How should clinicians talk to patients about changing their diet, stopping smoking, cutting down on alcohol, or becoming more physically active? Guidance on these conversations is everywhere - in national guidelines, training materials, journals and professional magazines. But how much of that advice is based on solid evidence?
A new systematic review from researchers at the Nuffield Department of Primary Care Health Sciences, published in BMC Medicine, examined guidance aimed at general practice professionals on how to communicate with adult patients about behaviour change, and then looked closely at the evidence used to support the guidance.
The researchers identified 84 different sources of guidance, containing 1,163 specific recommendations about how clinicians should communicate.
They then asked two simple questions:
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Does this recommendation cite any evidence?
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If it does, is that evidence actually relevant to the specific communication advice being given?
Just over half of the recommendations (58%) included at least one citation. However, when the team examined the 3,640 cited references in detail, fewer than four in ten were clearly relevant to the communication claim they were meant to support.
Overall, only one in five recommendations (20%) was based entirely on evidence that was directly relevant to the advice being given. More than 40% of recommendations did not cite any evidence at all.
The picture varied across topics. Guidance on alcohol and sexual health was more likely to include citations, while recommendations relating to diet and physical activity made up the largest share of recommendations overall but were less often supported by clearly relevant evidence.
Why does this matter?
‘Communication is central to primary care. The way clinicians introduce and frame behaviour-change conversations can influence whether patients take up referrals, adhere to treatment, or feel supported rather than judged,’ explained Charlotte Albury, Associate Professor in NDPCHS and senior author on the paper. ‘There is growing research showing that specific words, phrases and approaches can make a measurable difference to patients’ outcomes. If guidance and training do not clearly draw on this evidence, clinicians may not be getting the support they need to have these conversations confidently and effectively.’
The authors do not suggest that existing guidance is necessarily wrong. Rather, they highlight a lack of transparency and clear links between recommendations and the evidence behind them.
Anika Schwarze-Chintapatla, Medical Student Researcher in the Department and lead author on the study, said: ‘In some cases, recommendations stated that they were based on evidence but did not provide a citation. In others, documents claimed to be based on specific evidence but cited fewer studies than stated. This lack of clarity makes it difficult for readers to trace the evidence behind specific communication advice.’
The study concludes that behaviour-change communication guidance for general practice is rarely clearly substantiated with relevant evidence. The authors call for greater transparency in guideline development and for stronger integration of communication research into training and policy.
As communication underpins almost every aspect of care, the findings raise wider questions about how communication guidance is developed and how confidently we can assume it is evidence based.
Read the full paper 'Is behaviour change communication guidance for general practice healthcare professionals evidence based? A systematic review' in BMC Medicine