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- Am J Lifestyle Med
- v.13(6); Nov-Dec 2019
- PMC6796229
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Am J Lifestyle Med. 2019 Nov-Dec; 13(6): 615–618.
Published online 2017 Sep 13. doi:10.1177/1559827617729634
PMCID: PMC6796229
PMID: 31662729
Ryan R. Bailey, PhD, MSCI, OTR/L
Author information Article notes Copyright and License information PMC Disclaimer
Abstract
Health behavior change is challenging for most individuals, but there are manystrategies that individuals can use to facilitate their behavior change efforts.Goal setting is one such strategy that assists individuals to identify specificbehaviors to change and how to go about doing so. For many, however, simplysetting a goal seldom leads to actual behavior change. For some, identifying anappropriate goal is difficult, while for others, putting goals into action isthe roadblock. Two strategies may be of assistance for setting and achievinggoals. First, consideration of key goal characteristics (eg, approach vsavoidance goals, performance vs mastery goals, level of difficulty) may resultin selection of more appropriate and feasible goals. Second, action planning canhelp individuals put goals into action. Clinicians can help patients utilizethese strategies to set and achieve goals for health behavior change.
Keywords: action planning, goal setting, health behavior, intrinsic motivation, self-efficacy
‘Setting a goal for health behavior change, however, is seldom sufficient forbehavior change to actually occur.’
Goals are mental representations of desired outcomes,1 and goal setting is the process by which one identifies specific goals anddetermines how they will be achieved.2 Because there are many ways in which one’s health can be improved, identifyingspecific and actionable goals is important for facilitating health behavior change.Setting a goal for health behavior change, however, is seldom sufficient for behaviorchange to actually occur. One need only consider the countless number of unfulfilled NewYear’s Resolutions to know this to be true.3 Called the “intention-behavior gap,” numerous studies have demonstrated thatintention to change behavior alone does not often result in actual behaviorchange.4-6 Intention precedes action;therefore, one must act on one’s intentions in order to changebehavior.4,6 Transformingintentions into action, however, can be challenging. Fortunately, research on goalsetting in recent years has yielded strategies for helping people set and achievedesired goals,1,2 which can beutilized by clinicians (ie, physicians, nurses, allied health professionals, etc) toexpedite patients’ behavior change efforts. Two such strategies include considering goalcharacteristics when setting goals and creating action plans that facilitate goalachievement.
Goal Characteristics
There are many factors to consider when it comes to setting goals. Should goalsspecify actions to take or actions to avoid, focus on measurable outcomes or onskills to be developed, or be challenging or easy? The answers to these questionsare important because they can influence goal achievement. Mann et al2 reviewed each of these goal characteristics, which should be considered whensetting health behavior goals.
Approach Versus Avoidance Goals
Approach goals help individuals move toward desired outcomes, whereas avoidancegoals help individuals move away from undesired outcomes.7 An example of a positively framed approach goal might be “I’m going toeat a cup of low-fat yogurt for my afternoon snack,” whereas a negatively framedavoidance goal might be “I’m not going to eat junk food as a snack.” Althoughthese goals appear to be similar in terms of promoting healthy snacking,psychological investigation has shown that different cognitive and emotionalprocesses are involved. Approach goals are associated with greater positiveemotions, thoughts, and self-evaluations and greater psychologicalwell-being.7,8 In contrast, avoidance goals are associated with fewerpositive thoughts and greater negative emotions.7,8 Given these findings,setting approach goals may be more helpful than setting avoidance goals forhelping patients change their health behaviors.2 Clinicians can help patients convert avoidance goals into approach goalsby substituting behaviors to avoid with behaviors to promote, as illustrated inthe following example: “Rather than watching television after dinner, I willwalk around the block for 20 minutes instead.”
Performance Versus Mastery Goals
Much of what is known about performance and mastery goals has come frompsychological studies of learning. Performance goals involve judging andevaluating one’s ability, whereas mastery goals (also called learning goals)involve increasing existing abilities and learning new skills.9 Failure to achieve a performance goal may be interpreted as a failure ofone’s abilities, but challenges that arise as one pursues a mastery goal areviewed as a natural part of learning, and encourage problem-solving and active engagement.9 Furthermore, mastery goals are associated with improved self-efficacy(ie, one’s confidence in one’s ability to perform a specific action),performance, and knowledge.10
These findings can inform the selection of health behavior goals in at least twoways. First, performance goals should not be set in the absence of masterygoals. If one sets a performance goal to lose 10 pounds over the next 4 weeksand then failed to do so, one might interpret this as a failure and attribute itto an inherent inability to lose weight. A more appropriate approach would be tosupplement the performance goal with one (or several) mastery goals. Forexample, to facilitate the aforementioned weight loss performance goal, onemight set a mastery goal to learn to prepare nutritious meals or to learn a newrecreational activity that encourages physical activity. Second, mastery goalsmay help individuals persist in their behavior change efforts when feelingchallenged or discouraged. Because mastery goals encourage problem solving andactive engagement,9 failing to achieve a specific mastery goal may provide feedback that aparticular approach for achieving the goal was insufficient and that a differentapproach should be considered. In this way, mastery goals may promoteself-evaluation of current efforts and problem solving for future attempts.Although additional research is needed to understand performance and masterygoals within the context of health behavior change, setting mastery goals in thepursuit of a broader performance goal may be helpful for patients in theirbehavior change efforts.
Difficult Versus Easy Goals
Knowledge about goal difficulty has largely resulted from studies inorganizational psychology, which have consistently demonstrated that challenginggoals produce better results than easy goals, particularly when one is committedto the specific goal.11 In contrast, easy goals are associated with low effort and decreased performance.12 Goal commitment is influenced by many factors, including intrinsicmotivation and self-efficacy.11 Intrinsically motivated goals are inherently rewarding to the individual,and therefore an individual may be more willing to attempt an intrinsicallymotivating goal in spite of its difficulty.13 Additionally, intrinsic motivation is associated with improved learningand performance,14 which may facilitate goal achievement. Within the context of healthbehavior change, these findings suggest that a challenging goal that isintrinsically motivating to a patient may be more beneficial than an easy,effortless one.
Self-efficacy, or confidence in one’s ability to achieve a specific goal, alsoinfluences goal commitment. Setting and achieving challenging goals can enhance self-efficacy,11 but repeated failure to achieve a goal can result in diminishedself-efficacy, decreased satisfaction, and impaired futureperformance.15,16 One need only consider the phenomenon of learned nonuseafter stroke, where repeated failure to successfully perform a task using one’simpaired limb can lead to complete nonuse of the impaired limb, to understandhow very challenging goals can lead to decreased self-efficacy and subsequent performance.17
The optimal level of goal difficulty for any given individual will be influencedby goal commitment, motivation, and self-efficacy. As such, clinicians shouldencourage patients to set goals that are intrinsically motivating. Although adiscussion of assessing and harnessing motivation is beyond the scope of thisarticle, clinicians may find resources on Motivational Interviewing18,19informative.
Other Goal Characteristics
The SMART criteria are a relatively well-known set of rules for goalspecification. This acronym stands for Specific, Measurable, Achievable,Realistic, and Timed,20 and it grew out of business/organizational culture. Following thesecriteria, patients create specific goals with well-defined criteria for success.An example of a SMART goal is, “I will engage in 30 minutes of aerobic physicalactivity 5 days a week for the next 4 weeks.” Well-defined goals are necessaryfor goal attainment because they help individuals focus their desires andintentions and create a standard by which success can be measured. Furthermore,using the goal characteristics described above, a SMART goal should beintrinsically motivating, approach and mastery based, and appropriatelychallenging. A limitation of SMART goals, however, is that they do not specifyhow the goal will be implemented. In the example mentionedabove, physical activity can be achieved in various ways: walking around theblock, running on a track, going to the gym, one 30-minute bout of physicalactivity, or three 10-minute bouts of physical activity. To facilitateimplementation of SMART goals, clinicians can help patients develop actionplans.
Action Plans
Action plans specify where, when, andhow a goal will be implemented21,22 and help individuals plan thespecific actions they will take to achieve their overarching goal. Important actionplan characteristics include being conceived by the individual, shared with others,and of short duration (ie, 1 week duration and reevaluated weekly).21,23 If a SMARTgoal is considered a long-term goal, then an action plan is a short-term goal,specifying the steps by which the SMART goal will be achieved. Additionally, onemust be confident (ie, self-efficacy) in one’s ability to carry out the action plan.Often, patients are asked to rate their confidence for carrying out their actionplan on a 10-point scale. If patients rate their confidence lower than a 7, a morefeasible action plan should be selected.21 Like mastery goals, action plans—due to their short duration and frequentreevaluation—provide feedback to the individual on whether the chosen action planwas appropriate or if it needs to be modified.4,15
Action planning has been studied in primary care settings. In a proof-of-conceptstudy, Handley et al24 tested an action plan intervention in patients with coronary heart disease,which involved 375 patients and 43 physicians across 8 clinical practices. Theintervention occurred during a regularly scheduled clinical appointment. Using anAction Plan Form, physicians asked patients to identify a general goal (eg, becomemore physically active, improve food choices, reduce stress), create an action planfor accomplishing the goal, and rate their confidence for carrying out their actionplan. During a follow-up phone call 3 weeks after the action plan was made, not onlydid most patients recall making the action plan, but 53% reported making behaviorchange consistent with their action plan.24 Furthermore, the physicians involved in the study reported that the behaviorchange discussion only took an average of 7 minutes to complete; physicians alsoreported that the discussions were equally or more satisfying than previous behaviorchange discussions they had with patients.25 These results are encouraging for patients and clinicians alike because theysuggest that a brief discussion involving action planning can be implemented inclinical settings and that many patients who develop action plans are likely toimplement those plans.
Coping Plans
Closely related to action planning is coping planning, which is the process ofanticipating barriers and challenges that may interfere with action plans andmaking plans to overcome such barriers.6 Whereas action plans are designed to initiate desired actions, copingplans are designed to “shield” action plans from distraction and derailment. Ifone’s action plan is to walk around the neighborhood for 10 minutes after dinnereach evening, one can easily be derailed by bad weather. However, if one createda coping plan (eg, walk on a treadmill, turn on an exercise video, perform a10-minute exercise routine using resistance bands or weights) in advance of thebad weather, one would be less likely to be derailed from one’s overall goal ofbeing more physically active. Importantly, use of both action and coping plansfor health behavior change confers greater benefits than action plans alone.26 Thus, clinicians can assist patients in their behavior change efforts byhelping their patients create action and coping plans for carrying out specifiedgoals.
Limitations
Setting appropriate goals and creating action plans can help transform intentionsinto action, but they cannot guarantee behavior change. There is no substitute forvolitional action: Having set a goal and developed an action plan, one must act upon it.6 For this reason, the suggestions provided in this article should beconsidered when setting goals and creating action plans. Furthermore, goal settingand action planning need not be used in isolation. Many strategies for facilitatinghealth behavior change exist (eg, self-monitoring, enlisting social support, problemsolving, skills training), which can (and should) be used in conjunction with goalsetting and action planning.27
Conclusion
Health behavior change is not an easy process, but clinicians are well positioned toencourage and help patients in their behavior change efforts. Specifically,clinicians can help patients set appropriate goals and create action (and coping)plans for achieving those goals. When setting goals and creating action plans,patients need to understand that the way in which goals and plans are framedmatters: goals and action plans should be approach and mastery based, appropriatelychallenging, and intrinsically motivating. Furthermore, action plans can helpspecify the steps patients will need to implement to achieve their goal. Their1-week timeframe provides patients with immediate feedback about their efforts, thusallowing patients to “try out” different strategies for discovering what does anddoes not work, and building self-efficacy in the meantime. Goal setting and actionplanning for health behavior change need not require a significant amount of time,and although it does require effort, both clinicians and patients may benefit frommaking goal setting and action planning a priority.
Acknowledgments
Dr Bailey wrote this article while an advanced fellow in geriatrics at the Atlanta VAMedical Center.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to theresearch, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/orpublication of this article.
Ethical Approval: Ethical approval was not sought for the present study because the work does notinvolve animal or human research.
Informed Consent: Not applicable.
Trial Registration: Not applicable.
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