The lifestyle risk factors of smoking, nutrition, alcohol and physical activity (SNAP) are common among patients attending general practice.1 They contribute significantly to the burden of disease, largely due to their effect on the incidence and complications of chronic diseases such as diabetes, cardiovascular disease (CVD), chronic respiratory disease and some cancers.2 General practitioners (GPs) and their teams can make an important contribution to managing each of the SNAP lifestyle behaviours, including smoking,3,4 dietary change,5 hazardous drinking,6 physical activity7,8 and weight.9,10
Each of these risk factors may interact with the others throughout the lifecycle and need to be considered together rather than separately.11 The 5As is an internationally accepted framework for organising the assessment and management of behavioural risk factors in primary healthcare.12–14 It consists of the following:
- Ask – A systematic approach to asking all patients about their SNAP, which may occur opportunistically as they present for other conditions and/or by recall for health checks.
- Assess – Assess readiness to change, and dependence (for smoking and alcohol).
- Advise – Provide brief, non-judgemental advice with patient education materials.
- Assist/agree – Work with the patient to set agreed goals for behaviour change; provide motivational interviewing; refer to telephone support services, group lifestyle programs or individual providers (eg dietitian or exercise physiologist); consider pharmacotherapy.
- Arrange – Regular follow-up visits to monitor maintenance and prevent relapse.
Progress along the pathway from assessment and advice to goal setting, referral and follow-up is associated with increased patient motivation and behaviour change.15 A number of evidence-based preventive care guidelines are based on the 5As framework.9