Review
Goal-setting for behavior change in primary care: An exploration and status report

https://doi.org/10.1016/j.pec.2009.06.001Get rights and content

Abstract

Objective

This paper explores the behavior change method of goal-setting and reviews the literature on goal-setting in primary care for patients with chronic conditions.

Methods

A literature search was conducted resulting in eight articles meeting the criteria of goal-setting interventions in primary care for adults or adolescents with chronic conditions.

Results

Hypotheses are advanced that goal-setting is generally conducted by collaboratively working with patients to set short-term and specific goals, with follow-up to provide feedback to patients. The articles reviewed generally confirmed these hypotheses. This review did not focus on clinical outcomes, but on the processes of engaging patients in goal-setting discussions.

Conclusion

Evidence that goal-setting is superior to other behavior change methods has not been shown. Since goal-setting is being utilized as a behavior change technique in many primary care sites, primary care practices can benefit from information on how best to implement this innovation.

Practice Implications

Generally, clinicians are minimally involved in goal-setting discussions with their patients. Engaging patients in goal-setting can be done with interactive computer programs and non-clinical members of the primary care team.

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?

  • 1.

    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

References (31)

  • M.H. Chin et al.

    Improving and sustaining diabetes care in community health centers with the health disparities collaboratives

    Med Care

    (2007)
  • T. Bodenheimer et al.

    Patient self-management of chronic disease in primary care

    J Amer Med Assoc

    (2002)
  • K.R. Lorig et al.

    Chronic disease self-management program: 2-year health status and health care utilization outcomes

    Med Care

    (2001)
  • E.B. Fisher et al.

    Ecological approaches to self-management: the case of diabetes

    Am J Public Health

    (2005)
  • V.J. Strecher et al.

    Goal setting as a strategy for health behavior change

    Health Educ Q

    (1995)
  • Cited by (0)

    View full text