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Behavior-Change Action Plans in Primary Care: A Feasibility Study of Clinicians

From the Department of Family and Community Medicine (KM, MH, SW, CS, KG, TB), University of California at San Francisco (UCSF), San Francisco, CA
Division of General Internal Medicine (DS), University of California at San Francisco (UCSF), San Francisco, CA

Correspondence: Corresponding author: Thomas Bodenheimer, MD, Building 80–83, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110 (E-mail: tbodenheimer{at}fcm.ucsf.edu)

Purpose: Collaborative goal-setting—with clinician and patient together deciding on concrete behavior-change goals—may be more effective in encouraging healthy behaviors than traditional clinician-directed advice. This study explores whether it is feasible for clinicians to engage patients with coronary heart disease (CHD) risk factors in collaborative goal-setting and concrete action planning during the primary care visit.

Methods: Primary care clinicians were trained in goal-setting and action planning techniques and asked to conduct action plan discussions with study patients during medical visits. Clinicians’ experiences were documented through post-visit surveys and with questionnaires and semistructured interviews at the end of the study.

Results: Forty-three clinicians and 274 patients with CHD risk factors participated in the study; 83% of the patient encounters resulted in a behavior-change action plan. Goal-setting discussions lasted an average of 6.9 minutes. Clinicians rated 75% of the discussions as equally or more satisfying than previous behavior-change discussions, and identified time constraints as the most important barrier to adopting the goal-setting process.

Conclusions: Collaborative goal-setting between clinicians and patients for improved health behaviors is viewed favorably by clinicians in primary care. Time constraints could be addressed by delegating goal-setting to other caregivers.

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