Evaluation of a Community Health Promotion Resource for Primary Care Practices Susan A. Flocke, PhD, Lisa E. Gordon, MA, Ginger L. Pomiecko, MA Background: Primary care physicians’ ability to provide effective health behavior change advice might be leveraged by linking to available community resources. This study evaluates tools to facilitate such a link. Design: A mixed methods longitudinal pre–post-test study was conducted in 2004. Setting/ Participants: Seven primary care practices in northeast Ohio and two longitudinal cohorts of patients (n =784). Intervention: The practice-tailored intervention included two main components: (1) a web-based health behavior change resource including a database of community programs and patient education materials, and (2) a health behavior prescription pad. Main Outcome Measures: Rates of discussion of diet, exercise, weight management, and smoking cessation; and patient change in motivation to modify behaviors at 8 weeks post-visit. Qualitative field notes about practice routines, culture, and implementation efforts were analyzed to enhance understanding of the practice change process. Results: The post-intervention cohort reported higher rates of discussion of diet (25.7% vs 20.2%), exercise (27.8% vs 16.9%), and weight management (23.2% vs 16.3%), and greater referral to patient education materials (24.2% vs 21.6%) and community programs for health behavior change (16.0% vs 13.6%) (p 0.05). No difference in change in patient motivation to modify behavior was observed between the pre- and post-intervention cohorts. Evaluation of the qualitative field notes suggests that for six of seven practices, the intervention was not appreciably implemented. Conclusions: The intervention tools show promise for increasing clinician discussion of health behav- iors, information referral, and referral to community resources. Additional work to increase practice adoption of the tools is required to understand their potential to affect patient motivation to change behavior. (Am J Prev Med 2006;30(3):243–251) © 2006 American Journal of Preventive Medicine Introduction P rimary care clinicians encounter frequent oppor- tunities to provide health behavior advice for smoking, poor nutrition, and sedentary lifestyle in the context of routine outpatient visits. 1–4 Despite these opportunities, rates of health behavior advice in primary care remain low. 5,6 Time, lack of reimburse- ment, training, perceived lack of efficacy in health behavior counseling, 7–12 and lack of engagement of office staff 13–17 have been cited as the most prominent barriers to providing health behavior advice. Asking primary care physicians to routinely provide in-depth advice and counseling during the typical 10-minute outpatient visit 18 is not tenable. The 5A’s framework, originally proposed for smok- ing cessation, but applicable to other health behav- iors, 19 breaks health behavior advice into discrete steps intended to help busy clinicians provide brief health behavior counseling. The 5A’s—assess, advise, agree, assist, and arrange follow-up 19 —do not necessarily need to be addressed within the same visit, nor do they need to be addressed by the primary care clinician. For example, the assessment component could be handled by office staff such as medical assistants. Some research- ers have recommended that clinicians selectively pro- vide brief advice and then engage others who have more time and greater health behavior change exper- tise to complete the 5A’s cycle. 20 Others have recom- mended that physicians use community-based re- sources as a means to support health behavior change. 21–23 Community-based resources to facilitate health behavior change may include a wide range of From the Department of Family Medicine (Flocke, Gordon, Pomiecko), and Department of Epidemiology and Biostatistics (Flocke), Case Western Reserve University, Cleveland, Ohio Address correspondence and reprint requests to: Susan Flocke, PhD, Department of Family Medicine, Case Western Reserve Univer- sity, 11001 Cedar Ave, Suite 306, Cleveland OH 44106-7136. E-mail: susan.flocke@case.edu. 243 Am J Prev Med 2006;30(3) 0749-3797/06/$–see front matter © 2006 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2005.10.021