Goal Selection and Behavioral Outcomes in Diabetes Self-Management

Background: Self-management is an integral part of optimal management of chronic diseases. Recent research has demonstrated that, when presented with the contrast between current and recommended self-management behaviors, patients with type 2 diabetes will set, and successfully achieve, goals to improve areas of deficiency. However, there is little applied health research examining the relations between self-regulatory strategies, such as goal selection, self-monitoring, and successful goal attainment.

Purpose: To document eating and exercise behavioral goal choices of participants in the My Path/Mi Camino web-based diabetes self-management program, and the relations between goal choice, baseline behaviors, baseline self-efficacy, and improvements in behaviors from baseline to 4 months.

Methods: Data are presented on goal selection characteristics, self-monitoring, and outcome results of 182 type 2 diabetes primary-care patients participating in an internet self-management program.

Results: For initial eating goals, given a choice of decreasing consumption of fast food, sugary beverages or fried food, participants chose fast food most often (41.5%) and fried food least often (22.5%). Participants did not always choose eating behavioral goals in areas most in need of improvement according to program recommendations. The 6-week physical activity goal averaged 322 minutes per week, an 11.8% increase over baseline levels. While few participant characteristics were related to 6-week eating goal choice, a number of participant characteristics were related to the 6-week exercise goal. Eating goals were more often achieved than exercise goals. Self-efficacy was related to goal selection and to the attainment of initial and 6-week eating and exercise behavioral goals.

Conclusions: Participants may need to be guided to select goals that will produce greater improvement in personal risk factors, rather than those which may be easiest to achieve. The balance of expert guidance and participant choice, and implications for goal selection and attainment are complex issues, important to study in behavioral medicine.