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Patient education and counseling
Nov, 2011;85 (2): e8-15.

Identifying teachable moments for health behavior counseling in primary care.

Deborah J Cohen, Elizabeth C Clark, Peter J Lawson, Brad A Casucci, Susan A Flocke
Author Information
  1. Deborah J Cohen: Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. cohendj@ohsu.edu
PMID: 21183305 DOI: 10.1016/j.pec.2010.11.009

Abstract

OBJECTIVE: Situations with potential to motivate positive change in unhealthy behavior have been called 'teachable moments'. Little is known about how they occur in the primary care setting.
METHODS: Cross-sectional observational design. Audio-recordings collected during 811 physician-patient interactions for 28 physicians and their adult patients were analyzed using conversation analysis.
RESULTS: Teachable moments were observed in 9.8% of the cases, and share three features: (1) the presence of a concern that is salient to the patient that is either obviously relevant to an unhealthy behavior, or through conversation comes to be seen as relevant; (2) a link that is made between the patient's salient concern and a health behavior that attempts to motivate the patient toward change; and (3) a patient response indicating a willingness to discuss and commit to behavior change. Additionally, we describe phenomena related to, but not teachable moments, including teachable moment attempts, missed opportunities, and health behavior advice.
CONCLUSIONS: Success of the teachable moment rests on the physician's ability to identify and explore the salience of patient concerns and recognize opportunities to link them with unhealthy behaviors.
PRACTICE IMPLICATIONS: The skills necessary for accomplishing teachable moments are well within the grasp of primary care physicians.

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Grants

  1. R01 CA105292/NCI NIH HHS
  2. R01 CA 105292/NCI NIH HHS

MeSH Term

Adolescent
Adult
Aged
Counseling
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Diet
Female
Health Promotion
Humans
Male
Middle Aged
Obesity
Patient Education as Topic
Physician-Patient Relations
Primary Health Care
Smoking Prevention
Teaching
Journal Article Research Support, N.I.H., Extramural
Article has an altmetric score of 6

Word Cloud

Created with Highcharts 10.0.0behaviorteachablemomentspatientchangeunhealthyprimarycarehealthmotivatephysiciansconversationconcernsalientrelevantlinkattemptsmomentopportunitiesOBJECTIVE:Situationspotentialpositivecalled'teachablemoments'LittleknownoccursettingMETHODS:Cross-sectionalobservationaldesignAudio-recordingscollected811physician-patientinteractions28adultpatientsanalyzedusinganalysisRESULTS:Teachableobserved98%casessharethreefeatures:1presenceeitherobviouslycomesseen2madepatient'stoward3responseindicatingwillingnessdiscusscommitAdditionallydescribephenomenarelatedincludingmissedadviceCONCLUSIONS:Successrestsphysician'sabilityidentifyexploresalienceconcernsrecognizebehaviorsPRACTICEIMPLICATIONS:skillsnecessaryaccomplishingwellwithingraspIdentifyingcounseling

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