Compliance-enhancing counseling strategies for cholesterol management

Abstract

Nutrition plays a major role in the prevention of coronary heart disease (CHD).I Several of the National Health Objectives for the year 2000 emphasize the importance of nutrition intervention in reducing coronary heart disease risks.2 Epidemiologic evidence from various studies identified elevated serum cholesterol as a coronary heart disease risk factor.38 The preferred initial treatment for lowering serum cholesterol is dietary treatment.9.10 Primary care providers have a role in nutrition counseling for elevated serum cholesterol because of the recommended treatment guidelines 10 and their frequent contact with patients. ll However, physicians report barriers to nutrition counseling such as lack of time, 12 staff, payment or insurance coverage; 13.14 lack of skills to give practical advice; and lack of confidence in their ability to help change patients' dietary behavior. 15-17 The adult treatment guidelines released by the National Cholesterol Education Program (NCEP) recommend that dietitians counsel individuals having difficulty adhering to therapeutic diets. lo As nutrition counselors, dietitians should use the best available strategies to promote patient compliance to the prescribed diet since dietary changes are effective in preventing CHD only if they are adopted over the long term. 18 This article reports on the extent to which counseling practices of dietitians coincide with state-of-the-art recommendations for enhancing dietary compliance for the treatment of adults with high blood cholesterol. Nutrition counseling is a personalized, systematic process that includes assessment, planning, implementation, and evaluation. 19 Experts in counseling advise counselors to use compliance-enhancing strategies, such as goal setting, contingency contracting with goals and a time frame set by both parties, reminder calls, follow-up visits, self-monitoring,