SNAP

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.

  1. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2013–14. General practice series no.36. Sydney:Sydney University Press; 2014.
  2. Australian Bureau of Statistics. Australian Health Survey: Physical Activity 2011–12. Cat. no. 4364.0.55.004. Canberra: ABS;2013.
  3. Australian Institute of Health and Welfare. Tobacco smoking (NDSHS 2013 key findings). [Accessed 15 September 2014].
  4. Australian Bureau of Statistics. Australian Health Survey: Updated results 2011–2012. Cat no. 4364.0.55.003. Canberra: ABS;2013.
  5. Australian Institute of Health and Welfare. Tobacco smoking. 10 July 2014].
  6. Peto R, Lopez PR, Boreham J, Thun M, Heath C. Morbidity from smoking in developed countries 1950–2000. Oxford: Oxford University Press; 1994.
  7. English DR, Holman CD, Milne E, et al. The quantification of drug caused morbidity and mortality in Australia. Canberra: Commonwealth Department of Health and Human Services; 1995.
  8. Australian Bureau of Statistics. Profiles of Health, Australia 2011–13. Cat no. 4338.0. Canberra: ABS; 2014.
  9. World Health Organization. The optimal duration of exclusive breastfeeding: A systematic review. Geneva: WHO. [Accessed 10 July 2014].
  10. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003, PHE 82.Canberra: AIHW; 2007.
  11. Australian Institute of Health and Welfare. Australia’s food and nutrition 2012: in brief. [Accessed 10 July 2014].
  12. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alchol. Canberra: NHMRC; 2009.
  13. Australian Institute of Health and Welfare. Risk factors contributing to chronic disease. Cat No. PHE 157. Canberra: AIHW;2012.
  14. Australian Institute of Health and Welfare. Australia’s health 2012. Australia’s health series no.13. Cat. no. AUS 156. Canberra:AIHW; 2012.
  15. Australian Institute of Health and Welfare. Cardiovascular disease: Australian facts 2011. Cardiovascular disease series. CVD 53. Canberra: AIHW; 2011.
  16. Waters AM, Moon L. Socioeconomic inequalities in cardiovascular disease in Australia. AIHW bulletin no. 37. Cat. no. AUS 74. Canberra: AIHW; 2006.
  17. Harris M, Furler J. How can primary care increase equity in health? NSW Public Health Bull 2002;13(3):35–8.
  18. Dosh SA, Holtrop JS, Torres T, Arnold AK, Baumann J, White LL. Changing organizational constructs into functional tools: an assessment of the 5 A’s in primary care practices. Ann Fam Med 2005;3 Suppl 2:S50–2.
  19. Hung DY, Rundall TG, Tallia AF, Cohen DJ, Halpin HA, Crabtree BF. Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q 2007;85(1):69–91.
  20. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol 2009;64(6):527–37.
  21. Lupu AM, Stewart AL, O’Neil C. Comparison of active-learning strategies for motivational interviewing skills, knowledge, and confidence in first-year pharmacy students. Am J Pharm Educ 2012;76(2):28.
  22. Daeppen JB, Fortini C, Bertholet N, et al. Training medical students to conduct motivational interviewing: a randomized controlled trial. Patient Educ Couns 2012;87(3):313–8.
  23. Anstiss T. Motivational interviewing in primary care. J Clin Psychol Med Settings 2009;16(1):87–93.
  24. Hinz JG. Teaching dental students motivational interviewing techniques: analysis of a third-year class assignment. J Dent Educ 2010;74(12):1351–6.
  25. White LL, Gazewood JD, Mounsey AL. Teaching students behavior change skills: description and assessment of a new Motivational interviewing curriculum. Med Teach 2007;29(4):e67–71.
  26. Burke PJ, Da Silva JD, Vaughan BL, Knight JR. Training high school counselors on the use of motivational interviewing to screen for substance abuse. Subst Abus 2005;26(3–4):31–4.Butler CC, Simpson SA, Hood K, et al. Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial. BMJ 2013;346:f1191.
  27. Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr Phys Act 2012;9:22.
  28. Taggart J, Williams A, Dennis S, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract 2012;13:49.
  29. Macdonald P, Hibbs R, Corfield F, Treasure J. The use of motivational interviewing in eating disorders: a systematic review. Psychiatry Res 2012;200(1):1–11.
  30. Hardcastle S, Blake N, Hagger MS. The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community. J Behav Med 2012;35(3):318–33.
  31. Chilton R, Pires-Yfantouda R, Wylie M. A systematic review of motivational interviewing within musculoskeletal health. Psychol Health Med 2012;17(4):392–407.
  32. Soderlund LL, Madson MB, Rubak S, Nilsen P. A systematic review of motivational interviewing training for general health care practitioners. Patient Educ Couns 2011;84(1):16–26.
  33. Smedslund G, Berg RC, Hammerstrom KT, et al. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011;5:CD008063.
  34. Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. J Consult Clin Psychol 2011;79(4):433–40.
  35. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2011;12(9):709–23.
  36. Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010(1):CD006936.
  37. Sharing Health Care: Guidelines for General Practitioners working with Chronic Conditions Melbourne: The Royal Australian College of General Practitioners; 2001.
  38. Nutbeam D. Building health literacy in Australia. Med J Aust 2009;191(10):525–6.
  39. von Wagner C, Steptoe A, Wolf MS, Wardle J. Health literacy and health actions: a review and a framework from health psychology. Health Educ Behav 2009;36(5):860–77.
  40. Australian Bureau of Statistics. Health literacy. Canberra: ABS; 2006.
  41. Chew LD, Griffin JM, Partin MR, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008;23(5):561–6.
  42. Royal College of General Practitioners. Health Literacy: Report from an RCGP-led literacy workshop [Accessed 9 August 2014].
  43. DeWalt D, Callhan L, Hawk V, et al. Health literacy universal precautions toolkit. Rockville: Agency for Healthcare Research and Quality; 2010.
  44. United States Department of Health and Human Services. Physical activity guidelines advisory committee report. Washington DC: US DHHS; 2008.
  45. Supporting smoking cessation: a guide for health professionals. Melbourne: The Royal Australian College of General Practitioners; 2014.
  46. Higgins K, Cooper-Stanbury M, Williams P. Statistics on drug use in Australia 1998. Drug statistics series. Cat. no. PHE 16. Canberra: AIHW; 2000.
  47. Hill DJ, White VM, Scollo MM. Smoking behaviours of Australian adults in 1995: trends and concerns. Med J Aust 1998;168(5):209–13.
  48. The Tobacco Use and Dependence Clinical Practice Guideline Panel and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. JAMA 2000;283(24):3244–54.
  49. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2013;5:CD000165.
  50. Hughes JR. A quantitative estimate of the clinical significance of treating tobacco dependence. Am J Prev Med 2010;39(3):285–6.
  51. Wynn A, Coleman T, Barrett S, Wilson A. Factors associated with the provision of anti-smoking advice in general practice consultations. Br J Gen Pract 2002;52(485):997–9.
  52. He J, Vupputuri S, Allen K, Prerost MR, Hughes J, Whelton PK. Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies. N Engl J Med 1999;340(12):920–6.
  53. World Health Organization. Report on passive smoking and children. Geneva: WHO; 2000.
  54. Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012;11:CD000146.
  55. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013;5:CD009329.
  56. Gibbons RD, Mann JJ. Varenicline, smoking cessation, and neuropsychiatric adverse events. Am J Psychiatry
  57. 2013;170(12):1460–7.
  58. Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2014;1:CD000031.
  59. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Canberra: NHMRC; 2013.
  60. Welborn TA, Dhaliwal SS, Bennett SA. Waist-hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Med J Aust 2003;179(11–12):580–5.
  61. Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr 2005;81(3):555–63.
  62. World Health Organization Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157–63.
  63. National Health and Medical Research Council. Australian dietary guidelines. Canberra: NHMRC; 2013.
  64. Steptoe A, Perkins-Porras L, McKay C, Rink E, Hilton S, Cappuccio FP. Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. BMJ 2003;326(7394):855.
  65. Miller M, Pollard C, D. P. A public health nutrition campaign to promote fruit and vegetables in Australia. In: Worsley A, editor. Multidisciplinary approach to food choice Proceedings of Food Choice Conference. Adelaide: University of Adelaide; 1993.
  66. Bhattarai N, Prevost AT, Wright AJ, Charlton J, Rudisill C, Gulliford MC. Effectiveness of interventions to promote healthy diet in primary care: systematic review and meta-analysis of randomised controlled trials. BMC Public Health 2013;13:1203.
  67. Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med 2002;35(1):25–41.
  68. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2008(2):CD007176.
  69. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:i–xii, 1–253.
  70. Guidelines for preventive activities in general practice, 8th edn. Melbourne: The Royal Australian College of General Practitioners; 2013.
  71. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 1998;158(16):1789–95.
  72. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT—the alcohol use disorders identification test: guidelines for use in primary care, 2nd edn. Geneva: World Health Organization; 2001. [Accessed 10 July 2014].
  73. Pilling S, Yesufu-Udechuku A, Taylor C, Drummond C, Guideline Development G. Diagnosis, assessment, and management of harmful drinking and alcohol dependence: summary of NICE guidance. BMJ 2011;342:d700.
  74. Department of Health and Ageing. Guidelines for the Treatment of Alcohol Problems. Canberra: DoHA; 2009.
  75. Tam CW, Zwar N, Markham R. Australian general practitioner perceptions of the detection and screening of at-risk drinking,and the role of the AUDIT-C: a qualitative study. BMC Fam Pract 2013;14:121.
  76. Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med 2003;163(7):821–9.
  77. Rehm J, Room R, Taylor B. Method for moderation: measuring lifetime risk of alcohol-attributable mortality as a basis for drinking guidelines. Int J Methods Psychiatr Res 2008;17(3):141–51.
  78. Pluijm SM, Smit JH, Tromp EA, et al. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 2006;17(3):417–25.
  79. Fletcher PC, Hirdes JP. Risk factor for accidental injuries within senior citizens’ homes: analysis of the Canadian Survey on Ageing and Independence. J Gerontol Nurs 2005;31(2):49–57.
  80. Aira M, Hartikainen S, Sulkava R. Community prevalence of alcohol use and concomitant use of medication--a source of possible risk in the elderly aged 75 and older? Int J Geriatr Psychiatry 2005;20(7):680–5.
  81. Foxcroft DR, Ireland D, Lister-Sharp DJ, Lowe G, Breen R. Longer-term primary prevention for alcohol misuse in young people: Cochrane systematic review. Int J Epidemiol 2005;34:758–9.
  82. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J, Force USPST. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004;140(7):557–68.
  83. Ballesteros J, Gonzalez-Pinto A, Querejeta I, Arino J. Brief interventions for hazardous drinkers delivered in primary care are equally effective in men and women. Addiction 2004;99(1):103–8.
  84. Ballesteros J, Duffy JC, Querejeta I, Arino J, Gonzalez-Pinto A. Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. Alcohol Clin Exp Res 2004;28(4):608–18.
  85. Fell JC, Voas RB. The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to .05 BAC. J Safety Res 2006;37(3):233–43.
  86. Taylor B, Irving HM, Kanteres F, et al. The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend 2010;110(1–2):108–16.
  87. Lunetta P, Smith GS, Penttila A, Sajantila A. Unintentional drowning in Finland 1970-2000: a population-based study. Int J Epidemiol 2004;33(5):1053–63.
  88. Driscoll TR, Harrison JE, Steenkamp M. Alcohol and drowning in Australia. Inj Control Saf Promot 2004;11(3):175–81.
  89. Kaye S, Darke S. Non-fatal cocaine overdose among injecting and non-injecting cocaine users in Sydney, Australia. Addiction 2004;99(10):1315–22.
  90. O’Kane CJ, Tutt DC, Bauer LA. Cannabis and driving: a new perspective. Emerg Med (Fremantle) 2002;14(3):296–303.
  91. Sullivan LE, Fiellin DA, O’Connor PG. The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med 2005;118(4):330–41.
  92. Morris EP, Stewart SH, Ham LS. The relationship between social anxiety disorder and alcohol use disorders: a critical review. Clin Psychol Rev 2005;25(6):734–60.
  93. Abrams K, Kushner M, Medina KL, Voight A. The pharmacologic and expectancy effects of alcohol on social anxiety in individuals with social phobia. Drug Alcohol Depend 2001;64(2):219–31.
  94. Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother 2007;5(1):64–74.
  95. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health 1999;23(1):40–54.
  96. Odendaal HJ, Steyn DW, Elliott A, Burd L. Combined effects of cigarette smoking and alcohol consumption on perinatal outcome. Gynecol Obstet Invest 2009;67(1):1–8.
  97. Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010;105(5):817–43.
  98. Australian Health Ministers’ Advisory Council. Clinical Practice Guidelines: Antenatal Care – Module 1. Canberra: Australian Government Department of Health and Ageing; 2012.
  99. Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug Alcohol Rev 2009;28(3):301–23.
  100. Apodaca TR, Longabaugh R. Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction 2009;104(5):705–15.
  101. Lundahl B, Burke BL. The effectiveness and applicability of motivational interviewing: a practice-friendly review of four metaanalyses. J Clin Psychol 2009;65(11):1232–45.
  102. Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med 2005;165(9):986–95.
  103. Raistrick D, Heather N, Godfrey C. Review of the effectiveness of treatment for alcohol problems. London: National Treatment Agency for Substance Misuse; 2006.
  104. Department of Health and Ageing. Quick Reference Guide to the Treatment of Alcohol Problems: Companion Document to The Guidelines for the Treatment of Alcohol Problems. Canberra: DoHA; 2009.
  105. National Institute for Health and Clinical Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical guideline 115. London: NICE; 2011.
  106. Brown W, Bauman A, Bull F, Burton N. Development of evidence-based physical activity recommendations for adults (18–64 years). Report prepared for the Australian Government Department of Health, August 2012.
  107. Bauman A, Bellew B, Vita P, Brown W, Owen N. Getting Australia active: towards better practice for the promotion of physical activity. Melbourne: National Public Health Partnership; 2002.
  108. Winzenberg T, Shaw KA. Screening for physical inactivity in general practice - a test of diagnostic accuracy. Aust Fam Physician 2011;40(1–2):57–61.
  109. Ridgers ND, Timperio A, Crawford D, Salmon J. Validity of a brief self-report instrument for assessing compliance with physical activity guidelines amongst adolescents. J Sci Med Sport 2012;15(2):136–41.
  110. Tudor-Locke C, Craig CL, Brown WJ, et al. How many steps/day are enough? For adults. Int J Behav Nutr Phys Act 2011;8:79.
  111. Tudor-Locke C, Craig CL, Beets MW, et al. How many steps/day are enough? For children and adolescents. Int J Behav Nutr Phys Act 2011;8:78.
  112. Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011;8:80.
  113. Schmidt MD, Cleland VJ, Shaw K, Dwyer T, Venn AJ. Cardiometabolic risk in younger and older adults across an index of ambulatory activity. Am J Prev Med 2009;37(4):278–84.
  114. Department of Health and Ageing. National physical activity recommendations for children 0-5 years. Canberra: Department of Health and Ageing; 2012.
  115. Okely AD, Salmon J, Trost SG, Hinkley T. Discussion paper for the development of physical activity recommendations for children under five years. Canberra: Department of Health and Ageing; 2008.
  116. Department of Health and Ageing. National physical activity and sedentary behaviour guidelines for children (5–12 years). Canberra: Department of Health and Ageing; 2012.
  117. Okely AD, Salmon J, Vella SA, et al. A Systematic Review to update the Australian Physical Activity Guidelines for Children and Young People. Report prepared for the Australian Government Department of Health and Ageing, June 2012.
  118. Okely AD, Salmon J, Vella SA, et al. A Systematic Review to Inform the Australian Sedentary Behaviour Guidelines for Children and Young People. Report prepared for the Australian Government Department of Health and Ageing, June 2012.
  119. Department of Health and Ageing. National physical activity and sedentary behaviour guidelines for young people (13–17 years). Canberra: Department of Health and Ageing; 2012.
  120. Department of Health and Ageing. National physical activity and sedentary behaviour guidelines for adults (18–64 years). Canberra: Department of Health and Ageing; 2012.
  121. Department of Health and Ageing. National Physical activity recommendations for older Australians (65 years and older). Canberra: Department of Health and Ageing; 2012. [Accessed 16 January 2015].
  122. Sims J, Hill K, Hunt S, et al. National physical activity recommendations for older Australians: Discussion document. Canberra: Australian Government Department of Health and Ageing; 2006.
  123. Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ 2012;344:e1389.
  124. Kolt GS, Schofield GM, Kerse N, Garrett N, Ashton T, Patel A. Healthy Steps trial: pedometer-based advice and physical activity for low-active older adults. Ann Fam Med 2012;10(3):206–12.
  125. Prince SA, Saunders TJ, Gresty K, Reid RD. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev 2014.
  126. American College of Sports Medicine, American Heart Association. Exercise and acute cardiovascular events: placing the risks into perspective. Med Sci Sports Exerc 2007;39(5):886–97.
  127. Cleland V, Granados A, Crawford D, Winzenberg T, Ball K. Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis. Obes Rev 2013;14(3):197–212.
  128. Pavey T, Taylor A, Hillsdon M, et al. Levels and predictors of exercise referral scheme uptake and adherence: a systematic review. J Epidemiol Community Health 2012;66(8):737–44.
  129. Jordan JL, Holden MA, Mason EE, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev 2010(1):CD005956.
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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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