Behavioural contracting as a tool to help patients achieve better health

Behavioural contracting is an intervention technique in which a client signs an agreement to make certain behaviour changes within a specified time, usually with explicitly defined rewards for adherence or success. Contracting is being increasingly used by health professionals to assist patients in making beneficial life style changes. This paper presents data on the outcome of behavioural contracting interventions to lower serum cholesterol and to increase exercise activity. Of 223 primary care patients enrolled in a health promotion programme, 179 met with the project health educator to improve their cardiovascular risk profile; 144 of these were classified as having 'high cholesterol' and 51 signed contracts to adopt the American Heart Association guidelines diet within a 3-month period. Everyone was encouraged to sign a contract to engage in aerobic exercise three times per week; 96 did so. The results indicate that contractors achieved greater beneficial health changes than non-contractors, and that the group which fully met their contract obligations experienced the greatest health benefit of all (either a lowering of cholesterol or a decreased exercising heart rate).