Agree
A goal and action plan: Moving forward with the ready patient
This step is about agreeing a goal and action plan. A goal is what the patient wants to achieve. An action plan is how they are going to achieve it. This step also involves explicit problem solving and relapse management.
In its simplest form you can ask “How much weight do you want to lose? By when? How do you intend to do this? What do you think might stop you achieving this? What can you do about that?”
Goal setting, action planning and problem solving
You might find it helpful to work through this form as a prompt with patients.
Try using it for yourself first: think of something you would really like to achieve – this could be anything from stopping biting your nails, to getting fitter. Try filling in this form, and see if you feel clearer about how you are going to do it and the steps that you need to take.
Click on the 'More info' buttons for further information on each aspect of the form.
Goal Setting
What do I want to achieve?
When do I want to achieve this by?
How important is it to me? ( 1 -10)
Not important Very important
Action planning /
What steps do I need to take?
What exactly am I going to do?
(How, what, when, where, how often)
What might get in the way?
What can I do about this?
How confident do I feel? ( 1 -10)
Not important Very important
You may download/ print a PDF version of this form to share with patients:
It can be done verbally as well, though patients often find a written record of the conversation helpful.
Case Scenario 2.6: Assess Beverley
Patient Details
- Name: Beverley Buthelezi
- Age: 24
- Ethnicity: Black South African
- BMI: 35
- Family Background: family history of hypertension and heart disease
- Last Appointment: 1 year and 3 months ago
Summary
Update
Activity
Help Beverley fill in her form and set achievable goals and realistic steps ...
Goal Setting
What do I want to achieve?
I just want to feel fitter and healthier.
What question(s) can you ask to help Beverley make this goal SMART-er?
Submit
Example question: "How will you know when you are fitter and healthier?"
For Beverley, being fitter may mean walking up the stairs without getting out of breath (by doing some regular exercise), and being healthier may mean reducing her blood pressure.
Beverly will need to improve her cardio vascular health, this will be evidenced when she’s lost 5% of her 90kg weight and exercising to national guidelines.
Write Beverley's goal in terms of exercise and weight loss.
SubmitExercise: as Zumba is vigorous exercise, 1 hour 15 minutes per week (approximately 2 classes).
National exercise guidelines are outlined on our exercise prescribing pad
When do I want to achieve this by?
I'm going on holiday with my boyfriend in a couple of weeks, it would be nicer to get this done by then!
How will you help Beverley set a more realistic time scale?
Submit
You may want to share information on the current guidelines for safe weight loss with Beverley: a maximum rate of 0.5kg to 1 kg /week.
Beverley currently weighs 90kg, she wants to lose 4.5 kg. She thinks she can manage to lose weight at 0.5kg per week. What would be a sensible timescale for her to achieve this goal?
Submit4.5 kg lost at 0.5kg per week =9 weeks
How important is it to me?
Not important Very important
How would you explore Beverley’s score (6)? Note that behaviour change is unlikely with a score less than 7.
SubmitYou could begin by asking her: why have you put a score of 6 and not 5 or 7?
This will allow her to assess why she has selected this score and potentially reassess, whether she could bring it up.
This is a good opportuntity to return to motivational interviewing:
- How would you feel if you managed to achieve this goal?
- What would be the benefits to you of achieving this?
- How would you feel if you didn’t manage to achieve this goal?
- Have you got the right goal? Is there something else that you feel is more important to your health at the moment?
Beverley decides that on reflection, this is actually more important to her and she moves her score up to a 7.
Action planning /
What steps do I need to take?
What exactly am I going to do?
(How, what, when, where, how often)
1] Zumba class and weekend walk
2] Improve my diet
What questions could you ask to help Beverley make this action plan more specific? How will she be keeping track?
Submit
- How often, when and where will do you do your Zumba class?
- How long will your weekend walk be?
- How do you intend to improve your diet?
- Exactly what changes do you intend to make today/tomorrow/this week?
This is Beverley’s revised plan:
1] Exercise - Zumba class on Tuesday and Thursday nights at local community centre, and a 1 hour walk with my boyfriend on Sunday afternoons
2] Diet – cut out sweet drinks, soft drinks, juices, smoothies etc, (drink tea / water instead), cut out sweets and cakes (fruit instead), cut down on take-away food during the week (once or twice per week only).
3] Weigh myself every week and record on a printed chart.
5
What might get in the way?
What can I do about this?
Feeling tired after work and not wanting to cook
My work friends offering cake round
Not feeling motivated to go to Zumba classes
How would you advise Beverley to overcome these barriers?
Submit
- Cook some extra at the weekend and freeze it
- Let her colleagues know that she is trying to lose weight
- Join Zumba classes with a friend
How confident do I feel?
Not confident Very confident
Beverley has chosen a score of 4, what question could you ask to increase her confidence?
SubmitExample question: What do you think would move your confidence up from a 4 to a 5?
Beverley replies:
I think I will stop keeping sweet drinks in the house. I find them very hard to resist if they are there. I will have to negotiate this with my boyfriend as he likes them too.
