Community Nursing SNAP Trial

Project Number

Project Status

Chief Investigators
Mark Harris, Gawaine Powell Davies, Rachel Laws, Anna Williams, Bibiana Chan

Associate Investigators
Upali Jayasinghe, Mahnaz Fanaian

Other Team Members
Janine Asquith, Sue Buckman, Stephen Clark, Sharon Ible, Anne Mitchell, Kate Partington, Ros Whittaker


Smoking, nutrition, alcohol and physical activity (SNAP) are the major preventable risk factors for chronic diseases in Australia and throughout the Westernised world. The findings of a previous feasibility study (Community Health Risk Factor Management Research Project) support community health services as an appropriate setting to address lifestyle risk factors. However there is limited previous research examining the effectiveness of brief lifestyle interventions delivered by community health staff on client behaviour change. NSW Health is funding an efficacy trial of SNAP risk factor management in community nursing services. The findings will inform policy and practice for chronic disease prevention in primary health care.


This study aims to evaluate the impact of a community nursing intervention delivered as part of routine consultations on the change in clients’ behavioural risk factors.

The study has three main objectives:

1. To develop an intervention to facilitate community nurses performing behavioural interventions during routine activities with clients and to promote referral of clients to available private and public sites

2. To evaluate the impact of these interventions on change in behavioural risk factors and related mediators (eg stages of change).

3. To describe the indicative costs and resources utilised by the community nurse sites in delivering the intervention.

Design and Method

This study will use a quasi-experimental design involving 4 sites (Lower Hunter, Newcastle, Warilla/Dapto and Wingcaribee/Macarthur). Sites have been randomly allocated to ‘early’ or ‘late’ intervention. ‘Early’ intervention sites will be provided with training and support for clinicians in identifying and offering brief SNAP intervention for clients during routine consultations (see study intervention). Clients will be recruited from both ‘early’ and ‘late’ intervention sites and data will be collected from clients at baseline, 3 months and 6 months to examine change in behavioural risk factors. This will enable a comparison of client outcomes between early and late intervention sites. After the 6 month data collection point ‘late’ intervention services will be offered the same training and support as early intervention services. Follow up interviews/focus groups will be conducted with clinicians and clients to explore the feasibility and acceptability of the study intervention.

Clinician intervention:

The intervention for clinicians will involve the following components:

  • A one day training program for participating clinicians on undertaking SNAP screening and interventions including how to raise SNAP issues with clients, screening for SNAP risk factors as part of the routine assessment process, assessing readiness to change and providing stage matched interventions such as motivational interviewing and goal setting.
  • The integration of standard screening tools for SNAP into the assessment process used by clinicians.
  • The establishment of local referral sites pathways for community nurses to refer their clients for SNAP risk factors including Division, local government and private providers (eg local referral directory and mechanisms for direct referral to Quitline and Heartmoves classes).
  • The provision of resources to support SNAP intervention


Client Intervention:

The client intervention will involve the following components in line with the 5As model of brief intervention for behavioural risk factors:

  • Ask: Screening for SNAP risk factors as part of the routine assessment process
  • Assess: Assessment of clients’ readiness to change.
  • Advise/Assist: stage matched brief counseling (motivational interviewing, goal setting) delivered over at least 2 visits.
  • Arrange: Referral of high risk patients who ready to change to support services

Key Publications

The CN SNAP Trial Protocol paper. Click here to view.

CN SNAP Newsletter Arpil 2010. Click here to view

Community Nursing SNAP Trial Summary. Click here to view.