From the New York University School of Medicine, New York, NY (Drs. Gutnick and Jay), University of Colorado Health Sciences Center, Denver, CO (Dr. Reims), University of British Columbia, BC, Canada (Dr. Davis), University College London, London, UK (Dr. Gainforth), and Stonybrook University School of Medicine, Stonybrook, NY (Dr. Cole [Emeritus]).
Abstract
Objective: To describe Brief Action Planning (BAP), a structured, stepped-care self-management support technique for chronic illness care and disease prevention.
Methods: A review of the theory and research supporting BAP and the questions and skills that comprise the technique with provision of a clinical example.
Results: BAP facilitates goal setting and action planning to build self-efficacy for behavior change. It is grounded in the principles and practice of Motivational Interviewing and evidence-based constructs from the behavior change literature. Comprised of a series of 3 questions and 5 skills, BAP can be implemented by medical teams to help meet the self-management support objectives of the Patient-Centered Medical Home.
Conclusion: BAP is a useful self-management support technique for busy medical practices to promote health behavior change and build patient self-efficacy for improved long-term clinical outcomes in chronic illness care and disease prevention.
Chronic disease is prevalent and time consuming, challenging, and expensive to manage [1]. Half of all adult primary care patients have more than 2 chronic diseases, and 75% of US health care dollars are spent on chronic illness care [2]. Given the health and financial impact of chronic disease, and recognizing that patients make daily decisions that affect disease control, efforts are needed to assist and empower patients to actively self-manage health behaviors that influence chronic illness outcomes. Patients who are supported to actively self-manage their own chronic illnesses have fewer symptoms, improved quality of life, and lower use of health care resources [3]. Historically, providers have tried to influence chronic illness self-management by advising behavior change (eg, smoking cessation, exercise) or telling patients to take medications; yet clinicians often become frustrated when patients do not “adhere” to their professional advice [4,5]. Many times, patients want to make changes that will improve their health but need support—commonly known as self-management support—to be successful.
Involving patients in decision making, emphasizing problem solving, setting goals, creating action plans (ie, when, where and how to enact a goal-directed behavior), and following up on goals are key features of successful self-management support methods [3,6–8]. Multiple approaches from the behavioral change literature, such as the 5 A’s (Assess, Advise, Agree, Assist, Arrange) [9], Motivational Interviewing (MI), and chronic disease self-management programs [10] have been used to provide more effective guidance for patients and their caregivers. However, the practicalities of these approaches in clinical settings have been questioned. The 5A’s, a counseling framework that is used to guide providers in health behavior change counseling, can feel overwhelming because it encompasses several different aspects of counseling [11,12]. Likewise, MI and adaptations of MI, which have been shown to outperform traditional “advice giving” in treatment of a broad range of behaviors and chronic conditions [13–16], have been critiqued since fidelity to this approach often involves multiple sessions of training, practice, and feedback to achieve proficiency [15,17,18]. Finally, while chronic disease self-management programs have been shown to be effective when used by peers in the community [10], similar results in primary care are not well established.
