REVIEW ARTICLE
Health Promotion and Disease Prevention Strategies for
Today’s Physicians
Muni Rubens, MBBS, MPH, Venkataraghavan Ramamoorthy, MS, Jennifer Attonito, PhD,
Anshul Saxena, MPH, Rakesh Ravikumaran Nair, MD and Nancy Shehadeh, PhD
Abstract: The majority of preventable diseases in both developed and
developing countries could be strategically controlled by effectively
implementing existing health promotion and disease prevention (HPDP)
interventions. An important juncture for the implementation of risk-
reduction strategies is the point of interaction between health care
providers and patients during their scheduled visits. This article targets
strategies for physicians to effectively implement HPDP interventions
in a clinical setting. The factors that improve delivery of HPDP
interventions are discussed briefly. We subsequently introduce and
discuss the conceptual framework for enhanced patient education,
which is based on the information-motivation-behavioral skills model
and the health belief model. The article also describes an adapted
patient-practitioner collaborative model for HPDP. This adapted model
may serve as a blueprint for physicians to effectively execute HPDP
interventions during clinical encounters. The recommended models and
our conceptual frameworks could have limitations which need to be
field tested.
Key Indexing Terms: Health promotion and disease prevention;
Patient-practitioner collaborative model-adapted; Patient-physician rela-
tion; Information-motivation-behavioral skills; Health belief model.
[Am J Med Sci 2015;349(1):73–79.]
T he majority of mortality and morbidity in both developed
and developing countries is primarily due to preventable
risk factors.1,2 In the United States alone, in 2010, 24.2% of
all deaths were due to heart diseases, 23.3% were due to malig-
nant neoplasms and 5.6% were due to chronic respiratory dis-
eases.3 To a large degree, the morbidity and mortality
associated with these diseases could be successfully controlled
through preventive strategies. Hence, health promotion and dis-
ease prevention (HPDP) interventions are crucial components
of today’s health care, requiring intervention at intrapersonal,
interpersonal, community and societal levels.4,5 Within the
HPDP ecology, the patient-physician interaction is possibly
one of the most powerful and timely environments for the
delivery of effective risk-reduction strategies and messages at
intrapersonal and interpersonal levels.6
Health care delivery in the United States strives to
provide the most advanced treatment options and highest
quality of care.7 Today’s medical curriculum mainly focuses
on pathophysiological mechanisms of diseases, innovative
diagnostic procedures and testing capacities and highly
From the Departments of Health Promotion and Disease Prevention
(MR, JA, AS, NS) and Dietetics and Nutrition (VR), Robert Stempel College of
Public Health and Social Work, Florida International University, Miami,
Florida; and Department of Surgery (RR), Mount Sinai Medical Center,
Miami Beach, Florida.
Submitted January 29, 2014; accepted in revised form May 12, 2014.
The authors have no financial or other conflicts of interest to disclose.
Correspondence: Muni Rubens, MBBS, MPH, Department of Health
Promotion and Disease Prevention, Robert Stempel College of Public
Health and Social Work, Florida International University, 11200 SW 8th
Street, AHC II 559, Miami, Florida 33199 (E-mail: mrube001@fiu.edu).
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effective therapeutic interventions. Although it is highly recom-
mended that physicians give adequate attention to HPDP
because they have a great influence on patients and their modifi-
able risk factors, HPDP guidelines and recommendations are
rarely introduced in medical curriculum.8,9 Many innovative
theories and models have been proposed and tested by medical
and psychological studies that could effectively lay the ground-
work for physicians to deliver effective HPDP risk-reduction
messages to their patients.10,11
The main objective of this article was to describe
a conceptual/theoretical model along with an adapted patient-
practitioner collaborative model (PCM-A) as applied to the
clinical environment. The theoretical model provides insights
about the factors that intersect in the delivery of effective HPDP
guidance during the patient-physician interaction, and it serves
to simplify this potentially complex dynamic. The PCM-A
provides a practical strategy: (1) to consider the health issue
within the perspective of the patient’s life and (2) to decide
where patient and physician could partner together to design
and/or select an effective HPDP intervention that will maximize
long-term health outcomes. In addition, decision-making fac-
tors affecting patients’ HPDP choices and strategies for improv-
ing them are discussed.
FACTORS AFFECTING PATIENTS’
RECEPTIVENESS TO HPDP EDUCATION
During clinical encounters, several interpersonal and
intrapersonal factors influence the quality of patient-provider
communication. Factors that promote interaction quality
include race concordance between patients and physicians
and patients having health insurance. Seeking continuous
care from the same provider over time is also known to help
relationship development.12,13 Certain patient qualities are
known to adversely affect the quality of patient-provider
interaction, including belonging to a racial minority, male
gender, lower education level, perceived discrimination by
physicians, poor self-perceived health status and clinical
depression.12–14 Furthermore, the level of trust that patients
place with their physicians significantly influences receptive-
ness to health education directives.13,15,16 Greater trust in
physicians is associated with a number of patient qualities
like age (higher trust levels tend to be experienced by young
adults and elderly patients), female gender, higher education,
white race, poor health status, prolonged relationship with
the same health care providers, overall trust in health care
delivery resources and gender concordance between patients
and physicians.17–22 Thus, both personal factors and interper-
sonal factors contribute to establishing trust in the provider,
potentially bearing on quality communication during clinical
encounters and the probability of effective delivery and
receptivity of HPDP messages. In other words, patients at
risk for lower trust are much more likely to neglect HPDP
guidance during clinical encounters.
73
Rubens et al
CONCEPTUAL FRAMEWORK FOR ENHANCED
PATIENT EDUCATION
The conceptual framework presented here is based on 2
established theories in HPDP: the information-motivation-
behavioral skills (IMB) model and the health belief model
(HBM). This article proposes a framework that assimilates key
constructs from these 2 models in building better HPDP
strategies in the primary health care setting.
Information-Motivation-Behavioral Skills Model
The IMB model, proposed by Fisher and Fisher,23 was
designed to explain influences on performing health behaviors
at the individual level. The IMB model is based on the premise
that information about specific techniques associated with
improving or preventing a health condition, along with the
motivation to take an action, will operate through necessary
behavioral skills that influence a health behavior.23,24 Applied
to the clinical setting, the information construct may include
a patient’s knowledge and awareness about his/her disease con-
dition, including risk factors, etiology, natural history and spe-
cific behavioral strategies the patient can enact to achieve
optimal health outcomes. Motivation includes affective changes
that lead to favorable attitudes and beliefs toward the informa-
tion gained and the target HPDP-related behavior. The behav-
ioral skills component of the model includes not only the
measurable target HPDP behavior but also the individual’s
objective ability and perceived self-efficacy in performance of
health actions. Self-efficacy is associated with willingness to
initiate healthy behavioral changes, efforts needed to continue
the changes and sustainability of the changes that are already
instituted.
Health Belief Model
HBM is typically used in health care to explain sets of
beliefs and perceptions associated with health behaviors,
particularly related to chronic diseases. HBM is based on the
premise that health-related actions are guided by 6 main
constructs that are related to an individual’s perceptions about
the risk factors.25–28 These constructs include perceived suscep-
tibility, perceived severity, perceived benefits, perceived bar-
riers, cues to action and self-efficacy (refer to the note in
Figure 1 for the description of these 6 constructs).28 Each of
these major HBM concepts offers potential intervention points
for physicians to help patients reduce risk and improve positive
health behaviors. For example, when targeting an obese pa-
tient’s perceived severity of disease risk, a physician may
explain that his/her condition is often associated with enhanced
risk for many diseases like diabetes mellitus, cardiovascular
conditions, metabolic syndrome and others. Increasing aware-
ness of risk is one of the motivating factors believed to change
behavior in this model.
Integration of IMB and HBM Theories
The HBM and IMB, individual-level theories, explain
health behaviors from different standpoints; where the IMB
models 3 large-scope constructs known to precede a health
behavior, HBM uses more narrowly defined belief states
affecting behavior change. Integration of the 2 may add pre-
dictive value and clinical utility than either theory on its own.
Figure 1 outlines a proposed model that assimilates IMB
and HBM theory constructs to lay the groundwork for improved
HPDP intervention and health outcomes. Arrows indicate the
directional relationships between the different components of
the model. “Education by physician” acts as an initiating factor,
74
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moderated by baseline factors like age, gender, education, socio-
economic status and life stressors, operating through a web of
mediating factors, ultimately influencing the final outcome: pos-
itive health behaviors and improved health outcomes. Education
by physician is filtered through information, motivational and
behavioral skills factors, as well as belief systems central to the
HBM. Other factors that may impact a patient’s ability to receive
and act on the provider’s HPDP guidance include memory, com-
prehension and cognitive abilities of patients. As mentioned
above, the factors that may impede the achievement of positive
health outcomes might include belonging to a racial minority,
male gender, lower education levels, patients’ perception of dis-
crimination by the physicians, poorly perceived health status, low
levels of trust and depressive symptoms.
PATIENT-PRACTITIONER COLLABORATIVE
MODEL ADAPTED FOR HPDP
The above-presented integration of the HBM and IMB
models focuses on the processes of the patient. It is important to
take into account tested models that have been used specifically
for evaluating or improving interpersonal communication,
particularly in the health care setting. Jensen et al11 proposed
the PCM based on their research, identifying factors concerning
patients’ receptivity to health-related interventions delivered by
providers. This model is focused on the provider’s skills and
was aimed to: (1) improve health care workers’ interactions
with patients, thereby (2) increasing patients’ adherence to
treatment. PCM is based on the premise that both these goals
can be effectively achieved if providers adopt a collaborative
relationship with their patients and understand the personal,
environmental, social and medical factors influencing patients’
health. A model of PCM adapted for HPDP target behaviors is
presented here. The original PCM constructs were adjusted to
account for a wider range of HPDP interventions; the adapted
model is called PCM-A.
According to PCM-A (Figure 2), there are 4 major tasks
that physicians should follow to improve HPDP outcomes:
establishing their position as a trusted advisor, estimating risk
factors through effective inquiry, finding common solutions
through open, 2-way dialog and delivering effective health edu-
cation messages and follow-up evaluations.
The first step in the model is developing a sound
relationship with the patient during the clinical encounters
using both verbal and nonverbal cues based in patient-centered
health care.29–31 These cues might include good eye contact,
nonhierarchical seating arrangement, inquiring about the
patient’s life, communicating with respect and care, displaying
patience when listening and showing empathy. Helping the
patient feel respected and comfortable encourages patient par-
ticipation and increases the likelihood of effective 2-way HPDP
communications.32
The second step is to estimate risk factors through
effective inquiry where both physicians and patients assess
one another’s knowledge, beliefs and competencies. During this
process physicians should: (1) inquire about patient’s knowl-
edge about risk factors (eg, ask for a description of his/her
chronic disease condition and associated risk factors), (2)
inquire about the patient’s experience with chronic diseases
(eg, ask a patient about how his/her chronic condition is affect-
ing his/her daily living activities and what other people are
thinking about his/her condition), (3) introduce HPDP ap-
proaches to care and (4) inquire about the patient’s opinions
about the feasibility of HPDP suggestions (eg, ask about HPDP
interventions and perceived barriers toward adherence).
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 Health Promotion and Disease Prevention Strategies

FIGURE 1. Theoretical concept of patient education. Note: perceived susceptibility—belief that one has a chance of acquiring a par-
ticular disease condition; perceived severity—belief that a disease condition has serious implications; perceived benefits—belief that
particular actions could reduce their vulnerability to a disease condition; perceived barriers—perceived obstacles that prevent a person
from taking positive health actions; cues to action—factors that remind or urge a person toward a healthy change; self-efficacy—
confidence in one’s ability to successfully institute and continue learnt healthy behaviors.

The third step recommends that the physician find
a common ground with the patients regarding HPDP intervention
based on the information derived from the preceding steps. For
example, a physician may ask the patient to briefly outline the
pros and cons of a particular HPDP intervention and ask for his/
her opinions. By taking into account the patient’s perception of
feasibility and compliance in enacting the HPDP alternatives dis-
cussed, a mutual agreement is attained from the perspective of
both parties. This step also involves ensuring clear delivery and
reception of the HPDP intervention approaches from the patients’
perspective. This step should also include an assessment of spe-
cific barriers to HPDP interventions, self-efficacy issues and the
development of a concrete long-term and short-term goals.
The fourth step recommends that physicians actively
engage in educating patients during each clinical encounter.
This involves teaching and problem solving, designing
reminder strategies and using success indicators to give self-
appraisal about the progress achieved by patients during each
follow-up visit. The physician should encourage and educate
patients to implement and monitor HPDP strategies on their
own, as well as weigh costs and benefits of possible future
interventions. This way the patients will be self-motivated to
work toward reducing barriers and increasing adherence to the
intervention they have chosen in the third step.
The six problem-solving skills discussed by Jensen et al11
have been added to this model to make it dynamic, thereby

FIGURE 2. Patient-physician collaborative model adapted for HPDP with additional dynamic components. HPDP, health promotion
and disease prevention.

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Rubens et al
increasing the ease of transition between the steps (Figure 2).
These skills are:
1. Reword the issues in behavioral terms;
2. Motivate the patients to explore their negative internal
dialog (eg, I cannot possibly do this) and encourage
instead the use of concrete, self-directed questions about
barriers to change by asking, “Why, when, where, how
and what are the reasons for not enacting change?”
3. Together, explore responses to the patient’s “why, when,
where, how and what” for each task associated with the
intervention;
4. Evaluate the advantages and disadvantages of all individ-
ual options by asking the patient to rank them from least
feasible to most feasible;
5. Suggest that the patient begin implementing intervention
tasks with flexibility and
6. On follow-up, review any problems encountered and
inquire about the patient’s opinion on continuing with this
intervention or changing to a different one.
DECISION-MAKING FACTORS AFFECTING
PATIENT HPDP CHOICES
Options presented by health care providers are always
directed toward maximizing benefits for patients, although it is
ultimately the choice of the patient to decide if he/she will follow-
through. Patients have complex lives and multiple issues
affecting his/her decision-making process, along with free will
to choose from the provider’s given options. Studies have shown
that the presentation of HPDP options to patients does not nec-
essarily impact the patients’ health behavior choices.33–35 Other
studies have challenged this proposition, suggesting that patients
tend to overestimate the gains and underestimate the losses
associated with the health choices presented to them.36,37 This
could lead to inaccurate projections by patients about the net
worth of an option at a future point in time. Such a fallacy causes
patients to adopt choices believed to yield higher future gains
and can lead to nonconsideration of other better choices. This
fallacy is a decision bias, and heuristic strategies can be taken to
prevent such biases. Table 1 shows a number of these biases and
heuristic approaches that could be used during patient-physician
interactions.
STRATEGIES FOR IMPROVING PATIENT CHOICES
Several health care settings have reported difficulties in
the implementation of collaborative models due to increased
patient-physician encounter time and decreased cost effective-
ness.38–40 One recommended solution has been empowering the
patient to investigate and adopt their own HPDP behavior
changes requiring only intermittent physician involvement.41
However, physicians could use some strategies to increase pa-
tients’ abilities toward following their directives to decrease
encounter time while implementing PCM-A. Some of these
strategies are discussed below.
Banks et al42 conducted a study on utilization of mam-
mography after 2 forms of behavioral interventions—1 with
positive message (benefits of mammography) and the other with
negative message (risks of not having mammography). Partic-
ipants who received the negative messages showed significantly
higher number of mammography scans in the following year
when compared with those who received positive message.
This shows the importance of framing messages with consider-
ation of health beliefs (eg, perceived severity) when devising
HPDP interventions. Similarly, Halpern et al43 proposed that
76
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recommended screenings and other HPDP measures (mammog-
raphy after 40 years and immunizations for communicable dis-
eases) be offered on a “default” or “opt out” basis. According to
this study, patients are more receptive to evidence-based screen-
ings and interventions when they are default options. Volandes
et al,44 in a study on elderly patients, showed that video depic-
tions were more effective than audio counseling in helping
patients make decisions about rehabilitative choices for demen-
tia. This study concluded that video depictions were more vivid
than audio counseling, thereby suggesting that the power or
vividness of a message may be as important as the message
content in affecting patient decision making. In another study
on sexual risk behaviors, Richard et al45 stressed the importance
of “regret” in effective HPDP persuasion. This study showed
that sexual risk–taking behaviors were more amenable to pos-
itive change when the patient was exposed to the regret aspects
of such behaviors, which include testimonial from people who
are already suffering the adverse consequences of their actions.
Finally, to address patients’ tendency to mispredict future chal-
lenges and lose self-efficacy, Ubel et al46 stressed the impor-
tance of refocusing patients’ perspectives and attitudes about
health behavior changes. Refocusing involves guiding patients
to recall changes they had made in the past despite challenges
they faced, thereby reinforcing their confidence in taking pos-
itive actions.
Although it is understood that physician-patient interac-
tion time is precious, it may be possible to use elements of the
strategies just described (Table 2) in addition to constructs in
the integrated IBM/HBM, PCM-A and heuristic approaches
described earlier. If the physician has the opportunity to learn
these skills and models and gain practice in using them in
a clinical setting early in medical training or their career, inte-
gration into later practice will be more natural and not neces-
sarily require additional patient time.
LIMITATIONS
Conceptual Framework
The IMB model cannot be applied to all HPDP strategies
because studies have revealed several shortcomings between
individual constructs.23,24 Although the model specifies that
“information” is a significant contributor to health behavior
change, this may not happen in all situations. The phenomenon
of “learned helplessness” is one such example where, despite
having adequate information about the disease and its risk fac-
tors, the patient remains unable to adopt healthy behaviors.
Sometimes information cannot arouse sufficient motivation
due to factors like depression, previous unsuccessful attempts
and mistrusting behaviors.47
The HBM has some limitations as well. First, HBM
combines the perceived susceptibility and severity of disease
into a single construct. This may not be true in situations where
disease severity is not associated with perceived susceptibility.
Chronic diseases are especially prone to this fallacy. Diseases
like diabetes mellitus have very severe symptoms but do not
induce the expected amount of perceived susceptibility. The
HBM is further limited because it considers only cognitive
constructs without any consideration for the emotional compo-
nents of behaviors. Witte et al48 has criticized this model
because he believes that fear, an emotional variable, positively
influences the efficacy of several interventions. He argues that
fear influences perceived susceptibility much more than any
other construct and yet this does not have a place in the model.
Furthermore, although the HBM has a construct called cues to
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 Health Promotion and Disease Prevention Strategies

TABLE 1. Decision biases, examples and heuristic strategies to overcome them

Decision biases
Availability bias: bias due to readily
available examples affecting
decision making
Inappropriate vulnerability bias: being
unduly influenced by the relatively
small number of favorable outcomes
Side-effect aversion bias: short-term side
effects influence the deletion of choices
with long-term favorable outcomes
Monte Carlo fallacy: belief that when
favorable outcomes occur more frequently
in 1 scenario, unfavorable outcomes
would predominate in another scenario
(or vice-a-versa) due to hypothetical
balancing effects in nature
Choice-supportive bias: bias due to
retroactively assigning positive qualities
to an option selected in the past
Functional fixedness: bias arising from
a perception that objects should be used
only in a way that it has been traditionally
used
Proinnovation bias: bias due to the belief
that the most recent innovation is the
most effective and should be adopted
by the whole society
Peltzman effect: bias due to increased risk
seeking behavior in 1 area after successful
risk reduction in another area thereby
compromising net benefits of risk
reduction
Example
An obese patient refuses to adopt healthy
behaviors like reduced fat options because
of isolated events of rebound increase in
weight after discontinuing a healthy diet
plan
An obese patient refuses to adopt healthy
behaviors like reduced fat options because
the patient perceives that he/she may be in
the smaller percentage of obese adults who
are considered healthy despite their excess
weight
An obese patient refuses to exercise for an Educate the patient that injuries due to falling
hour because of the fear of injuries due
to falling (short-term side effect)
An obese patient thinks that he/she is not
vulnerable to malnutrition states due to
their obesity and they are therefore
noncompliant with multivitamin
supplementations recommended by their
dietary plan
An obese patient thinks that he/she made
the right choice of not exercising in the
past because they would have gained
weight once they discontinued their
exercising routines
An obese patient skips exercise schedules
complaining the lack of any recreation
facility in the neighborhood
An obese patient skips exercise schedules
because he/she has switched to the most
efficient weight loss pill recently
developed and advertised by a reputed firm
An obese patient indulges in binge eating
during the weekend under the pretext of
rigorous exercise schedule and dietary
restrictions during the weekdays
Heuristic strategies
Educate the patient before providing healthy
dietary options that there are chances of
rebound weight gain in a very small
percentage of obese patients but that
should not prevent the patient from
adopting healthy diet plans due to other
health benefits
Educate the patient that he/she is vulnerable
to be in the diseased category of obese
patients because they constitute a majority
group when compared with the smaller
percentage of obese adults who are
considered healthy
and other short-term side effects are rarer
possibilities (unless the patient has risk
factors associated with fall injuries) when
compared with the significant benefits
achieved through regular exercise
Educate the patient before giving dietary
plans that nutrition is dependent on several
complicated factors and his/her increased
weight cannot account for micronutrient
deficiency states during dietary
interventions
Educate the patient before assigning
exercising schedules that in addition to
weight loss, the ulterior goal of exercise is
the heath benefit associated with it
Educate the patient that exercise schedules
could also be effectively accomplished at
home within the limited resources
available
Educate the patient that although the pills
may be effective, they are not without side
effects and the better alternative for weight
control includes restricting calorie
consumption and increasing calorie
expenditure through exercise
Educate the patients that dietary restrictions
and balanced exercise schedules provide
healthy outcomes only when followed
consistently

actions, a comprehensive definition of this construct is not
available in the literature.49
Although we have combined the IMB theory and HBM
to create a new integrated framework, the omission of some
important constructs may have helped create a more parsimo-
nious model. Although the integrated model remains somewhat
complex, we aimed to overcome some of the other challenges
found in the IMB theory and HBM. First, for the HBM, we
separated perceived susceptibility and disease severity as 2
independent constructs. We addressed the issue of “cues to
action” by positioning this variable as a moderator. We also
considered decision biases and provided heuristic approaches
that could be related to the cues to action variable. Addressing
limitations of the IMB model, we combined all of the IMB
constructs together rather than expecting that information and
skills could sufficiently increase motivation to change behavior.
In addition, self-efficacy has been added as its own unique
construct here such that it cannot be used as a proxy for moti-
vation or behavioral skills. Finally, it should be noted that this
model remains untested. It is expected that, over time, some
variables and paths may require further consideration.
Patient-Practitioner Collaborative Model
The PCM-A provides a practical approach to increase
persuasive interactions between physicians and patients. We
tried to assimilate this model with necessary changes for HPDP.
We also included the 6 problem-solving skills for physicians as
one of its constructs to make it a more dynamic model.
Although we adapted the PCM for HPDP, there are certain
differences between the original and adapted models. For
example, in the original model, disease and illness are consid-
ered as 2 different constructs with a common intercept; disease

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Rubens et al

TABLE 2. Additional strategies for improving patient choices

Persuasive strategies
Framing HPDP messages
Setting defaults for
HPDP messages
Vivid descriptions of adverse
outcomes
Regret for unhealthy options
Refocusing the strengths
HPDP, health promotion and disease prevention.
Examples
An obese patient is persuaded to control calories and exercise regularly after viewing a documentary
of people who have achieved weight control with positive health benefits, side by side with people
who have never sought weight reduction approaches and are experiencing extremes adverse effects.
This should be followed by reinforcing messages to control weight
An obese patient automatically controls his/her calorie intake to 2,000 Cal/d based on the American
Dietetic Association determined defaults for standard caloric intake per day
An obese individual decides to act on HPDP advice after being introduced to another obese person
who had suffered extreme adverse events due to the risk factors associated with obesity
An obese patient is persuaded to follow dietary modifications and exercise schedules when he/she is
enlightened about the regrets they would feel (toward themselves, toward their family and others) if
they failed to take action now and later experienced an adverse event associated with obesity
An obese patient is enlightened about his/her will power in other abilities, and the same strengths are
cognitively applied to healthy dietary modifications and exercise schedules, thereby increasing the
chances of him/her accepting positive HPDP strategies

indicates improper functioning of the body, whereas illness
represents patient’s subjective experiences due to the disease.11
We intentionally considered both disease and illness as a single
entity in our adapted model because subjective experiences
(pain, discomfort, fatigue and others) often take longer to
develop even when the pathological processes have already
begun in chronic diseases. Although PCM has been extensively
used, there are few studies that discuss its shortcomings.
DISCUSSION
The relationship between patients and health care
providers is one of the most powerful tools in delivering HPDP
interventions. Several new strategies in HPDP could be
implemented through the vehicle of the patient-provider
interaction. The major burden of responsibility to deliver
effective HPDP messages and improve intervention delivery
strategies falls primarily on physicians and nurses. Physicians
should continuously strive to improve their ability to commu-
nicate effectively with patients and incorporate evidence-based
approaches to overcoming the barriers and delivering effective
HPDP interventions.
This article recommends strategies to implement HPDP
interventions that may increase patients’ responsiveness to the
physicians’ directives and several plans for improving patient
choices. The factors that affect a patient’s receptiveness to
HPDP interventions, although many of them are nonmodifiable,
could be effectively harnessed for better health outcomes. The
theoretical models could be used to understand the dynamic
interaction of factors starting from “educating the patient” to
“adopting healthy behaviors” and beyond. The PCM-A pro-
vides practical strategies to increase the concordance between
physicians and patients to improve the quality of care through
effective implementation of HPDP interventions. The article
finally discusses the decision-making factors affecting patient’s
HPDP choices and strategies for maximizing the benefits of
interventions through better decision-making skills.
Furthermore, it is important that physicians take the most
ecological and holistic approaches when caring for patients,
consisting of several models and taking into account the many
levels of influence on the patient in their health behavior
decision-making process. Physicians should be aware that
HPDP is a rapidly evolving branch with many burgeoning
research areas worldwide; remaining informed of new HPDP
strategies would likely improve patient health outcomes. In
addition to those described in this article, physicians should
seek out other models and frameworks and make wise choices
in selecting the best methods according to their own needs. The
models discussed are imperfect and have certain limitations,
requiring further field testing through large scale, preferably
longitudinal studies and interventions. Such studies would
further aid physicians in their efforts to help patients live
healthier lives.
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