Chapter 2

Approach to preventive care in general practice

The 5As is a key framework for organising the provision of preventive care in primary healthcare.18,19 This includes the actions taken by healthcare providers in supporting their patients to change their risk (refer to Table 2).

Table 2.

Table 2.

The 5As
Figure 1.

Figure 1.

Using the 5As for SNAP

Motivational interviewing is a non-confrontational client-centred counselling strategy aimed at resolving ambivalence and increasing a person’s motivation to change.20 It is an acknowledged care skill required by a wide range of healthcare workers.21–26 There is strong evidence of the benefit and impact a motivational interviewing approach has on health outcomes in a number of areas, including lifestyle change, chronic disease and adherence.27–37

Motivational interviewing involves:38

  • helping the patient to identify areas for change
  • highlighting any discrepancies between present behaviour and broader goals
  • encouraging the patient to examine the benefits they would experience from improving their lifestyle (eg. nutrition, physical activity) and self-management skills
  • asking the patient to compare potential outcomes if they do make changes versus if they do not
  • asking the patient to identify any challenges, barriers or negative aspect involved in making improvements (eg. costs, access to good food)
  • helping the patient determine specific and achievable solutions to the challenges, barriers and negative aspects involved in change
  • establishing the patient’s motivation and confidence to make changes
  • asking the patient to summarise, in their own words, their goals and how they are going to achieve them.

There are various contributors and barriers to consider when determining the best approach to assess and assist behavioural change, including cultural issues, physical environment/residence, beliefs and expectations, literacy, interest and motivation, addictive behaviour, coping style, and emotions and mood.

For patients who are not confident about their ability to succeed, various methods can be used to help them commit to making a change (refer to the list above). Asking patients to weigh up the pros and cons of making a change versus staying the way they are is a common technique. This is called ‘decision balance’ and can help patients decide whether to immediately make a change.

For those patients who are ready to make a change, time can be spent explaining and planning how they can make that change. Patients who have already made a change may require follow-up to monitor progress and deal with any relapses or difficulties.

The process provides insight into the issues that patients have around their health-related lifestyle and the importance, motivation and ability to make any changes in their behaviour. 

Health literacy can be defined as the capacity to acquire, understand and use information for health.39 It is important because it influences how patients use health services, how they communicate with providers and how they manage their own lifestyle.40 Low health literacy is common in the Australian population and associated with low income and educational attainment, as well as with higher risk behaviours.41 There are a number of screening tools that can be used to detect health literacy levels in these patients.42

More effective communication with patients with low health literacy involves:43

  • prioritising key points
  • using specific plain language (not medical terms)
  • using graphic images
  • encouraging questions
  • arranging follow-up.

‘Teach-back’ is a technique in which patients are asked to use their own words to explain what they have understood via education or information they have received.44 Communication and patient education materials also need to be tailored to the language and culture of the patient.

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This guide has been designed to assist GPs and practice staff (the GP practice team) to work with patients on the lifestyle risk factors of smoking, nutrition, alcohol and physical activity (SNAP).

Organisations working with general practices, such as primary care organisations, public health services and other agencies that provide resources and training for primary healthcare staff, may also find this guide valuable.

The SNAP guide is based on the best available evidence at the time of publication. It adopts the most recent National Health and Medical Research Council (NHMRC) levels of evidence and grades of recommendations. Recommendations in the tables are graded according to levels of evidence and the strength of recommendation.

The levels of evidence are coded by the roman numerals I–IV, while the strength of recommendation is coded by the letters A–D. Practice points (PP) are employed where no good evidence is available.

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