A METAANALYSIS OF TRIALS EVALUATING PATIENT EDUCATION AND COUNSELING FOR 3 GROUPS OF PREVENTIVE HEALTH BEHAVIORS

Objectives: To examine the overall effectiveness of patient education and counseling on preventive health behaviors and to examine the effec ts of various approaches for modifying specific types of behaviors. Da ta sources: Computerized databases (Medline, Healthline, Dissertation Abstracts, and Psychological Abstracts), bibliographies 1971-1994. Sea rch terms (patient education, patient compliance, and self care) with modifiers (evaluation and specific preventive behaviors). Study select ion: Randomized and non-randomized controlled trials measuring behavio r in clinical settings with patients without diagnosed disease. Abstra cts and retrieved studies screened by multiple reviewers; 13% of retri eved studies met screening criteria. Data extraction: Replicated codin g by multiple observers. Data synthesis: Behaviors were grouped based on whether the behavior is addictive and whether the desired change re quired subtraction of existing behaviors or adding new behaviors. The weighted average effect size from a random effects model for smoking/a lcohol studies was 0.61 (CI = 0.45, 0.77), for nutrition/weight, 0.51 (CI = 0.20, 0.82) and for other behaviors, 0.56 (CI = 0.34, 0.77) indi cating that the behavioral outcomes for these subgroups were significa ntly different from zero. Multiple regression models for the three gro ups indicated that using behavioral techniques, particularly self-moni toring, and using several communication channels, e.g., media plus per sonal communication, produces larger effects for the smoking/alcohol a nd nutrition/weight groups. Conclusions: Patient education and counsel ing contribute to behavior change for primary prevention of disease. S ome techniques are more effective than others in changing specific beh aviors. (C) 1997 Elsevier Science Ireland Ltd.