Counseling: Reinforcement of Educational Messages

Education and counseling can be a daunting task. However, the primary care physician has many tools at his/her disposal to help reinforce prevention education.

Continuity of Care

Family Medicine physicians, internists, and other primary care providers are in a unique position to reinforce counseling points to patients and reassess behaviors. They can have long-term continuity relationships that allow physicians to build rapport, permit follow-up contact to provide support, and/or adjust the treatment plan over the patient’s life span.

Interdisciplinary Approach

The primary care provider is not alone in encouraging patients toward behavior change and risk reduction. Multiple opportunities to convey the “same message” and “same support” are available through close interdisciplinary work. Nursing professionals can provide effective education and counseling, and also assess the patient’s understanding of the “take home message” from the physician. Nurses can then review and/or emphasize the major points. Similar roles are played by nutritionists, social workers, medical assistants, the front desk staff, the local pharmacist, and medical specialists. With the patient’s permission, family and friends can also contribute support and reinforcement.

Written Materials

Patients often retain less than half of what was discussed at a physician visit. Printed patient education materials should be offered as another resource. The materials should be culturally sensitive, in the appropriate language, targeted to an appropriate level of health literacy, and drawn from a reliable source. For optimal comprehension and adherence, patient education materials should be written at a sixth-grade or lower reading level, preferably including pictures and illustrations.

There are reliable handouts in the patient education area of this web site. Another easy-to-use source ( sponsored by the American Academy of Family Physicians provides patient education handouts in both Spanish and English.

Primary Care and Public Health

The medical community works together with public health agencies to provide education around and incentives towards healthier life choices. For example, optimal success in reduction of tobacco-use prevalence is achieved when evidence-based clinical services are integrated with community level interventions. Community-level interventions include city-wide smoking bans and restrictions; increased tobacco taxes; media campaigns; and telephone quit support (Ockene, 2007).

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