Intervention Strategies - Lifestyle Assessment

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In most cases some form of lifestyle assessment is necessary for identifying and prioritizing the behaviors that elevate risk, and the lifestyle factors/issues that should be considered in encouraging behavior change.

OVERVIEW

Lifestyle assessment is the process of identifying behavioral risk factors particular to an individual with the intent to encourage behavior change for the prevention of poor health outcomes in the future.^1,2,3 A good assessment will identify what behaviors need to be changed as well as how best to intervene.³ The most common behaviors of focus in lifestyle assessments are smoking, alcohol use, diet, and physical activity.⁴

EVIDENCE

There is mixed evidence as to the accuracy of lifestyle assessments in determining risk, predicting future health outcomes, and accurately guiding counseling. Conclusions from two reviews of lifestyle assessments in the form of health risk appraisals suggest that, at minimum, lifestyle assessments are able to differentiate low and high risk and thus long-term survival.^2,5 Two other reviews of the evidence suggest that lifestyle assessments may underestimate some risk factors due to the complexity of measuring behaviors.^3,6 The well known phenomenon of self-report measures and social desirability bias would suggest that respondents report healthier behaviors than would be assessed through more objective measures.^7,8 This phenomenon must be considered when interpreting lifestyle assessment data.

IMPLEMENTATION GUIDANCE

Lifestyle assessment considerations include the content of the assessment tool, as well as factors related to the format and implementation of the assessment tool.

Content of Assessment Tool

• Assessment tools can be quite simple in nature, such as focusing on what an individual has thought about or knows regarding a particular health behavior. Or they can function as a wide lens capturing the range of behavioral risk factors relevant to an individual.^3,4,9
• In addition to assessing specific behavioral risks, it is important to ask questions to help identify how best to intervene for a particular behavior change. Factors to consider include: intention or readiness to change, perceived benefits or concerns related to specific behaviors, and perceived behavioral skills.^2,3,10

Format and Implementation of Assessment Tool

• It is important to consider practicality when implementing a lifestyle assessment. Ideally, assessment tools should be short and easily scorable.^3,10
• There are a large number and variety of existing assessment tools that have been validated through research. Validated tools needed for a specific purpose can be identified through the research literature.
• Self-report assessment tools can be used in conjunction with laboratory screening (e.g., one can measure carbon monoxide levels in blood to assess smoking); however, laboratory-based assessment can significantly increase the cost of a comprehensive health assessment.¹

ADAPTATIONS

• New technologies have increased the potential efficiency of lifestyle assessments. Rather than having individuals complete assessments in person—thus delaying the ability of the practitioner to respond in a timely manner—assessments can be completed and submitted electronically before a meeting with the practitioner. This maximizes the time spent face-to-face in discussing the results of the assessment.^3,11
• A review of technology used in assessment found that internet, CD-ROMs, and interactive voice response technologies (telephone-based) are the strongest tools, followed by personal digital assistants (PDAs) and printed forms, and last e-mail.¹¹

TIPS

• Tailoring is often considered for behavior change programs but it can also be useful to assessment processes. Factors useful to consider tailoring in lifestyle assessments include age, gender, and race/ethnicity. For example, a dietary assessment tool might reflect certain types of foods that are more common for individuals of a particular race/ethnicity.¹

REFERENCES

¹ Babor, T. F., Sciamanna, C. N., & Pronk, N. P. (2004). Assessing Multiple Risk Behaviors in Primary Care Screening Issues and Related Concepts. American Journal of Preventive Medicine,27(2S), 42-53.

² Strecher, V. J., & Kreuter, M. W. (2000). Health risk appraisal from a behavioral perspective: Present and future. The International Electronic Journal of Health Education, 3(Special), 169-179. Retrieved January 5, 2008, from http://www.kittle.siu.edu/iejhe/3special/pdf/strecher.pdf

³ Whitlock, E. P., Orleans, C. T., Pender, N., & Allan, J. (2002). Evaluating primary care behavioral counseling interventions: an evidence-based approach. American Journal of Preventive Medicine, 22(4), 267-284.

⁴ Pronk, N. P., Peek, C. J., & Goldstein, M. G. (2004). Addressing multiple behavioral risk factors in primary care: a synthesis of current knowledge and stakeholder dialogue sessions. American Journal of Preventive Medicine, 27(2S), 4-17.

⁵ Idler, E. L, & Benyamini, Y. (1997). Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21-37. Retrieved May 11, 2008, from http://www.jstor.org/stable/2955359

⁶ Newell, S. A., Girgis, A., Sanson-Fisher, R. W., & Savolainen, N. J. (1999). The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. American Journal of Preventive Medicine, 17(3), 211-229.

⁷ Adams, S.A., Matthews, C.E., Ebbeling, C.B., Moore, C.G. Cunningham, J.E., Fulton, J., Hebert, J. R. (2005). The effect of social desirability and social approval on self-reports of physical activity. American Journal of Epidemiology, 161(4), 389-398.

⁸ Miller, T. M., Abdel-Maksoud, M. F., Crane L. A., Marcus A. C., & Byers, T. E. (2008). Effects of social approval bias on self-reported fruit and vegetable consumption: a randomized controlled trial. Nutrition Journal, 7(18).

⁹ Elder, J. P., Ayala, G. X., & Harris S. (1999). Theories and intervention approaches to health-behavior change in primary care. American Journal of Preventive Medicine, 17(4), 275-284.

¹⁰ Ammerman, A., Pignone, M., Fernandez, L., Lohr, K., Jacobs, A. D., Nester, C., et al. (2002). Counseling to promote a healthy diet. Systematic Evidence Review No. 18 (Prepared by Research Triangle Institute/University of North Carolina under Contract No 290-97-0011). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved May 9, 2008, from http://www.ahrq.gov/downloads/pub/prevent/pdfser/dietser.pdf

¹¹ Glasgow, R. E., Bull, S. S., Piette, J. D., & Steiner, J. F. (2004). Interactive behavior change technology. A partial solution to the competing demands of primary care. American Journal of Preventive Medicine, 27(2 Suppl), 80-87.