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The 5 A's

A unifying conceptual framework used on a one-to-one basis or in groups by health care professionals is known as the 5 A’s construct (Goldstein, Whitlock, & DePue, 2004). The 5 A’s are Assess, Advise, Agree, Assist and Arrange. Basically, these are a set of behavioral strategies which encourage patients to engage in self-management and include:

  1. Establishing rapport with patients to ensure patients have opportunities to express their priority concerns.
  2. Setting a visit agenda with patients to ensure that both health professionals’ and the patients’ concerns are addressed in the visit.
  3. Getting patients to complete a Health Risk Appraisal at home to provide an opportunity for patients to obtain independent objective information about their health and what they need to do to address these concerns. The information can be discussed with the health professional.
  4. Assessing patients’ readiness to change a behavior to enable the health professionals to use appropriate behavioral change strategies.
  5. The “Ask-Tell-Ask” strategy is a technique to ensure that patients get the information they are after.
  6. The “Closing the Loop” technique is used to ensure patients understand the information provided by health professionals.
  7. Getting patients to make “Action Plans” is the process by which patients specify a particular behavior they will engage in.
  8. The “Problem-Solving Process” teaches patients a process to solve problems when they arise in their daily lives.
  9. Ensuring that “Follow-up” takes place facilitates the success of making action plans.

These activities are not necessarily linear. This construct has been applied to primary care interventions for a variety of behaviours (Goldstein, DePue, & Kazura, 1998; Ockene et al., 1995; Pinto, Lynn, Marcus, DePue, & Goldstein, 2001).The goal of the 5 A’s is to develop a personalized, collaborative action plan that includes specific behavioural goals and a specific plan for overcoming barriers and reaching those goals. The 5 A’s are elements that are interrelated and are not designed to be used in isolation, and superior results will occur if a combination of interventions are used, especially for complex cases (Glasgow, Toobert, Barrera, & Strycker, 2004).

Professional Associations and major hospitals have used the 5A’s construct as the basis of their evidence-based “Best practice Guidelines” in providing self-management support to adults with chronic health conditions (RNAO, 2010) and in caring for children experiencing chronic health conditions (Cincinnati Children’s Hospital, 2007). The Registered Nurses Association of Ontario has just released their newest Evidence-Based Practice Guidelines entitled: “Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients” These Guidelines are based on the 5 A’s Approach and are the techniques and strategies that nurses (and other health care providers) can use when interacting with patients with chronic health conditions. The document reviewed all the available research literature and gave each strategy a specific level of strength of evidence. The document can be downloaded at no cost by clicking here.

Cincinatti Children’s Hospital Medical Centre. (2007). Chronic Care: Self-Management Guideline Team, Cincinnati Children's Hospital Medical Center: Evidence-based care guideline for Chronic Care: Self-Management. 

Glasgow, R.E., Toobert, D.J., Barrera, M. Jr., & Strycker, L.A. (2004). Assessment of problem-solving: A key to successful diabetes self-management. Journal of Behavioral Medicine, 27(5), 477-490.

Goldstein, M.G., DePue, J., & Kazura, A. (1998). Models for provider-patient interaction: Applications to health behavior change. In S.A. Shumaker & E.B. Schon (Eds.), The handbook of health behavior change, (2nd ed.), (pp. 85-113). New York: Springer.
Goldstein, M. G., Whitlock, E. P. and DePue, J. (2004) Multiple health risk behavior interventions in primary care: summary of research evidence. American Journal of Preventive Medicine, 27 (2 Suppl), 61–79.
Ockene, J.K., Ockene, I.S., Quirk, M.E., Hebert, J.R., Saperia, G.M., Luippold, R.S., … Ellis, S. (1995). Physician training for patient-centred nutrition counseling in a lipid intervention trial. Preventive Medicine, 24(6), 563-570. Pinto, B.M., Lynn, H., Marcus, B.H., DePue, J., & Goldstein, M.G. (2001).

Physician-based activity counselling: Intervention effects on mediators of motivational readiness for physical activity. Annals of Behavioral Medicine, 23(1), 2-10. Registered Nurses’ Association of Ontario. (2010).