The 5A’s can be used by any health care team member and in all types of health care settings.

During each stage of the process the following steps are recommended:

ASSESS:

•Review goals that the patient has or that have been set previously.

•Evaluate both levels of behavior and how the patient feels about the behavior he or she is trying to implement

•Ask what the patient wants to discuss

ADVISE:

•Communicate that what the patient does is as important as medication

•Provide short statements with specific recommendations

•Link recommendations to the patient’s views, risks, symptoms etc to make them relevant

•Ask what the patient thnks about the recommendation

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AGREE:

•Ask the patient what he or she most wants to work on

•Ask the patient what he or she thinks would be a reasonable goal

•Use questions and comments to help patient’s focus and be specific; the patient should set a goal they want to work on NOT a goal the provider thinks they should work on

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ASSIST:

•Ask the patient what he or she sees as the greatest challenges to achieving the goal

•Ask what he or she has done in the past to overcome obstacles

•Create a written action plan for the patient to refer to….be aware of low literacy, many patients will need simple wording and some will need an action plan with pictures instead of words

•Include supports and resources to help with the goal

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ARRANGE (Follow-up):

•Set a specific time for the next contact

•Tell the patient you want and need to hear how they are doing

•Begin the next contact with a review of progress on the goal or goals

•Follow-up on the patient’s experience with any referrals to community resources.

Research on the implementation of the 5A’s to facilitate self-management suggests 4 keys to success:

1.Employ all 5A’s during each interaction with the patient.

2.Use open-ended questions to enhance patient centeredness.

3.Use the 5A’s in conjunction with proactive care and follow-up

4.Document the deliver of the 5A’s and provide the patient with written or, in the case of low literacy patients, diagrammatic copies of the action plan.

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As previously stated, the 5A’s provide guidelines to facilitate many of the self-management support concepts recommended in the Institute for Health Improvement’s toolkit. Community resources may also help patients and family members successful engage in self-management.

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Reference:

World Health Organization (2004). Self-management support for chronic conditions using 5A’s. Available at:

http://www.who.int/diabetesactiononline/about/WHO 5A ppt.pdf