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[Comments on theory development in "public health". Berlin Public Health Research Committee--partial projects "Goals and goal indicators for public health in East and West Berlin"].

Due to extensive government funding, public health research in Germany presently goes through times of revival and relative prosperity. The multiprofessionality of its background, its nearly disrupted scientific tradition in Germany, and the idiosyncrasies in their understanding of "health" among different professions impede the development of a common scientific identity. This paper underscores the importance of semantic precision and the avoidance of pretentious, overstrained theories in favour of pragmatic scientific approaches. Complementary to its action-oriented rationale, the German public health community should more than ever devote itself to health objectives and outcomes.

Berlin↗
PubMed1995

[The Lee-Carter model of the prognosis of mortality in Germany. Berlin Public Health Research Group--partial project "Goals and Goal Indicators for Public Health in East and West Berlin"].

A model for forecasting mortality developed by Lee and Carter is applied to data of West Germany. The logs of the age-specific death rates are modeled as a linear function of an unobserved mortality index using the singular value decomposition method. The forecasts are based on projections of all individual trends of the mortality rates. Applied to life expectancy at birth between 1969 and 1992 the model implies an increase of 2.2 years in life expectancy for men and 2.4 years for women in 2002.

Adolescent↗
PubMed2002

Patient-centered goals for pelvic floor dysfunction surgery: what is success, and is it achieved?

OBJECTIVE: The purpose of this study was to describe patient-identified goals for pelvic floor dysfunction surgical procedures and patient-reported achievement of those goals. STUDY DESIGN: Thirty-three consecutive patients scheduled for pelvic floor dysfunction surgical procedures completed a preoperative questionnaire on which they listed up to 5 personal goals for surgical outcomes. At 6- and 12-week follow-up, patients reported the degree (rated 1-5) to which each goal had been met (1 = strongly disagree that the goal was met; 5 = strongly agree). Age, race, vaginal parity, previous pelvic surgical procedures, pelvic floor dysfunction diagnosis, pelvic floor dysfunction surgical procedure, and perioperative complications were also recorded. Goals were categorized as being primarily related to symptom relief, increasing activity, general or other health concerns, social relationships and self-image, or physical appearance. Rates of self-reported goal achievement at 6 and 12 weeks were calculated, and differences in the proportion of goals achieved by category were assessed. RESULTS: Women reported a mean of 3.6 goals; 24 of 33 women (72.7%) listed > or = 4 goals. Of the 119 goals listed, 51 goals (42.9%) dealt with urinary or bowel symptoms; 36 goals (30.3%) dealt with improving activity; 15 goals (12.6%) dealt with general health concerns; 14 goals (11.8%) dealt with social relationships and self-image, and 3 goals (2.5%) dealt with physical appearance. Twenty-seven of the 33 women (81.8%) listed symptom relief; 22 women (66.7%) listed at least 1 activity-related goal; 14 women (42.4%) listed general or longer term health, and 11 women (33.3%) listed a social or self-image goal. Of the 119 goals listed, women agreed or strongly agreed that 88 goals (73.9%) were met at 6 weeks, and 101 goals (84.9%) were met at 12 weeks (chi(2) = 3.7 for difference between proportion at 6 and 12 weeks; P =.054). At 6 weeks, women agreed or strongly agreed that most goals had been met for activity, symptoms, general health, and appearance, but not for social/self-image goals (chi(2) = 24.9; P <.001). However, by 12 weeks, women agreed or strongly agreed that most goals had been met in all categories. CONCLUSION: Women who undergo pelvic floor dysfunction surgical procedures have a variety of desired subjective outcomes. Goals that relate to social roles, sexuality, and self-image may take longer to successfully achieve than other types of goals. Longer-term follow-up is crucial to determine whether initial improvements have been maintained. Assessment of patient goals is quick and easy and may help clinicians better understand and care for their patients.

Adult↗
PubMed2002

Assigned versus self-set goals and their impact on the performance of brain-damaged patients.

The purpose of this study was to investigate the role played by goal difficulty and goal origin (i.e., self-set vs. assigned) on the performance of patients with brain injuries in a simple arithmetic task. Eighty-seven patients with either cerebral vascular accidents or traumatic brain injuries were investigated. Patients were randomly assigned to one of three conditions: (1) one in which a specific, high goal was assigned, (2) one in which a "do your best" goal was given, and (3) one in which a personal goal has to be stated. The results indicate that both goal difficulty and goal origin had an influence on performance. Assigned difficult goals lead to better performance than assigned easy goals. Self-setting a goal did not increase performance to the same level than the assignment of a difficult goal. This lower performance increase with self-set goals can be explained by the fact that participants selected goals which were not as difficult as the assigned difficult goal. Self-set goals were attained by most of the patients and only 1 patient showed a high discrepancy between self-set goal and actual performance. These findings suggest that goal origin and goal difficulty are important moderators in the goal setting process. Furthermore, patients with brain injuries do not necessarily set unrealistic high goals.

Adult↗
PubMed2003

Life goals: the concept and its relevance to rehabilitation.

OBJECTIVE: Life goals are desired states that people seek to obtain maintain or avoid. These goals may influence motivation to participate in the rehabilitation process. The aim of this paper is to review the literature on life goals and the influence of life goals on the rehabilitation process. METHODS: The MEDLINE, EMBASE, Psychlit and CINAHL databases were searched with the keywords goals, life goals, aim of life, meaning of life, motivation, assessment (identification) of life goals, goal planning, disability, coping and rehabilitation. RESULTS: The initial search produced 917 abstracts. After going through these abstracts, 39 articles were selected for inclusion in the review. Age, gender, personality, experiences and society and environment influence life goals. Pursuit and attainment of life goals affect sense of well-being. Life goals are accessible to conscious awareness and can be identified. Several questionnaires are available for assessment of life goals. Different questionnaires assess different aspects of life goals. All except one of these questionnaires need to be tested for validity and reliability in a rehabilitation setting. Disabilities interfere with goal striving and result in emotional distress. Motivation to participate in a rehabilitation programme depends on concurrence between a patient's life goals and treatment goals. Incorporation of a subject's life goals into a management programme resulted in better outcomes in various physical and psychiatric disorders. There are no data on the efficacy of life goal-orientated rehabilitation programmes. CONCLUSIONS: Life goals influence patients' motivation to participate in and compliance with treatment programmes. We still do not know whether rehabilitation programmes focusing on life goals make any difference in outcome. There is need for further studies in this area.

Adaptation, Psychological↗
PubMed2004

Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up.

OBJECTIVE: This study was undertaken to describe long-term postoperative perceived achievement of subjective preoperative goals for pelvic floor dysfunction (PFD) surgery. STUDY DESIGN: From March 2000 through December 2001, 123 PFD surgical patients completed a preoperative open-ended questionnaire on which they described up to 5 personal outcome goals for PFD surgery. Patients were asked to review their original goals list and assess the degree to which they had met their goals on a 5-point scale (-2=strongly disagree the goal had been met to +2=strongly agree that the goal had been met) 3 months after surgery and again between 1 and 3 years after surgery. At the second follow-up, patients also completed the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) instruments to assess life impact and symptom distress, respectively. RESULTS: Of 50 women to date with long-term follow-up, 98% were white, 96% had delivered at least 1 child, 38% had previous surgery for PFD, mean weight was 74.2 +/- 14.1 kilos, and mean age was 65.4 +/- 11.5 years. Mean follow-up duration was 1.8 years, and ranged from 0.98 to 3.01 years. Of 194 goals listed by participants, 40.2% had to do with resuming previous activities or lifestyle, 38.1% with symptom relief, 9.3% with improving self-image and social relationships, 7.7% with improving general health, and 4.6% with improving physical appearance. At the individual goal level, 72% of goals were attained at short-term, and 68% attained at long-term follow-up. Long-term goal achievement did not vary significantly by category of goal. Goal achievement was lower only for symptom relief at long-term follow-up (68.9%) than at short-term follow-up (87.4%, P <.001). At the person level, 45.8% of women reported achieving all listed goals in the short term, and 42.0% in the long term. Long-term goal achievement was associated with PFD-specific quality of life (UDI-6 and IIQ-7 scores) and inversely associated with surgical complications, but was not associated with other clinical or demographic variables, including weight, parity, PFD diagnosis, psychiatric comorbidity, surgical route, or previous surgical history. CONCLUSION: Self-reported achievement of preoperatively recorded goals for PFD surgery persisted 1 to 3 years after surgery. The association of goal achievement to IIQ-7 and UDI-6 scores suggests that goal achievement is related to, but not identical to, overall measures of PFD life impact and symptom distress. Future work should examine the association of goal achievement to clinical measures of PFD severity, and compare surgically and medically managed patients. Preoperative assessment of goals may be a useful addition to clinical and subjective data in the long-term management of women with pelvic floor disorders.

Aged↗
PubMed2004

Achieving weight and activity goals among diabetes prevention program lifestyle participants.

OBJECTIVE: The Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention reduced the risk of diabetes by 58%. This paper examines demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants. RESEARCH METHODS AND PROCEDURES: Lifestyle participants (n = 1079; mean age = 50.6, BMI = 33.9, 68% female, and 46% from minority groups) had goals of 7% weight loss and 150 min/wk of physical activity. Goal achievement was assessed at the end of the 16-session core curriculum (approximately week 24) and the final intervention visit (mean = 3.2 years) as a function of demographic, psychosocial, and behavioral variables. RESULTS: Forty-nine percent met the weight loss goal and 74% met the activity goal initially, while 37% and 67%, respectively, met these goals long-term. Men and those with lower initial BMI were more likely to meet activity but not weight loss goals. Hispanic, Asian, and Native Americans were more likely to meet the long-term activity goals, and whites were more likely to meet the initial weight loss goal. In multivariate analyses, meeting the long-term weight loss goal and both activity goals increased with age, while psychosocial and depression measures were unrelated to goal achievement. Dietary self-monitoring was positively related to meeting both weight loss and activity goals, and meeting the activity goal was positively related to meeting the weight loss goal. Participants who met initial goals were 1.5 to 3.0 times more likely to meet these goals long-term. DISCUSSION: Success at meeting the weight loss and activity goals increased with age. Initial success predicted long-term success. Self-monitoring and meeting activity goals were related to achieving and sustaining weight loss.

Adult↗
PubMed2001

Academic Self-Handicapping and Achievement Goals: A Further Examination.

This study extends previous research on the relations among students' personal achievement goals, perceptions of the classroom goal structure, and reports of the use of self-handicapping strategies. Surveys, specific to the math domain, were given to 484 7th-grade students in nine middle schools. Personal performance-avoid goals positively predicted handicapping, whereas personal performance-approach goals did not. Personal task goals negatively predicted handicapping. Perceptions of a performance goal structure positively predicted handicapping, and perceptions of a task goal structure negatively predicted handicapping, independent of personal goals. Median splits used to examine multiple goal profiles revealed that students high in performance-avoid goals used handicapping more than did those low in performance-avoid goals regardless of the level of task goals. Students low in performance-avoid goals and high in task goals handicapped less than those low in both goals. Level of performance-approach goals had little effect on the relation between task goals and handicapping. Copyright 2001 Academic Press.

Journal Article↗
PubMed2006

Dysphoric adolescents' causal explanations and expectancies for approach and avoidance goals.

Relatively little research has studied emotional disturbance from a motivational perspective. The current study aimed to investigate personal goal systems at different levels of analysis, namely, personal goals, associated causal explanations and goal expectancies, as a function of dysphoria. Dysphoric (n = 28) and non-dysphoric (n = 28) adolescents (16-18-yr-olds) selected from a larger school sample completed tasks that measured number of approach goals and avoidance goals, causal explanations for goals, and perceived likelihood and control estimates for idiographic goals. As predicted dysphoric adolescents, relative to controls, generated a combination of more avoidance goals and fewer approach goals, and thought of more reasons that explain why goals would not be achieved and fewer reasons that explain why goals would be achieved (irrespective of goal type), and considered avoidance goal outcomes as more likely to occur and approach goal outcomes as less likely to occur. In addition, dysphoric adolescents anticipated less personal control in implementing their goals than controls. Overall, the data identified distinct personal goal systems that function differently in dysphoric and non-dysphoric adolescents.

Adolescent↗