Using Action Plans to Help Primary Care Patients Adopt Healthy Behaviors: A Descriptive Study

Abstract

Purpose: An action plan is an agreement between clinician and patient that the patient will make a specific behavior change. The goals of this study are to: determine whether it is feasible for patients to make action plans in the primary care visit; determine whether patients report carrying out their action plans; and describe the action plans patients choose.Methods: Forty-three clinicians in 8 primary care sites were recruited to hold action-plan discussions with patients. Research assistants contacted patients by telephone 3 weeks later to assess whether patients had conducted their action plans.Results: Eighty-three percent of enrolled patients (228) made an action plan during a primary care visit. Of the 79% who recalled making the action plan when interviewed by telephone 3 weeks later, 56% recalled the details of their action plan, and an additional 33% recalled the general nature of the action plan. At least 53% of patients making an action plan reported making a behavior change consistent with that action plan.Conclusions: Most patients reported making a behavior change based on an action plan, suggesting that action plans may be a useful strategy to encourage behavior change for patients seen in primary care. Assisting patients to improve health-related behaviors is an important responsibility of primary care clinicians.1 However, physicians in primary careseldom have time to engage in behavior-change counseling and may be unsure how to discuss behavior change with their patients. 2-4One strategy to encourage behavior change involves a collaborative process in which patients choose a goal and clinicians and patients negotiate a specific action plan to assist in the goal's attainment. For example, the goal may be to lose 10 pounds; an initial action plan may be to substitute water in place of sugar-containing sodas. Patients should have a high level of confidence that they can accomplish the action plan; success increases selfefficacy (a person's confidence that he/she can make positive life changes), and self-efficacy has been associated with healthier behaviors and improved clinical outcomes. 5Several studies suggest that collaborative goal setting and action planning may be more effective in promoting behavior change than traditional clinician-directed advice.6 -8 However, no study offers details on action plans as a specific behavior-change intervention in primary care.We performed a descriptive study of action plans in a diverse sample of primary care patients with coronary heart disease (CHD) risk factors. A companion article 9 discusses the acceptability and feasibility of primary care clinicians engaging their patients in action-plan discussions. In this article, we explore the following questions. 1) To what extent are patients able to make an action plan with their clinician during a routine primary care visit? 2) What types of action plans do patients and clinicians make? 3) What proportion of patients are able to describe, and report carrying out, their action plans after 3 weeks? 4) Are c...

Facilitating Behavior Change With Low-literacy Patient Education Materials

“…Action plans are designed by the patient with support from the health care pro-vider. 12 The use of action plans is consistent with the framework offered by social cognitive theory. Action plans operationalize the process of goal setting and can lead to early successes, which build self-efficacy.…”

“…12,20,21 Further research is necessary to evaluate the success of using written health materials in conjunction with brief provider interventions to assist patients in making sustained behavior change. …”

“…A brief intervention to teach patients how to develop their own action plans can help them learn to create the short-term goals that are the springboard for sustained behavior change. 12 Action plans are short-term, easily achievable, and highly specific goals for immediate behavior change. For example, the patient who is interested in losing weight as a long-term goal may create as an action plan "I will walk around the block before I sit down to watch television 3 times during the next week."…”

Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial

“…This study adds to the growing literature on goal setting and action planning within primary care quality improvement initiatives, which has shown similarly high rates of progress toward goals related to diet, exercise, and medication adherence. 27,28 Informing physicians of patients' receptivity to counseling and resultant attempts to change behaviors may provide motivation to counsel more frequently.…”

Electronic Communications and Home Blood Pressure Monitoring (e-BP) study: Design, delivery, and evaluation framework

“…The pharmacist then summarizes this information obtained and, with the patient's assistance, collaboratively creates an action plan. The action plan has been successfully used to plan self-management in Chronic Care Model interventions [38,39]. The action plan has five components: (a) instructions for monitoring blood pressure; (b) current medication list; (c) healthy-lifestyle choice behavior-change activity; (d) proposed changes to the action plan (e.g., increasing a medication dosage); and (e) plans for follow-up (needed laboratory tests and next communication).…”