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The power of action planning

CARE’s approach to addressing non-adherence

Tess van Leeuwen

Digital Lead

16 June 2022

When I moved from Amsterdam to London and met my partner, he was charmed by the idea of learning a foreign language. How hard could it be to learn Dutch when one’s partner is from the Netherlands? Twelve years later, he can tell you, the answer is ‘hard’! Learning a new language requires dedication and time. If the outcome is ambiguous - what use will this new skill be? - following through is a challenge. And when the reward is not immediate but in the future, finding the drive to work for it now can be tiresome.

After years of Duolingo, crash courses during family gatherings, and many an educational book, the temptation to throw the towel in altogether was alluring; the intention to speak Dutch was there, but the behaviour to follow through was lacking.

When we translate this to healthcare, the struggles of patients trying to stick to a treatment regime are all too familiar. Often patients want to get better or stay on top of their health condition, but there is an ‘implementation gap’ between good intentions and actual behaviour. This reflects a common observation in psychological research: good intentions alone are not enough to ensure behavioural change.

Making a specific plan which ties taking medication to an existing routine, therefore, helps people to remember. –

Action plans can aid the process of making an intention achievable without the need for endless psychological resources. Unlike goals that solely focus on the desired outcome (“I want to get better” or “I want to learn Dutch”) an action plan which links a trigger or cue to a desired outcome through a clear implementation intention specifying the exact when, where and how, is much more likely to succeed. Making a specific plan which ties taking medication to an existing routine, therefore, helps people to remember. The more specific a plan is, the easier it is to follow. So instead of saying “I will take my pills in the evening” say “If I go to bed and am in the bathroom to take out my contact lenses, then I will take my pills which are in the bathroom cabinet next to the saline solution.” This is also called an if-then plan.

Healthcare professionals (HCPs) can help patients form these action plans. Not by making suggestions (after all, we do not know the weird and wonderful routines of others) but by asking questions about existing routines and behaviour. This way we can help a patient come up with, discuss and note down their own action plan. And although forming this plan is a deliberate, conscious act, following through can be automatic and non-conscious (like brushing our teeth).

In the case of my husband, he realised that soon he wouldn’t be able to follow the conversations between me and our daughters and changed tack. A regular Sunday lunchtime class was scheduled with an actual teacher (who was not his wife and had to be paid). As a family we agreed to ‘dedicated Dutch time’– if we were on a short car journey then we would speak Dutch. This made it part of our routine, manageable and meaningful. Action plan for the win!

Adriaanse, M.A. et all., Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence. Appetite, 2011-02, 56 (1), p.183-193

Hagger, M.S. and Luszczynska, A., Implementation Intention and Action Planning Interventions in Health Contexts: State of the Research and Proposals for the Way Forward. Applied Psychology: Health and Well-being, 2014, 6 (1), p. 1–47

Webb, T. and Sheeran, P., Does Changing Behavioral Intentions Engender Behavior Change? A Meta Analysis of the Experimental Evidence. Psychological Bulletin, 2006-03, 132 (2), p.249-268