Behavior change can be a complex and difficult journey. However, having a simple framework can make it approachable for both you and your patients. A few weeks ago I met with a physician who shared the framework that works best for him. We were discussing how overwhelming behavior change can be for patients. He said he likes to think of behavior change in three stages: “1 – Believe, 2 – Know, 3 – Act.” This approach really resonated with me. It may seem obvious, but I think we often rush patients into the “act” stage and forget that they won’t act until they believe a change is necessary and can’t act unless they know what to do to be successful.

We all know that behavior change is crucial because it can significantly improve chronic disease outcomes. I am working on breaking down my behavior change approach with my patients into stages of “believe, know, and act.” Here are some ideas I’m sharing with you so that you too can have better conversations and outcomes with your patients:

Believe

Behavior change starts with believing that change is necessary and possible. An individual must believe that behavior change will impact an outcome that they actually want to achieve. And they must have confidence in their ability to control their motivation, behavior, and social environment—which is no small undertaking.

If a patient has made it to an education session, they are probably at least open to believing. But they may not be ready to move right into the “know” stage. Does your education process spend some time attempting to move attendees through believe and into know? In an interactive group setting, you can leverage the members of the group that are already past the “belief” stage to influence those that are not.

In a presentation-style format, this is going to be more challenging because you may not be able to tell where each participant is on the spectrum from believe to act. One suggestion would be to conduct a pre-session survey to understand beliefs and try to schedule 1-on-1 interventions with patients that are clearly not ready to move to the “know” stage.

Know

Once an individual believes that change is necessary and possible, they are ready to learn what to do to achieve the desired outcome. In an interactive group session, through conversation, you will pick up fairly quickly what your patients know (and don’t know!). Throughout the session, it is likely that in addition to you sharing information, your patients that are more experienced with managing diabetes will also share their knowledge. Peer discussions can be very influential.

If you are doing a classroom-style group session, you might want to use your pre- and post-session surveys to assess knowledge. Identify the gaps to address in the next session or in a 1-on-1 session.

Act

The final component of behavior change is to act on the knowledge and do what needs to be done to improve health outcomes. These actions might include eating healthy, physical activity or stress reduction. Ask your patients how they plan to apply their knowledge to their daily routine and follow up with them in your next discussion. Integrating a formal goal-setting exercise into your session is a good way to get patients to write down their intended actions. Many research studies show that just the act of writing down a goal makes you far more likely to act upon it and achieve it.

Believe, know, and act is a practical way to think about what is needed to deliver behavior change. How do you drive behavior change? How will you apply this strategy to your interactions with patients?