The Department of Veterans Affairs has a proven record of delivering Health Promotion Disease Prevention services to Veterans at a higher overall rate than that of non-VA health care entities. Many of these services are well-incorporated in VA facilities because of an established Health Promotion Disease Prevention Program (HPDP) that implements performance measures and reminders that prompt staff to discuss prevention along with discussing behavior change and setting goals with Veterans.To encourage Veterans to choose healthy living behaviors and goals, VA’s across the country implemented nine key evidence based healthy living messages. These messages cover core prevention areas including nutrition, physical activity, weight management, smoking, alcohol use, stress management, clinical preventive services, safety, and health care communication. These topics were chosen because of their importance for reducing chronic disease morbidity and mortality and improving quality of life.
West Palm Beach VA Health Promotion Disease Prevention Program trains Primary Care staff to utilize effective brief interventions for weight management, tobacco cessation and other patient education topics for Veterans. Helping patients achieve weight loss and make dietary and physical activity improvements is difficult; some patients need more intense behavioral counseling. A review of behavioral counseling interventions for healthy diet, physical activity, or a combined lifestyle can result in small but significant improvements in the amount of salt, fat, fruits/vegetables, and calories; minutes of physical activity per week, and physiologic measures of body mass index, blood pressure and cholesterol.
The National Center for Health Promotion Disease Prevention suggests that establishing a strong relationship with patients and using communication techniques such as motivational interviewing, health coaching, and shared decision making can help patients make better choices around behaviors that can impact health, such as physical activity, eating habits, tobacco cessation, and alcohol misuse.
The premise of this approach, which is termed patient-centered care, is to elicit the patient’s priorities and goals, rather than telling the patient what those priorities should be. This approach allows patients to prioritize and decide what they are ready to change and has been shown to be effective in promoting behavior change. With practice, these types of conversations can be conducted efficiently and effectively.
Training staff in patient-centered communication skills have proven successful in promoting and supporting tobacco cessation and can be expanded to address physical activity and diet choices. Staff are able to emphasize the importance of these behaviors in preventing and managing chronic diseases and to offer more information on such topics if the Veteran expresses interest.
HPDP Program Managers and Health Behavior Coordinators (HBCs), in collaboration with Veterans Health Education Coordinators, play a critical role in training staff in effective communication strategies to promote prevention through health behavior change. The first of the two courses is TEACH for Success. TEACH guides clinicians in how to use evidence-based health education, counseling, and communication skills with patients and their family members.
The second course covers motivational interviewing. Derived from work with patients with substance abuse issues, motivational interviewing is now being widely used in the general health care setting. The philosophy of the motivational communication approach is to assume that it is natural for people to have mixed feelings (ambivalence) about making changes in their health-related behaviors. To successfully assist patients in making healthy lifestyle changes, health care staff establish a collaborative, empathetic relationship with their clients. The approach helps patients explore their ambivalence about health issues and change by teaching skills to resist lecturing, exploring patient motivations, partnering with patients through effective listening, and empowering patients by helping them explore how they can make a difference in their own health.
