Reports From the Field

Brief Action Planning to Facilitate Behavior Change and Support Patient Self-Management

Journal of Clinical Outcomes Management. 2014 January;21(1)

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Underlying Principles of BAP

BAP is grounded in the principles and practice of MI and the psychology of behavior change. Within behavior change, we draw primarily on self-efficacy and action planning theory and research. We discuss the key concepts in detail below.

The Spirit of MI

MI Spirit (Compassion, Acceptance, Partnership and Evocation) is an important overarching tenet for BAP. Compassionately supporting self-management with MI spirit involves a partnership with the patient rather than a prescription for change and the assurance that the clinician has the patients best interest always in mind (Compassion) [17]. Exemplifying “spirit” accepts that the ultimate choice to change is the patient’s alone (Acceptance) and acknowledges that individuals bring expertise about themselves and their lives to the conversation (Evocation). Adherence to “MI spirit” itself has been associated with positive behavior change outcomes in patients [5,28–32]. Demonstrating MI spirit throughout the change conversation is an essential foundational principle of BAP.

Action Planning and Self-Efficacy

In addition to the spirit of MI, BAP integrates 2 evidence-based constructs from the behavior change literature: action planning and self-efficacy [4,6,33–36]. Action planning requires that individuals specify when, where and how to enact a goal-directed behavior (eg, self-management behaviors). Action planning has been shown to mediate the intention-behavior relationship thereby increasing the likelihood that an individual’s intentions will lead to behavior change [37,38]. Given the demonstrated potential of action planning for ensuring individuals achieve their health goals, the BAP framework aspires to assist patients to create an action plan.

BAP also aims to build patients’ self-efficacy to enact the goals outlined in their action plans. Self-efficacy refers to a patient’s confidence in their ability to enact a behavior [33]. Several reviews of the literature have suggested a strong relationship between self-efficacy and adoption of healthy behaviors such as smoking cessation, weight control, contraception, alcohol abuse and physical activity [39–42]. Furthermore, Lorig et al demonstrated that the process of action planning itself contributes to enhanced self-efficacy [8]. BAP aims to build self-efficacy and ultimately change patients’ behaviors by helping patients to set an action plan that they feel confident in their ability to achieve.

Description of the BAP Steps

The flowchart in Figure 1 presents an overview of the key elements of BAP. An example dialogue illustrating the steps of BAP can be found in Figure 2 .

Three questions and 3 of the BAP skills (ie, SMART plan, eliciting a commitment statement, and follow-up) are applied during every BAP interaction, while 2 skills (ie, behavioral menu and problem solving for low confidence) are used as needed. The distinct functions and the evidence supporting the 3 questions and 5 BAP skills are described below.

Question 1: Eliciting a Behavioral Focus or Goal

Once engagement has been established and the clinician determines the patient is ready for self-management planning to occur, the first question of BAP can be asked : “Is there anything you would like to do for your health in the next week or two?”

This question elicits a person’s interest in self-management or behavior change and encourages the individual to view himself/herself as someone engaged in his or her health. The powerful link between consistency of word and action facilitates development and commitment to change the behavior of focus [43]. In some settings a broader question such as “Is there anything you would like to do about your current situation in the next week or two?”