A randomized controlled trial of behavior change counseling education for medical students

Figures & data

Table

Practice points

Behavior change counseling is a patient-centered approach that can be used in a variety of clinical encounters to help clinicians navigate discussions with patients about changing healthcare behaviors. Medical students appear to prefer a patient-centered and collaborative style to health behavior consultations over more traditional directive advice-giving methods. A 2-h workshop on behavior change counseling can lead to measurable improvements in knowledge and skills in second year medical students.

Table 1.  Multiple choice questions used to assess knowledge of behavior change counselling

1. Which of the following strategies is most consistent with behavioral change counseling?

a. Providing expert information to guide the patient in forming an action plan

b. Labeling the diagnosis and problem behavior for the patient

c. Asking the patient to rate their confidence in enacting an action plan

d. Prescribing an action plan for the patient

2. Which of the following responses to resistance is most consistent with behavioral change counseling?

a. ‘If your blood sugar doesn’t improve, this can lead to serious problems for your eyes, kidneys, and heart’

b. ‘So there's not really a problem in your blood sugar being high?’

c. ‘I am worried about your blood sugar being so high, so let us go over the diet plan again’

d. ‘Your blood sugar ought to be a lot lower if you want to feel better’

3. If a patient makes an inappropriate plan of action, which of the following responses would be most consistent with behavioral change counseling?

a. ‘I think you’re moving too quickly; you ought to consider taking smaller steps’

b. ‘Sounds like you’ve come up with a plan. Would it be okay if we discussed some possible concerns?’

c. ‘That sounds like a good plan for working on your weight, but we need to focus on your blood sugar first’

d. ‘A lot of other people have not succeeded in taking those steps. Would you be willing to consider doing something else?’

4. Which of the following concepts is central to behavioral change counseling?

a. Presenting reasons for change

b. Challenging resistance to change

c. Enhancing motivation for change

d. Directing change efforts

5. Which of the following examples of feedback and advice to give to patients would be most consistent with behavioral change counseling?

a. ‘You should probably stop smoking, and I recommend our smoking cessation group’

b. ‘Other patients have said that our smoking cessation group was helpful, so that might be something to consider’

c. ‘Experts have found that quitting smoking is best done in a structured program, so you should go to our smoking cessation group’

d. ‘Would it be okay with you if I told you why our smoking cessation group would be good for you’

e. ‘Other patients have said that our smoking cessation group was helpful, so you ought to give it a try’

6. Which of the following is most consistent with behavior change counseling principles?

a. Providing neutral feedback, such as ‘experts have found …’

b. Using clear diagnostic terms with patients, such as ‘alcohol dependence’

c. Encouraging the patient to follow his/her own plan, even if it doesn’t sound reasonable

d. Waiting for patients to ‘hit rock bottom’ before they are ready to change

e. Addressing patient resistance with confrontation of maladaptive behaviors

Figure 1. Overview of study design. Note: *Three students never completed assessments, and two students were dropped from analyses due to incomplete data.

Table 2.  Behavior Change Counseling Index (BECCI) pre-test and post-test descriptive statistics

	Control group (n = 18)		Intervention group (n = 17)
BECCI items	Pre-test	Post-test	Pre-test	Post-test
Practitioner …	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
(1) … invites patient to talk about behavior change	0.56 (0.70)	1.00 (0.77)	1.00 (0.79)	1.71 (0.69)^a
(2) … demonstrates sensitivity talking about other issues	0.89 (0.83)	1.22 (1.11)	0.82 (1.07)	2.06 (1.09)
(3) … encourages patient to talk about current behavior or status quo	2.33 (0.59)	2.22 (0.73)	2.00 (0.50)	2.65 (0.49)
(4) … encourages patient to talk about change	1.39 (0.98)	1.94 (0.94)	2.06 (0.97)	3.06 (0.56)^a
(5) … asks questions to elicit how patient thinks and feels about topic	0.83 (0.86)	1.11 (1.08)	1.00 (1.12)	2.29 (0.59)
(6) … uses empathic listening statements	0.00 (0.00)	0.17 (0.51)	0.00 (0.00)	0.29 (0.59)
(7) … uses summaries to bring together what patient says	0.78 (0.73)	1.00 (0.77)	1.00 (0.87)	1.71 (0.69)
(8) … acknowledges challenges about behavior change that patient faces	0.56 (0.51)	1.11 (0.83)	1.00 (1.00)	1.65 (1.17)
(9) … provides information sensitive to patient concerns and understanding	0.94 (1.35)	1.11 (1.37)	0.59 (1.06)	0.71 (1.05)
(10) … actively conveys respect for patient choice about behavior change	1.28 (0.83)	1.44 (0.86)	1.65 (0.70)	2.29 (0.85)
(11) … and patient exchange ideas about how patient could change current behavior	1.44 (0.86)	1.56 (0.70)	2.00 (0.87)	2.41 (0.62)^a
BECCI practitioner total score	1.00 (0.50)	1.26 (0.44)	1.19 (0.51)	1.89 (0.35)

Notes: Mean scores can range from 0 (not at all) to 4 (a great extent). Group × time effect, p < 0.05, for BECCI total score and items 5, 7, 8, and 10. ^aGroup × time effect, Bonferonni-corrected, p < 0.005.