Implementation of a low-budget, lifestyle-improvement method in an ordinary primary healthcare setting: a stepwise intervention study

OBJECTIVE To evaluate, in an ordinary primary healthcare setting, the effects of a screening questionnaire and a self-administered health profile dealing with special reference to the involvement of motivated individuals in need of lifestyle changes. DESIGN Intervention study in a naturalistic context, using a screening questionnaire offered to consecutive patients, followed by a self-administered health profile and a health dialogue. SETTING Hisingen primary healthcare area (130 033 inhabitants), Gothenburg, Sweden. PARTICIPANTS Men and women aged between 18 and 79, visiting any of the eight public primary healthcare centres (PCC) during an 8-month period, were presented with a screening questionnaire and, were offered, a health profile, a plasma glucose (p-glucose), blood pressure check and a health dialogue. MAIN OUTCOME MEASURES Motivation level, negative lifestyle factors in screening questionnaire and intraindividual changes in blood pressure, p-glucose, body mass index (BMI) and lifestyle factors between baseline and 1-year follow-up. RESULTS Subjects with less favourable lifestyle and higher motivation chose to participate. A higher percentage of presumptive participants reported a less favourable lifestyle. The presumptive participants also indicated higher motivation. Participants showed more readiness to initiate lifestyle changes compared to non-participants (p<0.001). At 1-year follow-up significant reductions in BMI, waist circumference, waist-hip ratio (WHR), blood pressure and p-glucose were observed. CONCLUSIONS The results indicate that the method is on target and applicable to motivated individuals with a 'risk profile'. A pedagogical model including a self-administered health-profile and a health dialogue, combined with emphasising the individual's own resources, seems to be a feasible method for effective preventive work in primary healthcare.