ReviewGoal-setting for behavior change in primary care: An exploration and status report
Section snippets
What is goal-setting?
Collaborative goal-setting for health behavior change is a process by which caregiver and patient agree on a health-related goal. The goal could be general (losing 10 pounds, exercising more, or reducing stress) or specific (drinking water rather than coca-cola, walking for 15 minutes four times a week, or attending a weekly yoga class to reduce stress). Specific goals are called action plans, which involve caregivers and patients agreeing on a concrete course of action to move the patient
Methods
We conducted a search for articles that related to goal-setting interventions/action-planning for promoting behavior change using MedLine and the Cochrane Library databases to identify primary articles published in English. The focus was to identify articles in which: (1) the goal-setting intervention took place in a primary care practice or clinic; (2) goal-setting was the principal or only intervention and not an ancillary component of another intervention; (3) the goal-setting intervention
Workplace goal-setting
Serious study of goal-setting commenced around 1970 when Ryan introduced the concept that conscious goals affect action [16]. Until the 1990s, the field of goal-setting focused on such matters such as employee productivity in business enterprises. Research demonstrated that when managers set specific performance goals for employees, the employees did better than if they were simply asked to “do your best” [15].
A concept intertwined with goal-setting is self-efficacy [17]. Self-efficacy means
The primary care goal-setting literature
Eight articles were found involving goal-setting in the primary care setting [23], [24], [25], [26], [27], [28], [29], [30]. Five of the eight studies involved patients with type 2 diabetes, one study enrolled patients with cardiovascular risk factors including diabetes, and two studies looked at healthy adults or adolescents, some of whom were overweight. How does the primary care goal-setting literature deepen understanding of the eight hypotheses?
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General vs. specific: Six of the eight
Discussion: practice implications
As noted earlier in this paper, many primary care practices have instituted goal-setting as part of their management of patients with chronic illness. Does the literature – even with a lack of robust evidence on the effectiveness of goal-setting – suggest the best ways in which primary care practices might design goal-setting as a regular feature of their practice? Two issues are addressed here: (1) how do the hypotheses listed above and the literature reviewed suggest that goal-setting
Conclusion
Collaborative goal-setting is a novel paradigm increasingly being adopted by health care personnel in the management of patients with chronic conditions. The state of knowledge regarding goal-setting for patient with chronic conditions is as yet incomplete. Controlled trials involving goal-setting are needed to establish whether or not this activity improves outcomes. Such trials might involve goal-setting as the sole intervention vs. usual care, or might be designed to test a group of chronic
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