The effect of preventive consultations with psychosocial

Patients with many problems often face difficulties in modifying their behavior as desired. Uncovered basic needs may be an important barrier. This research tests the effect of patient-centered consultations for 20to 44year-old patients with multiple psychosocial and lifestyle problems. We focus on resources and barriers for obtaining self-chosen goals within life circumstances and lifestyle. At 28 general practitioners, 2056 patients aged 20–44 years were screened with a 33-item problem-score on resources, network, lifestyle and social conditions. The 30% who had most problems were invited to complete a more comprehensive questionnaire at home. Intervention was preventive consultation with a 3-month follow-up. A total of 495 patients were randomized. One-year questionnaire follow-up showed significant improvement in Short Form Healthrelated Quality of Life Mental (MCS-SF12) in the intervention group (7.3) compared with the control group (3.0); the difference was 4.3 (95% confidence interval 1.6–7.0, P 5 0.002). The number of problems was reduced significantly more in the intervention than in the control group (1.8 versus 0.8, P5 0.03). Preventive consultation focusing on resources and barriers to self-chosen goals may improve MCS-SF12 and decrease the number of problems in patients with many psychosocial and lifestyle problems. This may be an indicator of improved specific self-efficacy and a key to lifestyle changes. We are currently witnessing a worldwide increase in lifestyle diseases, e.g. obesity, type 2 diabetes, vascular diseases and psychological and psychiatric problems [1, 2]. Changes in lifestyle regarding food, exercise and tobacco and alcohol consumption are widely recommended, but improvements are rarely achieved [1, 3]. Political regulation is recommended to make the healthy choice an easy choice [1]. Most people with multiple psychosocial problems find it difficult to change their behavior in response to information about risky lifestyle, in some cases because the user perceives the behavior, e.g. use of a stimulant like nicotine and alcohol, as a solution rather than a problem. Sometimes, an adverse reaction to information and advice is seen [4, 5]. Maslow’s theory ‘Hierarchy of needs’ offers some explanation about why people with unmet basic needs may not profit from preventive counseling focused on risk (Fig. 1) [6]. Maslow’s hierarchy implies that lower needs must be met before higher needs emerge. Unmet needs result in a state of tension and anxiety, that is, they hinder self-esteem, which lies at the root of self-actualization [7, 8]. Self-efficacy theory as described and explored in several studies provides explicit guidelines for how to enable people to exercise some influence over problems: a randomized trial on young adults