NC: Behavior Change Strategies (2007-2008)

Citation:

Shilts MK, Horowitz M, Townsend MS. Goal-setting as a strategy for dietary and physical activity behavior change: A review of the literature. Am J Health Promot. 2004 Nov-Dec; 19 (2): 81-93.

PubMed ID: 15559708
 
Study Design:
Narrative Review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

The purpose of the study was to examine goal-setting research specific to diet and physical activity among adults, adolescents and children. The primary objectives were to:

  • Determine the effectiveness of goal setting as a strategy for changing nutrition and physical activity behaviors 
  • Review the effect of goal-setting characteristics (types, components and properties) on behavior change
  • Summarize the effectiveness of interventions containing a goal setting component.
Inclusion Criteria:

This review included peer-reviewed studies of goal setting in an intervention to modify dietary or physical activity behaviors. Ages included:

  • Adults 20 years or older
  • Adolescents 12 to 19 years
  • Children under 12 years.
Exclusion Criteria:
  • Studies that evaluated goal-setting:
    • Cross-sectionally without an intervention
    • As a form of treatment for behavioral disorders
    • To improve academic treatment
    • In competitive athletics
  • Cell size less than five
  • Goal setting without an evaluation component
  • Goal-setting methodology in the treatment group without a description. 

 

 

Description of Study Protocol:

Recruitment

A literature search from January 1977 through December 2003 included

  • Current Contents
  • Biosis Previews
  • Medline
  • PubMed
  • PsycINFO
  • ERIC.

Design

  • For the review, the authors conducted a search of databases and reference lists
    • The following keywords were used: Goal, goal-setting, diet, dietary, physical activity, exercise, behavior change, interventions and fitness 
    • The search produced 1912 titles and from that, 144 papers were identified for full review
    • Twenty-eight articles were selected by using inclusion/exclusion criteria 
  • Articles were characterized by age of the target audience:
    • Adults 20 years or older
    • Adolescents 12 to 19 years
    • Children under 12 years
  • Articles were evaluated for methodological quality with a four letter rating system:
    • E = experimental design with random assignment to groups
    • S = sample size calculations reported
    • C = cell size of 30 or greater
    • G = goal-setting fully supported by the education intervention
  • Articles had three distinct research foci:
    • Goal-setting effectiveness
    • Goal-setting characteristic effectiveness
    • Goal-setting intervention evaluation
  • Each study was rated for level of goal-setting support:
    • Minimal support: Goal was set with no other support regarding feedback or goal attainment
    • Moderate support: Goal was set and some but not all aspects of goal-setting was supported (i.e., feedback, barriers and goal attainment)
    • Full support: A majority of the intervention focused on goal-setting and attainment with extensive and appropriate support provided.

Blinding Used

Not mentioned.

Intervention

  • Goal-Setting Effectiveness (13 studies):
    • An intervention with goal-setting for dietary and physical activity 
    • The participant were randomized to treatment or multiple treatments 
    • The intervention was not described
  • Goal-Setting Characteristic Effectiveness (six studies):
    • Self-set
    • Assigned
    • Participatory/collaborative
  • Components: Reward or feedback
  • Properties: Proximity, specificity, difficulty
  • Goal-Setting Intervention Evaluation (four studies):
    • Education intervention
    • Usual care  
  • Statistical:     
    • Difference between the mean.
Data Collection Summary:

Timing of Measurements

Articles from Janurary 1977 to December 2003.

Dependent Variables

  • Goal-setting effectiveness
  • Goal-setting characteristic effectiveness
  • Goal-setting intervention evaluation
  • Goal-setting support.

Independent Variables

  • Variable 1: Age
    • Adults 20 years or older
    • Adolescents 12 to 19 years
    • Children under 12 years
  • Variable 2: Research quality
    • E (experimental)
    • S (sample)
    • C (cell)
    • G (group).

Control Variables

  • Dietary behavior
  • Physical activity. 
Description of Actual Data Sample:
  • Initial N: 28 studies (13 adults, 1 adolescent, 4 children)
  • Attrition (final N): None
  • Age: 20 years or older to 12 years or younger
  • Ethnicity: Not mentioned
  • Other relevant demographics: N/A
  • Anthropometrics: N/A
  • Location: N/A.

 

Summary of Results:

Table 1.  Effectiveness of Goal-Setting (Intervention With vs. Intervention Without)

Study

Purpose

Number of Participants / Description

Group Assignment Finding

Goal-Setting Support*

Schnoll and Zimmerman

 

 

 

 

 

 

 

 

Evaluate goal setting and monitoring to enhance dietary fiber self-efficacy and consumption.

 

 

 

 

 

 

 

 

 

 

113 Students in an introductory college nutrition course.

 

 

 

 

 

 

 

 

 

Random assignment: (1) goal (N=29), (2) self-monitoring (N=29), (3) goal-setting and self-monitoring (N=29) or (4) no goal-setting or self-monitoring (N=26)

 

 

 

Subjects who set goals consumed 91% more fiber and scored 15% higher on a dietary self-efficacy scale than subjects who did not.

Full 

 

 

 

 

 

 

 

 

 

 

 

  

  

 

 

 

 

 

Mann and Sullivan

Determine the effect of goal-setting on a HTN reduction intervention.

66 Participants recruited at teaching hospital clinic.

Random assignment:(1)task-centered intervention (N=19), (2) task-centered intervention plus goal-setting and self-monitoring (N=19) or (3) no intervention control (N=18) Both intervention groups performed significantly better than the control group in achieving reduced dietary sodium intake; 83% of goals set was achieved, but no support was found for adding goal-setting and self-monitoring.

Full

Baron and Waters

Evaluate the effects of goal-setting and goal level on weight loss with restraint monitoring (not carrying out an intention to eat)

 

60 Recruited through advertisement in college newspaper.

Random assignment: (1) no goal setting (N=15), (2) low goal level (N=15), (3) moderate goal level (N=15), or (4) high goal level (N=15)

 

Goal-setting and goal level had no differential effect on weight loss. All groups lost about the same amount of weight.

Minimal

Lutz et al.

Evaluate the effects of computer-tailored nutrition newsletters to improve number and variety of fruits and vegetables.

Health maintenance organization members recruited via a mailed survey.

Random assignment: (1) computer-tailored newsletter with tailored goal-setting (N=146), (2) nontailored newsletter (N=140), (3) computer-tailored newsletter (N=136), or (4) control (N=151)

All intervention groups had higher intakes and variety scores compared with the control group. No significant differences were found among intervention groups, but a trend of improved intake and variety was found with the addition of each newsletter element (tailored or tailored + goal- setting) 

Moderate

*Minimal support. The goal was set and no futher support was provided regarding feedback or goal attainment. No goal-setting theory was mentioned as a guide to the goal-setting process.

*Moderate support. The goal was set and some but not all aspects of goal-setting are supported (i.e.. feedback, barriers and goal attainment). Goal-setting theory was used to formulate the goal.

*Full support. A majority of the intervention was focused on goal-setting and attainment, with extensive and appropriate support provided (i.e., feedback, contracting, barriers counseling, goal attainment and skills development). Goal-setting theory was used to formulate the goal and plan and develop the lessons.  

Table 2.  Goal-Setting Characteristic Effectiveness

 Study Purpose

# of Participants / Description

Group Assignment / Sample Size  Finding  Goal-Setting Support

Berry et al.

Evaluate addition of goal attainment strategies (knowledge and skills) to a goal-setting intervention to improve nutrition related behaviors. 60 Military personnel recruited at a teaching hospital. Random assignment:( (1) goal-setting + knowledge and skills (N=19), (2) goal setting only (N=13), or (3) no intervention control (N=22) Goal-setting + knowledge and skills group had significantly higher nutrition behavior scores than the control group. The goal-setting only group was not significantly different from any other groups.    Full
Mazzeo-Capulo et al. Evaluate effects of two teaching strategies on dietary change, which include participants receiving assigned goals or self-set goals. 56 College women enrolled in an introductory nutrition course.  Random assignment:(1) assigned goal-setting (N=22), (2) self-set goal-setting (N=17),or (3) no intervention control (N=17) Both intervention groups significantly decreased their intake of calories and total grams of fat and polyunsaturated fats compared with control.  Only the prescribed diet group maintained changes throughout the experiment.  Full
Zegman and Bak Evaluate proximal vs. distal goals on adherence to prescribed calorie intake  34 Military personnel recruited through base newspaper. Random assignment:  (1) proximal goal-setting (N=19), or (2) distal goal-setting (N=15) The distal goal group achieved greater weight lossess at cost of more deprivation and higher attrition.  Minimal

Table 3.  Effectiveness of Intervention with Goal-Setting (Intervention with Goal-Setting vs. Usual Care [No Goal Setting] or No Intervention)

 Study Purpose

# of Participants / Description

Group Assignment / Sample Size Findings Goal-Setting Support

Mayer et al.

 Evaluate goal-setting and counseling on health behaviors of older adults.  1800 subjects who are members of health maintenance organization were recruited.  Random assignment: (1) goal-setting and counseling intervention (N=899) or (2) usual care/control (N=901)  Intervention participants had significant increases in activity level and selected nutrition behaviors relative to control subjects.  Moderate
Burke et al. Evaluate an intervention with a goal-setting component to encourage physical activity, a healthy diet and weight control. 137 Couples living together less than two years.  Random assignment: (1) high level (half of the intervention was in person and half by mailings) (N=47 couples), or (3) usual care (N=43 couples)  Intervention participantsdecreased fat intake and increased physical activity and fitness compared with the usual care participants. Moderate
Boeckner et al. Evaluate nutrition course to reduce risk of coronary heart disease, cancer, osteoporosis, and obesity. 142 participants recruited via advertisement from seven counties in Nebraska. None - intervention group only  Participants made significant positive changes in food practices (decreased selection of high-fat cheeses, regular red meats, sodium-rich products, etc.)  Significant

Table 4 Effectiveness of Goal-Setting Characteristics (Intervention With Goal-Setting Characteristics A vs. Intervention with Goal-Setting Characteristics B or No Characteristics): Adolescent 

 Study Purpose

Number of Participants / Description

Group Assignment / Sample Size Finding Goal-Setting Support

White and Skinner

Evaluate the addition of a knowledge component to a nutrition and goal-setting intervention for high school health classes. 159 Ninth and tenth grade students in 12 classrooms from six high schools. Random assignment: (1) goal-setting intervention (N=2 schools, 51 students), (2) goal-setting + knowledge intervention (N=2 schools, 58 students), or (3) no intervention control (N=2 schools, 50 students) The addition of the knowledge component to the nutrition and goal-setting intervention did not produce significant differences compared with the goal-setting only group; 67% of the intervention participants reported improved intake of the nutrient they selected as a goal. Moderate

  

Author Conclusion:
  • Goal-setting has shown promise in promoting dietary and physical activity behavior change among adults
  • The 13 adult studies presented in the review provided a reference point from which to direct future studies
  • Some studies may have been unintentionally overlooked
  • The literature on goal-setting with adolescents and children is limited
  • No research has been conducted investigating goal-setting on dietary or physical activity behavior of youth
  • The author recommends that research employing the requisite methods be conducted to determine the effectiveness of goal-setting in the nutrition and physical activity fields, particularly with adolescents and children
  • Researchers should conduct goal-setting studies with attention paid to power calculations, fully supported goal-setting and the appropriate research focus to establish efficacy with adolescents and children.
Funding Source:
University/Hospital: California State University, University of California Davis
Reviewer Comments:
  • The author was clear in describing the review objective, data source and study inclusion and exclusion criteria
  • The data synthesis was difficult to understand
  • The author acknowledged the inconsistency of goal-setting support
  • The author attempted to reduce the confounding effect by rating each study
  • The rating system did not include any statistical calculations
  • The conclusion of the reviewed articles suggest that goal-setting may be promising
  • The author was very careful to conclude that more studies are needed, the methodology should be consistent and more research is needed in all age groups especially children, adolescents and youth. 
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? No
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes