The 5As Framework

In 2000, building on earlier work from the U.S. National Cancer Institute, the CTFPHC proposed a framework to guide physicians and health care systems in organizing their general approach to assisting patients with behavioral counseling interventions. In 2002, USPSTF adopted the

Table 6-6 The Five "A" Components of Behavior Counseling Interventions

Assess: Ask about or assess behavioral health risks and factors affecting choice of behavior change goals or methods.

Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.

Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.

Assist: Using behavior change techniques, aid the patient in achieving agreed-on goals by acquiring the skills, confidence, and social or environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate (e.g., pharmacotherapy for tobacco dependence, contraceptive drugs or devices).

Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance or support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment. Intervention to help patients change unhealthy behaviors often requires repetition over time.

Modified from Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002;22:267-284.

framework, known as the "5As," for evaluating the effectiveness of behavior counseling interventions (Table 6-6). The 5As framework is a powerful tool that can assist physicians in developing and evaluating their practice's behavior change interventions. USPSTF offers guidance on the evidence base for behavior change interventions for many specific behaviors.

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