Lessons from the Oslo Study Diet and Anti-Smoking Trial: a qualitative study of long-term behaviour change

Abstract

The aim of this study was to identify factors associated with sustainable behaviour change among persons at increased risk for future cardiovascular disease. A qualitative approach based on focus group interviews was used. Twenty-five men aged 62-71 years who participated in the Oslo Study Diet and Anti-smoking Trial were interviewed in four focus groups. The study identified five categories of factors linked to the process of lifestyle changes: the doctor-patient relationship, significant others, motivators, barriers, and empowerment. A strong personal attachment to the principal investigator of the Oslo Study was revealed. The relationship was described as friendly and supportive. The family based approach and the impact of spouses, in particular, was emphasized by the participants. Somatic symptoms and fear often acted as motivators to behavioural change. Individual feedback was also identified as an important motivator. Psychological resistance to external pressure, concerns regarding behaviour change, and benefits from current (unhealthy) behaviour were identified as barriers. Participants reported a process of empowerment and personal control as an important element of sustainable change. The importance of the unique relationship with a certain provider has implications for future healthcare planning. This factor may also limit the external validity of studies of human behaviour.

Keywords

health behaviour health education ischaemic heart disease primary healthcare.

Get full access to this article

View all access options for this article.

References

Stamler J. Established major coronary risk factors. In: Marmot M , Elliott P , editors. Coronary heart disease epidemiology. From aetiology to public health. Oxford: Oxford University Press, 1992: 35-66.

Marlatt GA , Gordon JR Determinants of relapse: implications for the maintenance of behavior change . In: Davidson PO , Davidson SM , editors. Behavioral medicine: changing health lifestyles. New York: Brunner/Mazel , 1980: 410-52.

Ebrahim S. , Smith GD Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease. BMJ 1997; 314: 1666-74.

Hjermann I. , Holme I. , Byre KV , Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet 1981; ii: 1303-10.

Ashenden R. , Silagy C. , Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract 1997; 14: 160-76.

Lawrence M. , Neil A. , Fowler G. , Mant D. Prevention of cardiovascular disease. An evidence based approach. Oxford: Oxford University Press, 1996.

Glanz K. , Lewis FM , Rimer BK Health behaviour and health education. Theory, research and practice. San Fransisco: Jossey-Bass Publishers, 1990.

Hjermann I. , Holme I. , Leren P. Oslo study diet and anti-smoking trial—results after 102 months. Am J Med 1986; 80 Suppl 2A: 7-11.

Morgan DL Focus groups as qualitative research. Beverly Hills: Sage Publications, 1988.

10.

Krueger RA Focus groups. A practical guide for applied research. Beverly Hills: Sage Publications, 1988.

11.

Patton. Qualitative evaluation and research methods. Newbury Park, California: Sage Publications Inc., 1991.

12.

Bradley CP Turning anecdotes into data—the critical incident technique. Fam Med 1992; 9: 98-103.

13.

Crabtree BF , Miller WL A qualitative approach to primary care research: the long interview. Fam Med 1991; 23: 145-51.

14.

Tones K. , Tilford S. , Robinson YK Health care contexts. Health education. Effectiveness and efficiency. London: Chapman and Hall Ltd, 1990 .

15.

Ley P. Communicating with patients. Improving communication, satisfaction and compliance . London: Chapman and Hall, 1988.

16.

Hauck FR , Zyzanski SJ , Alemagno SA , Medalie JH Patient perceptions of humanism in physicians: effects on positive health behaviors. Fam Med 1990; 22: 447-52.

17.

Kaplan SH , Greenfield S. , Ware Jr JE Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989; 27: S110-27.

18.

Roter DL Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance . Health Education Monographs 1977; 5: 281-315.

19.

Meland E. , Lærum E. , Mæland JG Life style intervention in general practice: effects on psychological well-being and patient satisfaction. Qual Life Res 1996 ; 15: 57-64.

20.

Curry SJ , Wagner EH , Grothaus LC Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. J Consult Clin Psychol 1991; 59: 318-24.

21.

Evans RG , Stoddart GL Producing health, consuming health care. In: Evans RG , Barer ML , Marmor TR , editors. Why are some people healthy and others not? The determinants of health in populations. Berlin: de Gruyter, 1994: 27-64.

22.

Nilsson PM , Möller L. , Östergren PO Social class and cardiovascular disease—an update. Scand J Soc Med 1995; 23: 3-8.

23.

Shattuck AL , White E. , Kristal AR How women's adopted low-fat diets affect their husbands. Am J Public Health 1992; 82: 1244-50.

24.

Janz NK , Becker MH The health belief model: a decade later. Hlth Educ Q 1984; 11: 1-47.

25.

Chapman S. , Wong WL , Smith W. Self-exempting beliefs about smoking and health: Differences between smokers and ex-smokers. Am J Public Health 1993; 83: 215-9.

26.

Carey AM , Smith MW Capturing the group effect in focus groups: a special concern in analysis . Qual Health Res 1994; 4: 123-7.