Brief Action Planning to Facilitate Behavior Change and Support Patient Self-Management
Journal of Clinical Outcomes Management. 2014 January;21(1)
References
Question 3: Arranging Accountability
Once the details of the plan have been determined and confidence level for success is high, the next step is to ask Question 3: “Would you like to set a specific time to check in about your plan to see how things are going?” This question encourages a patient to be accountable for their plan, and reinforces the concept that the physician and care team consider the plan to be important. Research supports that people are more likely to follow through with a plan if they choose to report back their progress [43] and suggests that checking-in frequently earlier in the process is helpful [55]. Ideally the clinician and patient should agree on a time to check in on the plan within a week or two (Figure 2, entry 29).
Accountability in the form of a check-in may be arranged with the clinical provider, another member of the healthcare team or a support person of the patient’s choice (eg, spouse, friend). The patient may also choose to be accountable to themselves by using a calendar or a goal setting application on their smart phone device or computer.
Skill 5: Follow-up
Follow-up has been noted as one of the features of successful multifactorial self-management interventions and builds trust [55]. Follow-up with the care team includes a discussion of how the plan went, reassurance, and next steps ( Figure 4 ). The next step is often a modification of the current BAP or a new BAP; however, if a patient decides not to make or work on a plan, in the spirit of MI (accepting/respecting the patient's autonomy) the clinician can say something like, "It sounds like you are not interested in making a plan today. Would it be OK if I ask you about this again at our next visit?"
The purpose of the check-in is for learning and adjustment of the plan as well as to provide support regardless of outcome. Checking-in encourages reflection on challenges and barriers as well as successes. Patients should be given guidance to think through what worked for them and what did not. Focusing just on “success” of the plan will be less helpful. If follow-up is not done with the care team in the near term, checking-in can be accomplished at the next scheduled visit. Patient portals provide another opportunity for patients to dialogue with the care team about their plan.
Experiential Insights from Clinical Experience Using BAP
The authors collective experience to date indicates that between 50% to 75% of individuals who are asked Question 1 go on to develop an action plan for change with relatively little need for additional skills. In other studies of action planning in primary care, 83% of patients made action plans during a visit, and at 3-week follow-up 53% had completed their action plan [56]. A recent study of action planning using an online self-management support program reported that action plans were successfully completed (49%), partially completed (40%) or incomplete (11% of the time) [35].
