In this paper, the authors compare the effectiveness of sequential vs. simultaneous theory-based behavioural interventions in a primary care environment. The target behaviours were smoking, physical activity, and dietary sodium intake. Patients were randomly assigned to standard care (no telephone follow-up), sequential intervention (telephone counselling on individual behaviour changes at 6 month intervals), or simultaneous intervention (telephone counselling for 18 months for all three behavioural changes). Counselling sessions were performed at 2, 4, 6, 8, 12, 16 and 20 weeks and were limited to 15 minutes. The authors concluded that it might be more effective to change multiple behaviours than to focus on individual behaviours in a sequential fashion. This paper is accompanied by an editorial by Steptoe who makes the point that several of our behaviours that promote chronic diseases such as cardiovascular disease and type 2 diabetes are interrelated and that it may be more efficient to take a more holistic approach to behavioural changes and modification. However, although maintaining motivation appears to be the key to changing health behaviours, more research is clearly needed to better understand how to successfully and permanently change the atherogenic and diabetogenic lifestyle of our patients.
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