This section provides recommendations for interventions to improve health outcomes related to tobacco smoking, overweight/obesity, alcohol, physical activity and gambling. In addition to specific tools mentioned within each risk factor section, the ‘5As’ model is recommended to assist primary care practitioners in a general approach to lifestyle risk factor assessment and management. The 5As originally proposed are outlined in Table 1.1.1
Table 1.1. The 5As model for behavioural and other interventions related to lifestyle risk factors
Ask about/assess behavioural health risk(s) and factors affecting choice of behaviour change goals/methods
Give clear, specific, and personalised behaviour change advice, including information about personal health harms and benefits. It recognises that the health practitioner can be a catalyst for action and can enhance motivation for change
Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behaviour. This involves joint consideration of treatment options, consequences and patient preferences and setting management goals
Using behaviour change techniques (self help and/or counselling), aid the patient in achieving agreed upon goals by acquiring the skills, confidence and social/environmental supports for behaviour change, supplemented with adjunctive medical treatments when appropriate (eg. pharmacotherapy for tobacco dependence)
Schedule follow up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialised treatment. Follow up visits often involve repeating the preceding 4As
|* Some models omit the ‘Agree’ component and include an initial ‘Ask’ component in which risk factors are identified
The 5As model was originally proposed by the US National Cancer Institute to assist with smoking cessation counselling.2 It was then adapted by the Canadian Taskforce on Preventive Healthcare and used by the US Public Health Service to report on the effectiveness of interventions to support tobacco cessation.3 It has since been adapted for use with broader preventive health interventions that are administered in a clinical setting.1,4 The model is well informed by systematic reviews of the evidence on behavioural interventions and is recognised as an effective mechanism for translating evidence into practice. It has demonstrated widespread utility in Australia and internationally.5,6
- Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002;22(4):267–84.
- Glynn TJ, Manley MW. How to help your patients stop smoking. NIH publication no. 89–3064. Bethesda, MD: National Cancer Institute, 1989.
- Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating tobacco use and dependence. AHRQ publication no. 00–0032. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality, 2000.
- Goldstein MG, Whitlock EP, DePue J. Multiple behavioral risk factor interventions in primary care: Summary of research evidence. Am J Prev Med 2004;27(Suppl 2):S61–79.
- The Royal Australian College of General Practitioners. SNAP – a population health guide to behavioural risk factor in general practice. Melbourne: The RACGP, 2004.
- Dosh SA, Summers Holtrop J, Torres T, Arnold AK, Baumann J, White L. Changing organizational constructs into functional tools: an assessment of the 5As in primary care practices. Ann Fam Med 2005;3 (Suppl 2):S50–2.