National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

Chapter 1: Lifestyle
☰ Table of contents


This section of the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (National Guide) provides recommendations for interventions to improve health outcomes related to the risk factors of tobacco, overweight and 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 model is outlined below.1

Box 1. The 5As model for behavioural and other interventions related to lifestyle risk factors

Assess – Ask about/assess behavioural health risk(s) and factors affecting choice of behaviour change goals or methods.

Advise – Give clear, specific and personalised behaviour-change advice, including information about personal health harms and benefits. This recognises that the practitioner can be a catalyst for action and enhance motivation for change.

Agree* – Collaboratively select appropriate treatment goals and methods based on the client’s interest in and willingness to change their behaviour. This involves joint consideration of treatment options, consequences and client preferences, and setting management goals.

Assist – 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).

Arrange – Schedule follow-up contacts (in person or via 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 four As.

*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 Health Care and used by the US Public Health Service to report on the effectiveness of interventions to support tobacco cessation.3 The model has since been adapted for use with broader preventive health interventions that are administered in a
clinical setting.1,4

The 5As model is well informed by systematic reviews of evidence on behavioural interventions and is recognised as an effective mechanism for translating evidence into practice, and it has demonstrated widespread utility in Australia and internationally.5–7 A randomised controlled trial (RCT) of the model, as part of a team-based care for obesity management, is currently underway in Canada.8

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people


  1. 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.
  2. Glynn TJ, Manley MW. How to help your patients stop smoking. NIH publication no. 89-3064. Bethesda, MD: National Cancer Institute, 1989.
  3. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence. AHRQ publication no. 00-0032. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, 2000.
  4. 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):61–79.
  5. The Royal Australian College of General Practitioners. Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factor in general practice. 2nd edn. East Melbourne, Vic: RACGP, 2015.
  6. 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):S50–52.
  7. Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Modified 5As: Minimal intervention for obesity counseling in primary care. Can Fam Physician 2013;59(1):27–31.
  8. Campbell-Scherer DL, Asselin J, Osunlana AM, et al. Implementation and evaluation of the 5As framework of obesity management in primary care: Design of the 5As Team (5AsT) randomized control trial. Implementation Sci 2014;9(1):78.