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

�

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

�

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

�

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.

●

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.

●

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