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

1) Ask permission to offer a behavioral menu. Asking permission to share ideas respects patient autonomy and prevents the provider from inadvertently assuming an expert role. For example: “Would it be OK if I shared with you some examples of what some other patients I work with have done?”

2) Offer 2 to 3 general yet varied ideas all at once (Figure 2, entry 5). It helps to mention things that other patients have decided to do with some success. Using this approach avoids the clinician assuming too much about the patient or allowing the patient to reject the ideas. It is important to remember that the list is to prompt ideas, not to find a perfect solution [17]. For example: “One patient I work with decided to join a gym and start exercising, another decided to pick up an old hobby he used to enjoy doing and another patient decided to schedule some time with a friend she hadn’t seen in a while.”

3) Ask if any of the ideas appeal to the individual as something that might work for them or if the patient has an idea of his/her own (Figure 2, entry 5). Evocation from the Spirit of MI is built in with this prompt [17]. For example: “These are some ideas that have worked for other patients I work with, do they trigger any ideas that might work for you?”

Skill 2: SMART Planning

Once an individual decides on an area of focus, the clinician partners with the patient to clarify the details and create an action plan to achieve their goal. Given that individuals are more likely to successfully achieve goals that are specific, proximal, and achievable as opposed to vague and distal [46,47], the clinician works with patient to ensure that the patient’s goal is SMART (specific, measurable, achievable, relevant and time-bound). The term SMART has its roots in the business management literature [48] as an adaptation of Locke’s pioneering research (1968) on goal setting and motivation [49]. In particular, Locke and Latham’s theory of Goal Setting and Task performance, states that “specific and achievable” goals are more likely to be successfully reached [47,50].

We suggest helping the patient to make smart goals by eliciting answers to questions applicable to the plan, such as “what?” “where?” “when?” “how long?” “how often?” “how much?” and “when will you start?” [51]. A resulting plan might be “I will walk for 20 minutes, in my neighborhood, every Monday, Wednesday and Friday before dinner.”

Skill 3: Elicit a Commitment Statement

Once the individual has developed a specific plan, the next step of BAP is for the clinician to ask him or her to “tell back” the specifics of the plan. The provider might say something like, “Just to make sure we understand each other, would you repeat back what you’ve decided to do?” The act of “repeating back” organizes the details of the plan in the persons mind and may lead to an unconscious self-reflection about the feasibility of the plan [43,52], which then sets the stage for Question 2 of BAP (Scaling for Confidence). Commitment predicts subsequent behavior change, and the strength of the commitment language is the strongest predictor of success on an action plan [43,52,53]. For example saying “I will” is stronger than saying “I will try.”