A literature search was performed to gain more insight in the effectiveness of previously implemented lifestyle interventions. In the report of Proper et al (2005), especially individually-based lifestyle interventions appeared to be effective [
19]. Since we were interested in smoking, diet and PA behaviour in particular, we looked at studies aimed at these three lifestyle factors. For smoking, it has been shown that a minimal contact behavioural intervention using the stage-of-change concept in Dutch general practice significantly improved self-reported abstinence rates at 12-month follow up [
20]. Duration and frequency of counselling in a smoking intervention appeared to have a strong dose-response relation with smoking cessation rates [
5,
21]. However, even though individual counselling is potentially effective in smoking cessation, success rates for smoking cessation and abstinence may be increased by using NRTs, such as nicotine plasters, gum and spray [
5]. Concerning dietary behaviour change, Steptoe et al. (1999) showed that brief dietary behavioural counselling led to decreased dietary fat intake among adults with increased CVD risk in general practice [
22]. Furthermore, personalised feedback has been shown to improve attitude and intention, and to significantly increase vegetable intake and decrease fat intake among healthy employees [
23]. Finally, evidence was found for the effectiveness of individually-based PA interventions, among sedentary adults in general practice [
24], as well as in a workplace setting [
25]. Individual counselling can be performed in several ways. In recent years, counselling has become more client-centred. One potential effective and client-centred technique is motivational interviewing (MI). MI is a non-directive, client-centred counselling method, which was originally developed for use in addiction interventions [
26]. In recent years, it has also been proven feasible and effective in lifestyle interventions [
27‐
29]. According to Rubak
et al. (2005), the effect of MI increases with an increasing number of face-to-face encounters [
30]. MI is based on five principles, i.e. showing empathy, avoiding discussion, rolling with resistance, supporting self-efficacy, and raising awareness of a dissonance between actual behaviour and behaviour goals. Important non-directive communication strategies used in MI are: Asking open questions, reflective listening and orderly summarizing. Providing information, provocation, and selective confirmation are more directive strategies. In MI a fluent continuum of readiness-to-change is presumed [
31]. The transtheoretical model (TTM) of stages of change (SOC) has played an integral role in the development of MI. Another model describing the stages of behaviour change that we found in the literature is the Precaution Adoption Process Model (PAPM) [
32]. The PAPM distinguishes seven stages: 1) Unaware of the health issue, 2) Aware of the issue but not personally engaged, 3) Engaged in the issue and deciding what to do, 4) Having decided not to act, 5) Planning to act but not yet having acted, 6) Initiating the behaviour, and 7) Having maintained the behaviour over time. In contrast to the TTM, the PAPM distinguishes between stages 1 and 2 and between stages 4 and 5. In a stage-based intervention, in general, persons unaware or unengaged may need to be made more aware of the risks of their own health situation and the possibility of behaviour change. They can be informed, advised and encouraged. With persons in the decision stage, barriers and benefits of behaviour change should be discussed, and 'the positive' should be accentuated. Persons in the preparation stage need to set short-term goals that are acceptable, accessible and effective, taking into account past experiences. Persons who just initiated behaviour change deserve affirmation for what they have accomplished and encouraging comments. They may need assistance in possible revision of their plans. In this stage, anticipation on possible future barriers may also be necessary. The same strategy holds true for persons who have already maintained behaviour over time [
33]. Persons who have relapsed into former behaviour need to be guided through the stages again. Persons who have decided not to change a certain (sub-) behaviour may decide to change another (sub-) behaviour. To achieve behaviour change, relevant determinants of behaviour will have to be addressed in the intervention. From the literature we learned that attitude, self efficacy, social influence (the principal components of the ASE-model [
34,
35]), intention [
34,
36], environment, and habitual behaviour [
37] are important behavioural determinants. Finally, we looked at literature about risk communication. Several studies have shown that the explanation of CVD risk to the patient or client should be clear and easy to understand, to prevent confusion or fear [
38] and to enable the client to make a well informed choice about if and what he wants to change [
39]. Based on the literature, we decided to develop an individually-based lifestyle intervention, comprising frequent contacts, applying MI, with the PAPM as a basis. Next to the SOC, behavioural as well as environmental determinants will be taken into account during the counselling sessions. The workers' CVD risk will be explained to him in an understandable way.