiment Videos

  • Counseling focused on smoking cessation, sodium reduction, and increased physical activity over 18 months.

    • Main Results:

    • No significant difference was found in meeting at least two behavioral goals at 18 months between groups (simultaneous: 6.5%, sequential: 5.2%, usual care: 6.5%).
    • The simultaneous approach showed better results for individual behavioral goals, such as reduced sodium intake at 6 months (29.6% vs. 16.5% vs. 13.4%, P = .01).
    • A trend favored the simultaneous group for smoking cessation (urine cotinine negative) at 18 months (20.3% vs. 16.9% vs. 10.1%, P = .08).

    Conclusions:

    • Achieving long-term multiple behavior change in primary care is difficult.
    • A sequential approach to counseling multiple behaviors is not superior and may be less effective than a simultaneous approach.