By Amanda Daley, Loughborough University, UK

In the United Kingdom and Ireland, the Making Every Contact Count initiative aims to use the thousands of consultations that take place every day between health professionals and patients, to promote healthy behavioural changes.  Specifically, Making Every Contact Count aims to enable and encourage health professionals to capitalise on naturally occurring opportunities in routine practice to deliver brief health behaviour change interventions to patients. The success of approaches such as Making Every Contact Count are dependent on health professionals being willing to have these conversations in consultations every day.  Making Every Contact Count is for everyone, and it is not restricted to specific health professionals, health services or patients.  For these reasons, Making Every Contact Count may reduce health inequalities because the idea is that an inclusive approach is taken whereby all patients receive this support within consultations.

The importance of supporting people who are inactive to become more physically active is becoming increasingly recognised as an important part of the role of health professionals. In addition, 1 in 4 people would be more active if advised by a health professional.  There is also evidence that brief (1-2 minutes) health behaviour interventions within consultations have the potential to be effective.  Making Every Contact Count is important because people who are regularly using health services and engaging with health professionals have, or are at risk of, non-communicable diseases, and are more likely to be inactive.  

Whilst guidance stipulates that adults should complete at least 150 minutes of moderate intensity physical activity per week, or 75 minutes of vigorous intensity, or a combination of both, it now also recognises the contribution that participation in short bouts of physical activity can have for health.  In fact, guidance states that any amount of physical activity is important for health, and some is better than none.  Routinely conveying these simple, but important, messages to patients during consultations could make a substantial difference to the health of the population throughout the world. 

An example of where Making Every Contact Count is being implemented in the United Kingdom is the Snacktivity™ research programme. Snacktivity™ encourages the public to participate in brief but frequent ‘snack size’ bouts of moderate-vigorous intensity physical activity, and muscle/strength-based activities across the whole day/week.  An ‘activity snack’ typically lasts between 2-5 minutes.  By design, Snacktivity™ naturally encourages breaking up prolonged sitting time throughout the day, through participation in regular physical activity snacks.  Examples of Snacktivity include brisk walk-talk conversations, using stairs instead of the lift, taking the dog for an extra brisk walk, calf raises when brushing your teeth, and squats while waiting for the kettle to boil. Snacktivity™ has been developed as a simple message for all health professionals to promote to patients in consultations across different health contexts. Snacktivity™ is focused on promoting physical activity into a format that is novel and motivating to the public, regardless of their physical ability and background, and without the need for equipment.  The potential convenience of accumulating Snacktivity™ through activities of every daily living makes it accessible to almost everyone.  Family doctors, nurses, dentists, physiotherapists, occupational therapists and podiatrists have been trained to promote Snacktivity™ within consultations, and they have reported it can work, with some flexibility in appointment scheduling.  

But of course, there may be barriers to delivering Making Every Contact Count, including having sufficient consultation time available to have such conversations with patients.  We know health professionals can be reluctant to raise topics related to preventive medicine in consultations for fear of not knowing how to best support patients, or concerns about causing offence.  Ensuring health professionals have the skills and confidence to have these kinds of conversations with patients is very important to ensuring the integrity of relationships with patients.  Promoting physical activity with patients who are consulting for reasons unrelated to health behaviours might seem rather out of place and inappropriate.  For example, a dentist would not usually discuss physical activity with patients because it is unrelated to oral health, although in the Snacktivity™ programme this does happen.  Nevertheless, it is important to acknowledge that health professionals do need to feel comfortable with delivering these kinds of brief health interventions to patients, but this can be achieved with training and practice.  

Here are five suggestions to consider for the implementation of Making Every Contact Count, such as Snacktivity™, by health professionals:

Practical recommendations 

1. Think about whether there are moments in your consultations where the topic of lifestyle behaviour change can be raised. For instance, take the opportunity to ask your patients about how much physical activity they do each week and whether there are times in their day they might include Snacktivity™ 
2. Explore if there are local opportunities where you can signpost your patients for additional support and resources to be physically active in their communities.
3. Look out for training opportunities in your country or online to develop your skills in delivering effective health behaviour change messages to your patients.  Here are two examples from the UK that might be useful: Making Every Contact Count (MECC) and Active Conversations.  
4. If you are experienced in promoting physical activity in consultations with your patients, you could help and support colleagues who might feel less confident to do so.
5. You could be an ambassador in your place of work to champion Making Every Contact Count.  If you are a senior leader or a health manager, you could review your health services to see how it might be integrated.