Loughborough University
Albury et al 2019 BMC Family Practice.pdf (941.58 kB)

Communication practices for delivering health behaviour change conversations in primary care: A systematic review and thematic synthesis

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posted on 2019-07-12, 13:34 authored by Charlotte Albury, Amanda Hall, Ayeshah Syed, Sue Ziebland, Elizabeth Stokoe, Nia Roberts, Helena Webb, Paul Aveyard
Clinical guidelines exhort clinicians to encourage patients to improve their health behaviours. However, most offer little support on how to have these conversations in practice. Clinicians fear that health behaviour change talk will create interactional difficulties and discomfort for both clinician and patient. This review aims to identify how healthcare professionals can best communicate with patients about health behaviour change (HBC). Methods We included studies which used conversation analysis or discourse analysis to study recorded interactions between healthcare professionals and patients. We followed an aggregative thematic synthesis approach. This involved line-by-line coding of the results and discussion sections of included studies, and the inductive development and hierarchical grouping of descriptive themes. Top-level themes were organised to reflect their conversational positioning. Of the 17,562 studies identified through systematic searching, ten papers were included. Analysis resulted in 10 top-level descriptive themes grouped into three domains: initiating; carrying out; and closing health behaviour change talk. Of three methods of initiation, two facilitated further discussion, and one was associated with outright resistance. Of two methods of conducting behaviour change talk, one was associated with only minimal patient responses. One way of closing was identified, and patients did not seem to respond to this positively. Results demonstrated a series of specific conversational practices which clinicians use when talking about HBC, and how patients respond to these. Our results largely complemented clinical guidelines, providing further detail on how they can best be delivered in practice. However, one recommended practice - linking a patient’s health concerns and their health behaviours - was shown to receive variable responses and to often generate resistance displays. Conclusions Health behaviour change talk is smoothly initiated, conducted, and terminated by clinicians and this rarely causes interactional difficulty. However, initiating conversations by linking a person’s current health concern with their health behaviour can lead to resistance to advice, while other strategies such as capitalising on patient initiated discussions, or collaborating through question-answer sequences, may be well received.


Charlotte Albury is funded by the National Institute for Health Research School for Primary Care Research. Paul Aveyard is an NIHR Senior Investigator and is part funded by the Oxford NIHR Biomedical Research Centre and CLAHRC. Sue Ziebland is an NIHR and BRC senior investigator.



  • Social Sciences


  • Communication, Media, Social and Policy Studies

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BMC Family Practice




ALBURY, C. ... et al., 2019. Communication practices for delivering health behaviour change conversations in primary care: A systematic review and thematic synthesis. BMC Family Practice, 20: 111.


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This is an Open Access Article. It is published by BMC under the Creative Commons Attribution 4.0 Unported Licence (CC BY). Full details of this licence are available at: http://creativecommons.org/licenses/by/4.0/

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