Every day, providers and clinic staff navigate a steady stream of mis/disinformation (MDI). Whether it’s “I heard birth control makes it so you can’t get pregnant after you stop using it” or “My friend’s IUD moved into her stomach,” MDI can derail visits and erode trust.
But they don’t have to.
When clients share MDI, it can also be an opportunity to listen, connect and build confidence in accurate, evidence-based information. When a client brings up something that isn’t fully accurate, it’s often for a good reason. They may be looking for clarity, expressing a fear, or repeating what they’ve heard from people they care about.
Adolescents and young adults, especially, say they want more information about contraception, abortion, and sexually transmitted infections (STIs) from trusted sources like their providers — but they don’t always get it. So, increasingly, social media has become a primary information source, where distinguishing high quality information from MDI is hard.
That’s where the Affirm-Share-Ask (ASA) Cycle comes in. The ASA Cycle is a practical, person-centered communication tool that helps flip MDI into meaningful dialogue. It respects what patients are feeling, supports their autonomy and opens the door for honest, trust-building conversations.
What is an ASA Cycle?
Developed by Patty Cason, MS, FNP-BC, and Joely Pritzker, MS, FNP-C, the ASA Cycle distills decades of counseling and adult learning theory research into an easy-to-remember, repeatable communication loop. It’s designed for real-world settings — short visits, complex questions, and high emotions included.
Each ASA Cycle has three simple steps:
- Affirm/Acknowledge
- Share Content/Information
- Ask a follow-up question
Together, these steps help transform misinformation from a roadblock into a moment for connection and understanding.
Step 1: Start by connecting– Affirm
When a client says something inaccurate or partially true, it’s natural to want to jump in with the facts right away. But doing so can miss the emotion behind their statement — feelings like worry, frustration, confusion — that often underlies MDI. More importantly, it can trigger defensiveness and make clients feel unheard.
The Affirm step helps slow things down and center the conversation on connection. It shows you’re listening and that their thoughts and experiences matter. That kind of empathy builds trust and lays the foundation for meaningful learning later.
Ways to Affirm:
- Show empathy if someone expresses an emotion. Rather than labeling their feelings, simply respond with a non-specific phrase that shows that you care how they feel: “I can see that this is something you’ve been thinking a lot about.”
- Find a point of agreement, by identifying a small kernel of truth: “You’re right that with one of the methods of contraception, the birth control shot, it can take longer for some people to get pregnant after stopping.”
- Point out a strength: “It’s great you’re asking questions before making a decision.”
- Normalize curiosity by validating: “That’s a really common question–I’m glad you brought it up.”
Step 2: Be purposeful: Share information
After affirming, Share concise, relevant information that directly connects to what the client said. The goal isn’t to share everything you know — it’s to provide clear, digestible facts that address their concerns and help make sense of what they’ve heard.
Research on health literacy and adult learning shows that people remember information best when it feels relevant and manageable. Too much detail too soon can overwhelm or confuse.
Tips for sharing information:
- Personalize it: Start with the most important fact and link it to the patient’s concern.
- Keep it conversational: Avoid jargon or long explanations. This is a dialogue, not a lecture.
- Use visuals and tactile aids: Diagrams, models, or a quick sketch can make complex information easier to understand.
Step 3: Keep the conversation open: Ask a follow-up question
Once you’ve shared information, bring the focus back to the client. Asking a thoughtful follow-up question helps them process what they’ve just heard and invites them to share their perspective. It keeps the dialogue going and reinforces that you’re partners in their care.
Examples:
- “Knowing that, what are your thoughts on [topic]?”
- “What questions do you have about that?”
- “How would that feel for you?”
When used optimally, the ASA Cycle is a conversational loop. Once the client responds to the question, you can start a new ASA cycle by affirming what they share, adding another bit of relevant information, asking a follow-up question and continuing the conversation.
Bringing ASA Cycles into practice
Here is an example of a full ASA cycle:
Client:
I heard that birth control makes it harder to get pregnant after you stop using it.
Provider:
Affirm (validation & agreement): “I hear that from a lot of people who see posts about that on social media. You’re right that with one method, the shot, it can take up to a year for someone’s ability to get pregnant to return to what’s normal for them.”
Share: “With other types of birth control, like the pill or IUD, your ability to get pregnant goes back to whatever is normal for you right away after stopping the method.”
Ask: “How does that line up with what you’ve been hearing?”
Even short exchanges like this can make a big impact. They show empathy, create space for honest questions, and keep the focus on shared understanding.
Like any skill, ASA Cycles take practice to feel natural, but once integrated, they can transform client interactions. Start small — try it out the next time a client mentions something they heard online.
Why ASA Cycles work for misinformation
Today’s clients bring stories from social media, community conversations, and lived experience into the exam room. These stories often mix emotion, anecdote, and partial truths.
Using ASA cycles helps providers to meet that mix with empathy, accuracy, and curiosity instead of confrontation. Because MDI spreads by heightening emotions, like fear, facts alone rarely change minds. What does work is pairing those facts with connection and compassion.
When clients feel heard, they’re more likely to trust what comes next.
Key points
- ASA Cycles offer an empathetic, effective way to respond to MDI in client visits.
- The loop, Affirm → Share → Ask, builds trust while providing accurate, relevant information. Repeat it often.
- Facts matter, but trust matters more. ASA cycles show clients you’re listening, understanding, and committed to their well-being.
Clinical resources
Affirm-Share-Ask (ASA) Cycles for Patient-Centered Communication and Counseling Video Series, eLearning Course and Palm Card from the Reproductive Health National Training Center
ASA Cycle Resources and Workforce Training Information from Envision SRH