The 5 A's

[Marc]

Definition:

Assess----to assess patients' knowledge, beliefs, concerns and daily behaviours related to his/her chronic condition and its treatment.

Questions:
what would you like to address today?
What do you know about ...........................e.g HIV/AIDS?
Tell me about a typical day including your problem and what you are doing to manage it.
Have you ever tried to...............................e.g change your diet. If yes, what was it like?

Definition:

Advise---correct any inaccurate knowledge and fill gaps in the patients' understanding of his/her conditions and/or risk factors and their treatment.

Questions:
i have some information about............................., would you like to hear it?
It has been shown that .....................e.g smoking does great damage to your health. What do you think about that?
What questions do you have about what I just told you?

Definition:

Agree---ensure that the negotiated goals are clear, measurable, realistic, under the patients direct control and are limited in number.

Questions:
Among the options we've discussed, what would you like to do?
followed by....'okay, so as I understand it, we've agreed that you will......................is this correct?

Definition:

Assist---provide adherence equipment e.g pill box by day of week, self monitoring tools e.g calendar or other ways to remind and record treatment plan.
Link to available support such as friends, family, peer support groups, community services for certain treatments, treatment supporter or guardian.

Questions:
What problem might arise when you follow this plan?
How do you think you can handle that?
What questions do you have about the plan or how to follow it?
Could you explain to me in your words what you understand about the plan?

Definition:

Arrange---arrange follow-up to monitor treatment progress and to reinforce key measures.

Questions:
I would like to see you again [specify a date if possible] to assess how you are doing. It's important that you come for this follow-up even if you are feeling well.


Regards, Marc

Keep up the SALTitude...

[Marc]

Way of thinking/Way of Working
1. Community with HIV/AIDS Problems
2. AIDS Competent Community
Look for Strong Capacities
1. Hope
2. Care
3. Change
4. Leadership
5. Sense of Community
SALT:
After empowering the SALT, we come to the 5 A’s. This is how all facilitators and collate workers must use this method to every family and not only patients.
How to Use the Caregiver Booklet – the 5 A’s
Assess:
1. assess patients’ status, offer advice and counseling.
2. assess patients and caregivers knowledge, concerns and skills related to his/her condition and treatment.
Advise:
1. use the booklet as a communication aid, you are teaching the patient, family, community and caregiver – use it as an aid to this. Do not just give the booklet to the family or ask them to read it while you watch.
2. only explain the management of a few symptoms or a few skills at a time. Chose those that are most important for the care of the patient now.
3. explain prevention to all.
4. demonstrate skills such as the correct method for range of motion or how to draw up the exact dose of a liquid medicine such as morphine, into the syringe.
5. ask if they have questions or will have problems giving the care at home. Ask them to demonstrate the skills or ask a good checking question.
Agree:
1. after giving information and teaching skills, make sure that they know what to do and that they want to do it. Empower them to stay in change. Support patient’s self management and family care.
Assist:
1. make sure they have the supplies required for care.
2. encourage them to refer to the booklet. If they are not literate, they can ask someone to read it to them.
Arrange:
1. ask them to return or to ask an experienced caregiver in the community if they have questions or are confused or concerned about how to give the care.
2. make sure they know when and who to call for help. Let them know how you can provide backup to their home care.

[Laurence Gilliot]

Hi Marc,

Could you explain more about the context in which you use the 5 A's? It is in a counselling session?
Thanks,

Laurence