What can we generalize from research on patient education and clinical health promotion to physician counseling on diet?

Objective: This paper explores the status of knowledge development from cli nical trials and other studies of patient education and clinical health pro motion. Design: It asks what this cumulative literature has to offer dietary counse ling of patients by family doctors. A series of meta-analyses of drug educa tion and preventive health education research in clinical settings provide a starting framework for guidelines on dietary counseling. Conclusions: Smoking cessation studies, in particular, have mounted in quan tity and quality to the greatest extent and offer the clearest statement on what can be achieved, under what conditions, and with what support beyond the physician's counseling session or sessions. The Precede-Proceed Model o ffers a further guide to assuring the comprehensiveness of approaches to di etary change - enabling and reinforcing the change, not just predisposing i t through admonitions and altering of knowledge, attitudes and beliefs. The specific evidence supporting the application of a patient counseling algor ithm based on the Precede-Proceed model is reviewed here.