It Begins with You

Patient Engagment > Activation and Engagement for Behavioral Health

Activation and Engagement for Behavioral Health

DECIDE Program

Researcher Margarita Alegría (2014) conducted a study to test a model of shared decision-making for people with behavioral health issues. Her research team tested an intervention called DECIDE, an acronym that stands for: Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; and Enjoy a shared solution. The researchers concluded that the model increased patient activation and self-management in behavioral health care. The model appears to help patients learn to effectively ask questions and participate in decisions about their behavioral health care. At the same time, however, some providers reacted negatively to the patients’ increased activation. Researchers suggested adding a provider coaching element and found they needed to make a case for the model with clinic administrators before they were able to gain their support for the model.

Health and Recovery Peer Program

Druss and colleagues (2010) conducted a study in which they found that a peer-led medical self-management program for people with serious mental illness (SMI), called the Health and Recovery Peer Program (HARP) program, was effective in helping people with SMI and other chronic diseases to improve their health. The researchers tailored the Stanford Chronic Disease Self-Management Program to address their needs. Materials were added to HARP to emphasize the connection between mind and body, and a section was added about coordinating medications between primary care providers and physicians. Individuals in the HARP group (aka the intervention group) participated in a six-session intervention program with mental health peer experts to help participants manage their chronic medical co-morbidities more effectively. Peer educators taught attendees how to develop short-term action plans for health behavior change.


After six months, patient activation was significantly higher in the HARP intervention group than in the usual care group. In addition, the HARP group exercised more, were more likely to adhere to medication instructions, and scored higher on the health-related quality of life measure. Researchers concluded that the peer-led program was effective and showed promise for increasing patient activation and improving health outcomes among mental health consumers with chronic diseases.