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PubMedDate not supplied

Neuropsychological status of alcohol-dependent patients: increased performance through goal-setting instructions.

AIMS: The effects of goal-setting instructions on neuropsychological performance of alcohol-dependent patients and control subjects were assessed. METHODS: 57 alcohol-dependent patients and 59 carefully age- and education-matched healthy control subjects underwent standard neuropsychological investigation. In addition, the goal-setting paradigm was used to systematically manipulate motivation. Participants were requested to calculate simple mathematical problems repeatedly within phases of a 2-min duration receiving normal or goal setting-instructions (to increase performance in the next phase by 20%). RESULTS: The patients demonstrated deficits in standard neuropsychological tests. Patients under goal-setting instructions demonstrated significantly higher improvement (correct responses: P = 0.016) relative to patients with standard instructions. Control subjects with goal-setting instructions demonstrated tendencies for higher improvement relative to control subjects with normal instructions. However, the differences were not significant. Interaction of group (patients vs. control subjects) and instructions (goal setting vs. normal) remained insignificant (P = 0.489) indicating that the increase through goal setting for the patients was not significantly higher than that for the control subjects. CONCLUSIONS: Despite of neuropsychological deficits in reasoning and psychomotor functioning, alcohol-dependent patients early in recovery are responsive to goal setting and able to increase neuropsychological performance. Therefore, goal-setting strategies might possibly be used in cognitive rehabilitation and therapy of alcohol-dependent patients. As there was no significant interaction in increase between patients and control subjects, our results do not support the hypothesis that the neuropsychological deficits are affected by or even caused by motivational limitations of the alcohol-dependent patients.

Adult↗

PubMed2006

Goal setting frequency and the use of behavioral strategies related to diet and physical activity.

Goal setting is an effective way to focus attention on behavior change. Theoretically, frequency of goal setting may indicate the level of commitment to diet and physical activity behavior change. Yet, little is known about the association between goal setting frequency and use of specific diet or physical activity-related strategies. This study examines whether changes in goal setting frequency predict changes in use of behavioral strategies over time, controlling for baseline strategy use, demographics and whether a person was trying to lose weight. Data are from a baseline and 1-year follow-up survey of adults in rural Iowa (n = 385). Overall, goal setting frequency was positively associated with use of the strategies measured, at baseline and overtime. Frequent goal setting that is focused specifically on diet or physical activity was more predictive of using dietary or physical activity strategies, respectively, than goal setting focused on weight loss overall. The study provides empirical support for what has been assumed theoretically, that is, frequent goal setting for weight management is an indicator of use of specific behavioral strategies. Significant challenges remain in regard to maintenance of this activity and attainment of weight loss goals.

Adult↗

PubMed2003

The use of individualized goal setting to facilitate behavior change in women with multiple sclerosis.

Setting goals is a useful strategy for changing behavior. The purpose of this study was to examine the effectiveness of a wellness intervention for women with multiple sclerosis (MS) on achieving health-related goals set individually by each participant in the experimental group (N = 57) using goal attainment scaling. The two-phase intervention included lifestyle-change classes over 8 weeks, then telephone follow-up over 3 months. Participants were followed over an 8-month period. Goal achievement was assessed at baseline, 2 months (following class), 3 1/2 months (6 weeks after class), 5 months (following 3 months of telephone follow-up), and at 8 months. The majority of the women met or exceeded all their individualized goals for changing behavior at the 6-week postclass assessment. Achievement and maintenance of individual goals remained high (59%-84%) over the 5 months after class follow-ups. These data support the positive effects of wellness interventions for helping women with MS to meet their own individualized health goals. Setting goals with incremental steps helped participants to articulate their individual goals and monitor achievement over time.

Adult↗

PubMed2000

Personal goals in social roles: divergences and convergences across roles and levels of analysis.

Most contemporary personal goal research aggregates across goals, perhaps masking important differences between goals. We assessed this risk by examining both similarities and differences between the goals that participants pursued in five important social roles. Previous relevant findings (Cantor, Norem, Niedenthal, Langston, & Brower, 1987) and self-determination theory (Deci & Ryan, 1985) were used to predict between-role differences in goal appraisal dimensions. Although theoretically meaningful differences were found across child, employee, romantic, friendship, and student goals, and also across within- and between-subject levels of analysis, all goals were essentially the same in one important way: Making longitudinal progress in them predicted positive change in accompanying role-circumstances and role-satisfaction (excepting friendship goals). This indicates that researchers do not necessarily lose information by aggregating, and affirms that goal-attainment is generally desirable.

Female↗

PubMed2002

Goal construction, reconstruction and depressive symptoms in a life-span context: the transition from school to work.

This study focused on investigating the kinds of personal goals young adults have when they are faced with the transition from school to work; the extent to which they reconstruct these goals as a consequence of their success in dealing with this transition; and how their goals influence their depressive symptoms. In order to investigate these research questions, 250 young adults who were facing a transition from school to work were studied at three points of the transition process: while they were still at school; 8 months after their graduation; and 1.5 years after it. At each measurement point, they were asked to complete the Personal Project Analysis, a revised form of Beck's Depression Inventory, and the Work Status Questionnaire. The results revealed that the outcomes of young adults' efforts to deal with the transition from school to work had consequences for the ways in which they reconstructed their goals: Those who were successful in this transition showed a decline in the number of personal goals that did not relate to the next stages of this particular developmental trajectory, whereas those who had problems turned to goals that concerned other life domains, as an alternative, compensatory control strategy. The results also revealed that the impact of personal goals on depressive symptomatology was moderated by individuals' life situations following the transition: Work-related goals reduced individuals' depressive symptoms only among those who had been able to find a job, whereas self-related goals decreased it in a moratorium-type of life situation.

Adult↗

PubMed2004

Goal setting is differentially related to change in fruit, juice, and vegetable consumption among fourth-grade children.

The impact of goal attainment in a dietary change program to increase fruit, 100% juice, and vegetable consumption was assessed among fourth-grade students. At each session, the students were given goals related to increasing fruit, juice, and vegetable consumption. Baseline consumption and postconsumption were assessed with up to 4 days of computerized dietary recalls. Analyses included regression models predicting postconsumption from the numbers of fruit-juice goals, vegetable goals, or total number of general goals attained, respectively. For students with low baseline fruit-juice preferences, attaining more fruit-juice goals resulted in increased post-fruit-juice consumption. Among those with low baseline vegetable consumption, attaining one vegetable goal was related to higher post-vegetable consumption. For boys and those with high baseline fruit, juice, and vegetable consumption, attaining three general goals was related to increased fruit, juice, and vegetable intake. The results show that goal attainment was somewhat effective in promoting dietary change among children.

Beverages↗

PubMed2004

Communication during goal-setting in physiotherapy treatment sessions.

OBJECTIVE: To analyse in detail therapists' and patients' communication practices during physiotherapy goal-setting in stroke rehabilitation settings. To deduce explanations for observed practices. To contribute to understanding of the communication challenges entailed in goal-setting. DESIGN: A conversation analytic study of video-recorded treatment sessions. SETTING: Physiotherapy 'gyms' in four UK hospitals. SUBJECTS: The 74 recorded sessions involved 21 patients (52-86 years, 11 female) and 10 senior physiotherapists. Patients' disabilities varied; none were severely aphasic. Nine of the therapists were female, postqualification experience ranged from 3 to 23 years. FINDINGS: Eight goal-setting episodes were identified. In all but one, therapists supplied the target problems or abilities for which goals were subsequently set. The case in which the patient was asked to propose problems prior to goal-setting is examined in detail. Various interactional difficulties and delays arose both in eliciting the patient's views and incorporating them into agreed goals. Strategies by which the therapist dealt with difficulties included repeated and constraining questions, negotiation, and amending proposed goals. CONCLUSIONS: Findings of this small, detailed study might help explain previous observations of infrequent goal-setting and failure to maximize patients' involvement therein. Goal-setting, particularly where patients' views are elicited and incorporated, involves skill and effort, and is influenced by powerful social constraints. Developing detailed knowledge of both practices and constraints may contribute to improving professional practice, guidance and education. The paper demonstrates the utility of detailed analysis of rehabilitation communication using conversation analytic methods.

Aged↗

PubMed2004

Goal setting as a measure of outcome in palliative care.

Setting goals and assessing outcomes are essential elements in palliative care. This paper describes a multiprofessional project, conducted under the auspices of clinical audit, which attempted to evaluate important outcomes of care. Over a six-month period there were 123 consecutive admissions to the hospice. These patients and their carers, as well as the staff, were encouraged to set explicit goals for, and evaluate outcomes of, their care. As anticipated, we encountered many difficulties in this, but there were benefits. We were able to record goals of admission from the patient in 97 cases (79%), their main carer in 74 cases (63%) and from hospice staff in 120 cases (98%). Patient and carer goals were often more functional and specific whereas the staff goals tended to be more problem or symptom focused. The achievement of these goals was evaluated by patients, carers and staff at discharge or death (where possible) with the majority being fully or partially met. Only 15 patients and 9 carers thought that some or all of their goals had not been achieved with just 4 recording that their goals had changed. Overall, it was a worthwhile (although time-consuming) exercise and, as a result of the 'audit', clear goals and outcomes from patient, carer and staff perspectives are now routinely recorded for all admissions to the hospice and are used to focus multiprofessional patient review. Having analysed the process as well as the results of the 'audit', we would encourage others not to be daunted from undertaking similar projects.

Adult↗

PubMed2005

Knowledge accessibility, achievement goals, and memory strategy maintenance.

BACKGROUND: An important aim of educational psychology is to account for the difficulties in cognitive strategy maintenance. Possible explanations may be found in developmental studies concerning the interdependence of knowledge accessibility and strategy use, and in current achievement goal models which assume that individuals with a learning goal use deeper strategies than those with a performance goal. AIMS: The purpose of this study was to examine how knowledge accessibility and achievement goals separately or conjointly affect the maintenance of a categorization strategy, recall performance, and perception of the strategy (utility, difficulty, effort) in a free recall task. SAMPLE: Participants were 93 first-year students from a human science university in France. METHOD: In the first phase, the students were taught how to use a categorization strategy in a recall task involving highly accessible (typical) items. In a subsequent transfer task, the same students were assigned to one of four experimental conditions where they were asked to recall a typical or atypical list and where a learning or performance goal was induced. RESULTS: Analysis showed that whatever the typicality of the list, a learning goal promoted maintenance of the categorization strategy, and of perception of its utility. Performance goal participants only maintained this strategy and its perceptions on typical lists, while on atypical lists they display less clustering and found the strategy less useful. CONCLUSION: Results suggest that maintenance of a cognitive strategy is facilitated when there is compatibility between a performance goal and the task demands, or when the participants are learning-goal oriented.

Achievement↗

PubMed2002

Influences of age and gender on workers' goals for retirement.

Having clear goals for retirement is a critical determinant of life satisfaction and adjustment during the post-employment transition period. The purpose of the present study was to explore individuals' goals for retirement and determine whether age and gender differences exist among those goals. A sample of 55 working adults (aged 20-67) were asked to list their retirement goals. Items contained on respondents' lists were then classified into a taxonomy of retirement goals adapted from the work of LaPierre, Bastin, and Bouffard (1997). Both age and gender differences were identified in the concreteness of individuals' goals. Additionally, the number of retirement goals individuals hold decreased across the lifespan. Results also revealed patterns of age and gender differences across the various coding categories in the goal taxonomy. Findings are discussed in terms of the applied benefits of understanding the retirement goals of American workers.

Adult↗

PubMed2004

Goal orientations of young male ice hockey players and their parents.

In this study, the researchers investigated the relationship between parent and player dispositional goal orientations associated with playing youth hockey. The authors used the Task and Ego Orientation in Sport Questionnaire (J. L. Duda & J. Whitehead, 1998) to measure task and ego orientation in 123 boys (10-13 years old) and 1 of their parents. Sons rated their own goal orientations for hockey and their perceptions of their parent's goal orientations. Parents rated their goal orientations for their son and their perceptions of their son's goal orientations. Mothers and fathers did not differ in their goal orientations for their son. Travel-team and nontravel-team players did not differ. For ego orientation, the son's self-ratings correlated significantly with the parent's goals for the son, but not for task orientation. Sons reported being significantly more ego-oriented than their parents desired. Sons perceived that their parents had goal orientations similar to their own. The data from this study are congruent with the assertion that parents socialize their children's goal orientations and that ego orientation may be more salient and easily communicated than task orientation.

Adolescent↗

PubMed2006

Goal-Directed Health Care and the chronic pain patient: a new vision of the healing encounter.

We introduce a new way to engage the patient with chronic pain, Goal-Directed Health Care (G-DHC). Identifying the patient's major life goals during the medical interview is the key element of this approach along with connecting these life goals to specific health-related goals. The implementation of G-DHC is a shift in process from the usual focus on disease-related goals such as relief of pain, titrating narcotic refills, and working on condition management to broader, long-term, personal goals. It emphasizes the importance of identifying the global life goals of patients and the reasons they wish to be well for and what they would do with improved health once they had it. Utilizing these life goals as a point of reference, discussion, and motivation makes clearer what specified health goals mean, whether or not the patient is ready to work on them, and most significantly, what the underlying motivation is to participate in their own care. We anticipate such a model of patient-centered care will shift the dynamic of the medical encounter with the patient with chronic pain to one that is ultimately more productive and satisfying for both patient and physician. Illustrations of cases, questions to ask patients, and a detail of the process may allow the reader to adopt this method into their practice.

Activities of Daily Living↗

PubMed1998

The Development and Validation of Scales Assessing Students' Achievement Goal Orientations

Achievement goal theory has emerged as a major new direction in motivational research. A distinction is made among conceptually different achievement goal orientations including the goal to develop ability (task goal orientation), the goal to demonstrate ability (ability-approach goal orientation), and the goal to avoid the demonstration of lack of ability (ability-avoid goal orientation). Scales assessing each of these goal orientations were developed over an eight year period by a group of researchers at the University of Michigan. The results of studies conducted with seven different samples of elementary and middle school students are used to describe the internal consistency, stability, and construct validity of the scales. Comparisons of these scales with those developed by Nicholls and his colleagues provide evidence of convergent validity. Confirmatory factor analysis attests to the discriminant validity of the scales. Copyright 1998 Academic Press.

Journal Article↗

PubMed2006

Baseline achievement of lipid goals and usage of lipid medications in patients with diabetes mellitus (from the Veterans Affairs Diabetes Trial).

The American Diabetes Association has established lipid goals for patients with diabetes. Although diabetic populations historically have poor low-density lipoprotein (LDL) cholesterol goal adherence, little is known about adherence to triglyceride and high-density lipoprotein (HDL) cholesterol goals. To determine the degree of lipid goal attainment among patients with diabetes, and to characterize the patterns of lipid medication use, we evaluated the baseline data from 1,742 enrollees of the national Veterans Affairs Diabetes Trial. Using current American Diabetes Association lipid guidelines, we calculated the proportion of participants achieving a LDL cholesterol level <100 mg/dl, triglyceride level <150 mg/dl, and HDL cholesterol level >40 mg/dl in men (>50 mg/dl in women). We also performed a descriptive analysis of the use of lipid medications in this population. The baseline LDL cholesterol level was 111 +/- 63 mg/dl, triglyceride level was 213 +/- 277 mg/dl, and HDL cholesterol was 36 +/- 10 mg/dl. At enrollment, 44% of veterans met the LDL cholesterol goal, 58% met the triglyceride goal, and 16% met the HDL cholesterol goal, but only 6% met all 3 goals. Of the 1,742 enrollees, 2/3 were receiving lipid therapy, with statins (58%) the most commonly used drug. Combination lipid therapy was used by 11% of enrollees. Although the enrollees of the Veterans Affairs Diabetes Trial demonstrated better adherence to the American Diabetes Association's LDL cholesterol goal than other diabetic populations recently studied, more aggressive and directed lipid medication use is needed to treat the overall lipid profile better.

Cholesterol, HDL↗

PubMed1997

Task-involvement and ego-involvement goals during actual and imagined movements: their effects on cognitions and vegetative responses.

It has been experimentally proven many times that the mental rehearsal of an activity not only improves motor performance but also has vegetative effects whose magnitude is correlated with the amount of imagined effort. These beneficial effects of mental imagery have been explained in terms of central programming structures capable of anticipating the metabolic demands of the task. Twenty-four subjects were asked to actually perform and also imagine an isometric contraction of the forearm under various goal conditions: a task-involving goal (8 subjects), an ego-involving goal (8 subjects), and no goal (8 subjects). During the contractions, electromyographic potential and heart rate were measured. Afterwards, the subjects were asked to indicate the amount of effort expended under different feedback conditions. The results showed no trace of electromyographic activity during the imagined contractions when the lack of movement was controlled using a force sensor. On the other hand, a significantly faster in heart rate was observed with a task- or ego-involving goal than with no goal, during both actual and imagined contraction. Similarly, as predicted, subjects said they applied less effort in the positive feedback condition, and more effort in the negative feedback condition with an ego-involving goal. The results are discussed in the light of goal theories, while regarding goals not only as serving to anticipate metabolic expenditures but also as promoting a self-image of competence, particularly in threatening, ego-involving situations.

Adult↗

PubMed1998

Treatment goals for panic disorder.

In light of the mounting evidence that panic disorder (PD) tends to run a chronic or recurrent course, treatment goals for PD--both specific and general--have been reviewed and a model has been developed to assess the achievement of these goals over the long-term treatment of this disorder. The role of patient education in setting treatment goals has received special attention. The Goal-Oriented Monitoring and Assessment of the Efficacy of Treatment model measures the efficacy of treatment in terms of which treatment goals have been achieved and to what extent. Success of long-term treatment of PD depends on clear formulation of realistic treatment goals; implementation of effective treatment modalities for achieving these goals; maintenance of all treatment gains; prevention of relapses, recurrences, and complications; ensuring decreased vulnerability for PD and its exacerbations; and continuity of care. The Goal-Oriented Monitoring and Assessment of the Efficacy of Treatment model was used to assess the treatment of 118 patients at a day clinic. Patients were followed up for 24 months. Most treatment goals were achieved during the initial intensive, integrative treatment, with treatment gains being successfully maintained during follow-up. The model identified often-neglected patient needs that required particular attention over the course of treatment and during follow-up.

Chronic Disease↗

PubMedDate not supplied

Relationship of oral antihyperglycemic (sulfonylurea or metformin) medication adherence and hemoglobin A1c goal attainment for HMO patients enrolled in a diabetes disease management program.

BACKGROUND: There is limited information in the primary literature regarding the relationship of medication adherence to attainment of glycosylated hemoglobin A1c (A1c) goals. The 2 oral antihyperglycemic medications, sulfonylurea and/or metformin, were chosen for retrospective analysis because they are the 2 most common oral medications used by patients with diabetes. OBJECTIVE: To describe the relationship between adherence with 1 or both of 2 oral antihyperglycemic medications (sulfonylurea and metformin) and A1c goal attainment for health maintenance organization (HMO) patients enrolled in a diabetes disease management program. METHODS: This was a retrospective, descriptive evaluation of patients enrolled in a managed care diabetes disease management program in a 188,000-member independent practice association model HMO located in the Southeast. The dataset in this analysis contained demographic, enrollment, pharmacy claims, and clinical laboratory data. Continuously enrolled patients were included if there was a documented A1c value obtained at least 90 days after the initial oral antihyperglycemic medication (sulfonylurea or metformin) prescription index date. The medication possession ratio (MPR) was calculated from the pharmacy claim records and correlated with the A1c value. RESULTS: A total of 42% of patients on sulfonylurea therapy and 46% of those on metformin reached an A1c goal of < or = 7.0%. For patients taking a sulfonylurea, the mean MPR for those who reached the predetermined A1c goal (< or = 7.0) was 0.82 (0.29) compared with 0.72 (0.31) for those patients who did not reach the A1c target goal (P < 0.001). For patients taking metformin, the mean MPR for those who reached the predetermined A1c goal was 0.77 (0.3) versus 0.62 (0.3) for those patients who did not reach the A1c target goal (P < 0.001). A Pearson correlation analysis revealed a positive relationship between the MPR and A1c for sulfonylurea (r = -0.295, P < 0.001) and for metformin (r = -0.285, P < 0.001). For those patients taking both sulfonylurea and metformin, the Pearson correlation analysis showed a positive relationship between the 2 MPRs (r = 0.65, P < 0.001). CONCLUSION: Medication adherence as measured by the MPR was higher for patients taking a sulfonylurea or metformin who reached the target A1c goal of d7.0% compared with patients taking these drugs who did not reach the target A1c goal.

Administration, Oral↗

PubMed2006

Evaluation of lipid-lowering therapy and cholesterol goal attainment in Finland: the National FINRISK Study.

BACKGROUND: European and US study findings show that patients in primary care and specialty care are not adequately treated for cholesterol reduction. OBJECTIVE: To evaluate lipid-lowering treatment in Finland, estimate the proportions of subjects who are achieving cholesterol goals, and assess the influence of determinants on goal attainment. METHODS: Subgroup analysis of the FINRISK study, a national study of cardiovascular disease risk factors in Finland. Study participants, the subgroup of patients on lipid-lowering therapy from FINRISK, completed a postal self-administered questionnaire on health/health behavioral factors. Serum total cholesterol (TC) and other clinical variables were measured using a standardized protocol. Ten-year coronary risk was computed using Framingham risk equations. The influence of certain factors on goal attainment was determined by logistic regression analysis. The main outcome measure was the proportion of subjects who were receiving lipid-lowering therapy and achieved a TC goal of <5 mmol/L (<194 mg/dL). RESULTS: Among 9581 respondents, 622 subjects were on lipid-lowering therapy. Of these, 68 subjects were excluded because of missing data on TC and/or the type/dose of therapy. Among the 554 subjects included, 210 (38%) were secondary-prevention patients and 51% had 10-year coronary risk >/=20%. Approximately two-thirds of subjects were prescribed simvastatin (42%) or atorvastatin (26%), and about half (51%) were prescribed low-equipotency HMG-CoA reductase inhibitors (statins). There was no difference in equipotent doses of statins prescribed for primary and secondary prevention. About half (54%) of subjects did not attain their cholesterol goal (TC <5.0 mmol/L [194 mg/dL]). Subjects with coronary heart disease (odds ratio [OR] 3.00; 95% CI 2.07, 4.35) and patients prescribed medium-to-high equipotent statins (OR 1.93; 95% CI 1.35, 2.76) were more likely to achieve cholesterol goals, whereas postmenopausal women (OR 0.61; 95% CI 0.42, 0.88) were less likely than men to achieve cholesterol goals. CONCLUSION: Most (92%) patients receiving lipid-lowering therapy in a Finnish population were managed on statin monotherapy and approximately half of the patients did not achieve their recommended cholesterol goals. More effective and safe therapies are needed to enhance cholesterol goal attainment. These treatments might include regimens that act on two or more pharmacologic pathways.

Aged↗