Quality assessment of health counseling: performance of health advisors in cardiovascular prevention.

Quality assessments of interventions are seen as essential in optimizing their implementation, interpreting their effectiveness, and illuminating their underlying processes. In Hartslag Limburg, a cardiovascular prevention project, the quality of a health counseling intervention was assessed as part of the process evaluation. Four health advisors each video-taped 16 counseling sessions, all of which were assessed by three independent observers. Health counseling was found to be a very difficult skill, but, all things considered, the overall quality was evaluated as rather encouraging. No indication was found of quality improvement over time. The interpretation of the findings was complicated by limited absolute interobserver agreement, but reliable relative distinctions could be made between the health advisors' performance and their application of various counseling skills. Future quality investigators are advised to carefully match study goals with study methods, and practitioners planning a health counseling project should take the complexity of the task into account.