The Art of Negotiating Diabetes-specific Behavioral Action Plans

AADE program session
Friday August 13, 2004
3:15 - 4:15 pm

Reviewed by Joelle Escoffery, PhD

Diabetes is primarily a disease of self management, and making behavior changes is a key component of successful diabetes outcomes. However, a majority of people with diabetes have difficulty making and sustaining behavior changes, especially changes related to weight management and physical activity. Generally speaking, a lack of motivation is not the problem; rather, patients lack the specific strategies to implement a change, and they encounter obstacles that prevent change from occurring. One very important strategy for behavior change is a specific plan of action. An action plan can provide patients with a road map for behavior change, and diabetes educators can assist their patients in the creation of these action plans. However, patients must be ready to change. They must be engaged with the educator, free from psychological comorbidities such as depression, believe in the importance of self management, and have the support necessary to make a change.

Once a patient has been identified as ready to make a change, there are five steps that are key to successfully creating a plan of action for behavior change. First, patient concerns need to be identified. The patient needs to feel involved in the process, because changes that are not meaningful to the patient are far less likely to occur. Next, the concern raised by the patient can be used to create a personally and physiologically meaningful goal. It is important that the identified goal be specific and realistic. It should focus on actions (walking 15 minutes for four days a week) rather than on vague recommendations (lose weight). Next, potential barriers and methods for overcoming them should be discussed with the patient. Finally, the educator should "close the deal" by having the patient make a verbal commitment to the agreed upon plan. By focusing on the patient and negotiating a specific action plan based on small but meaningful changes, the likelihood of patient success will be much greater.