• Pernille H Kjaer, Lawrence Fisher, Michael B Potter, Mansi Dedhia, José Parra, Niels Ejskjaer, Søren Skovlund, and Danielle Hessler.
• From the Department of Endocrinology, Aalborg University Hospital, Denmark (PHK, NE); Department of Clinical Medicine, Aalborg University, Denmark (PHK, NE, SS); Department of Family and Community Medicine, University of California-San Francisco, USA (PHK, LF, MBP, MD, JP, DH); Steno Diabetes Center North Denmark, Aalborg University Hospital (NE, SS). p.horsted@rn.dk.
• J Am Board Fam Med. 2021 May 1; 34 (3): 608-617.

IntroductionCollaborative goal setting and action-planning are key elements of self-management support for people with type 2 diabetes mellitus (T2DM), however little is known regarding action plan quality or correlation of quality in primary T2DM care.MethodsT2DM patients from 12 primary care sites participated in either: Connection to Health (CTH; 6 practices), consisting of a health survey followed by collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 practices), including additional training in relationship building promoting patient engagement. Action plan quality was rated using an adapted version of the Goal-Setting Evaluation Tool for Diabetes (GET-D) (dual coding of 20%, inter-rater reliability [IRR] >80%). Associations with patient characteristics were examined using generalized linear mixed models adjusting for clustering by clinic and intervention arm.ResultsWith a mean score ± standard deviation (SD) of 14.62 ± 3.87 on a 0 to 20 scale (n = 725), overall action plan quality was moderate-high. Higher health literacy (β = 1.184, 95% CI, 0.326-2.041; P = .007), and having no social risks (β = 0.416; 95% CI, 0.062-0.770; P = .021) were associated with higher action plan quality, whereas sex, age, language, education level, depression, stress, and health distress were unrelated to quality (P value not significant). Higher quality was associated with greater patient confidence in the plan (β = 0.050; 95% CI, 0.016-0.084, P = .004).ConclusionsAlthough there was a considerable difference in action plan quality ratings, ratings did not systematically differ based on most patient demographic or mental health measures. Results suggest that action planning should be tailored to health literacy and social risks. Further research should examine associations between quality and longer-term clinical outcomes.© Copyright 2021 by the American Board of Family Medicine.

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