Family Medicine

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World Book of Family Medicine – European Edition 2015 Deckers JGM, Paget WJ, Schellevis FG, Fleming DM. European primary care surveillance networks: their structure and operation. Fam Pract 2006;23:151-8. Fleming DM, Schellevis FG, Casteren V van. The prevalence of known diabetes in eight European countries. Eur J Publ Health 2004;14:10-14. Hannoun C, Dab W, Cohen JM. A new influenza surveillance system in France, the Ile-de-France GROG. I. Principles and methodology. Eur J Epidemiol 1989; 5: 285-93. Hardelid P, Fleming DM, Andrews N, Barley M, Durnall H, Mangtani P, Pebody R. Effectiveness of trivalent and pandemic influenza vaccines in England and Wales 2008-2010: results from a cohort study in general practice. Vaccine 2012;30:1371-8. Woodhead M, Fleming D, Wise R. Antibiotics, resistance, and clinical outcomes. Br Med J 2004;328:1270-1. 154
World Book of Family Medicine – European Edition 2015 Norbert Donner-Banzhoff, MD, MHSc Norbert@staff.uni-marburg.de 50 – Stages of Behavioural Change – a Helpful Concept for GPs? Norbert Donner-Banzhoff, MD, MHSc Prof. Department of General Practice, University of Marburg, Germany also the lack thereof. Stages of change originated from the field of counselling for addiction disorders. Instead of treating every patient in a one-size-fits-all fashion, a motivational diagnosis is made before doctor and patient embark on a treatment plan. A patient may have tried to stop smoking or drinking several times. Subsequently, a person probably does not have to be informed about the fact that smoking or drinking is bad for his health and perhaps even the health of others. There are others, however, who initially need to be informed that their weekly alcohol consumption is above safe levels. While the former may benefit from a precise plan for when to stop and how to manage the transition, the latter would be forced into resistance when confronted with a prescription of this kind. Instead, patient-communication should roll with resistance. Clinicians should only propose to the patient what he can realistically achieve at his current motivational stage (1). Stages of change implies that humans go through a sequence of defined stages of contemplation, preparation and observable action. For each stage, tailored interventions are available to help the patient move on to the next and, finally, to the aspired behaviour. Since they drew upon previous models, Prochaska and DiClemente coined the notion of a Transtheoretical Model (2). Twenty years ago this approach became almost orthodox in the treatment of behavioural problems related to health. This happened despite the empirical evidence supporting the model being somewhat contradictory (3). Moreover, Stages of Change came under the attack from scientists proposing different models of behavioural change (4,5). Despite this, Stages of Change has had a long-lasting appeal with General Practitioners (GPs) (6). While the scientific debate centred on the descriptive and analytical validity of the model, clinicians embraced it for its pragmatic utility. The model may not apply to all human beings in the process of changing their minds and their behaviours. But GPs find the model useful for distinguishing between those in which immediate intervention makes sense and those in which friendly waiting is to be preferred. Counsellors in specialised clinics usually see those who have decided to seek help, their clients are at least ambivalent and perhaps even ready for change. GPs, on the other hand, see smokers not because they want to stop their smoking habit but because of their cough or other manifested illness. In primary care we are thus confronted with a much broader range of motivational stages than the specialist counsellor. While in a specialised clinic the stages of contemplation and preparation are more frequent, primary care more closely reflects the distribution in the general population. The latter is U-shaped with most people having no intention at all or being past the sequence of changes (maintenance). GPs thus need a tool to decide where to invest their time and energy. The “Stages of Change“ model provides exactly that. It helps identify opportunities for change but 155
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Family Medicine

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