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Care Management

Help Patients Develop Healthy Behaviors with SMART Goals

June 4th, 2024 | 7 min. read

Kathryn Anderton, BSN, RN, BC-RN, CCM

Kathryn Anderton, BSN, RN, BC-RN, CCM

Director of Clinical Services, ThoroughCare

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Health behavior change is challenging for most individuals and can be particularly difficult for patients living with chronic health conditions or physical, mental, or social risk barriers. Care management programs and clinical teams can provide personalized and powerful support to facilitate the changes that patients seek.

Research has shown the value of goal setting in achieving health behavior changes and the benefit of focusing on particular goal characteristics and aspects of action planning. 

When goal-setting considers these characteristics, evidence points to improved goal achievement, as well as patient self-efficacy, and provider satisfaction.   

How care managers can expedite behavior change

This strategy supports improved patient behavior change by considering three characteristics that affect the type and nature of the patient’s goals. 

These characteristics make goals more appropriate, feasible, and personalized for each patient.

Help patients select the most effective goals

Identifying specific and actionable goals is crucial in supporting health behavior changes. 

Choosing which aspect of one’s health to focus on, which activities to select, and how often to participate in those activities can be overwhelming.

Plus, patients must overcome the “intention-behavior gap.” Numerous studies have shown that while intention precedes action, acting towards goals can be challenging. 

Research has demonstrated that choosing specific goal characteristics helps people set and achieve them. This is particularly powerful when developing new patterns of healthy behaviors.

Goal Characteristic: Approach vs. Avoidance

Goals that use an “approach” focus move toward desired outcomes. Avoidance goals focus on efforts to move away from undesired outcomes. 

For example, an approach goal could be, “I will walk outside or in place at home for 10 minutes each morning.” This goal is framed in the positive.

An avoidance goal could be “I won’t eat junk food for my afternoon snack.” This goal is framed in the negative. You’re avoiding something deemed “bad” versus engaging in more healthy actions.

While these goals could be viewed as similar as they relate to eating more healthily, psychological research published in the Journal of Personality and Social Psychology and the Personality and Social Psychology Bulletin found that different cognitive and emotional processes are involved and influence success. 

These studies showed that approach goals are “associated with greater positive emotions, thoughts, and self-evaluations and greater psychological well-being. In contrast, avoidance goals are associated with fewer positive thoughts and greater negative emotions.” 

Clinicians and care managers can enable more effective goals by guiding patients to create approach-oriented goals. This helps patients move toward better alternatives to poorer ones. 

Additionally, consider establishing an approach goal in contrast to an avoidance goal, or using an “If-Then” methodology. 

If the goal is to be more active and less sedentary, the approach goal would be, “Rather than watching television after dinner, I will walk around the block for 20 minutes instead.”

Goal Characteristic: Performance vs. Mastery

Psychological studies of learning have provided best practices for achieving personal goals. 

Understanding the difference between performance and mastery goals encourages a patient’s problem-solving abilities and self-efficacy. That’s because performance goals include judging and evaluating one’s ability to carry out an activity. In contrast, mastery goals involve enhancing existing abilities and learning new skills as part of building up capabilities and capacity. 

When a patient is unable to achieve a performance goal, they may interpret it as a personal failure. Mastery goals, on the other hand, honor mistakes, failures, and challenges as a natural part of learning. Also, mastery goals are associated with improved self-efficacy, which enhances a patient’s confidence in their abilities, performance, and knowledge.

Clinicians and care managers can use this information to help guide patients in selecting their health behavior goals in two ways: 

Performance goals work best when they are tied to mastery goals. If a patient sets a performance goal to lose 10 pounds over the next two months and fails to achieve that goal, they might interpret this as a failure and think they can’t lose weight. Instead, connect their performance goal with one or more mastery goals. 

For example, a weight loss performance goal could be connected with mastery goals like learning how to shop for and prepare nutritious meals, learning about intermittent fasting, or walking for weight loss. 

Mastery goals encourage problem-solving and build the capacity to persist: Learning and creating new abilities and skills helps patients grow beyond a specific performance goal. Researchers posit that this may help individuals stay motivated to behavior change efforts when they feel discouraged. 

Also, mastery goals promote self-evaluation and the realization that there is more than one way to achieve a goal. For example, if exercising more often or vigorously is too challenging, controlling food calories or macronutrients could be complementary goals toward weight loss. 

Goal Characteristic: Difficult vs. Easy

Surprisingly, research shows that people tend to produce better results when working toward more challenging goals. Easy goals, in contrast, are associated with low effort and decreased performance. 

While many factors influence a patient’s commitment to their goal, intrinsic motivation and self-efficacy are two of the most influential. Intrinsically motivated goals are innately rewarding to the patient, which can enhance their commitment to act consistently over time despite the challenges they face. A patient’s self-efficacy, or confidence, influences their goal commitment. 

Setting and achieving challenging goals is thought to enhance self-efficacy. 

However, it’s critical to strike a balance by setting goals that are challenging enough, but not unrealistic. 

Clinicians and care managers can encourage patients to set intrinsically motivating goals and use motivational interviewing to uncover and leverage how each goal connects to the patient and their view of themselves.

Maximize the value of SMART Goals

SMART goals are a standard part of care coordination and patient engagement. 

Research on the effectiveness of SMART goals in healthcare and care coordination shows the value of a patient-centric, concrete approach. When implemented with adequate follow-up and support, this approach guides patients to take committed, measurable action to improve their health and well-being.

Combining these three goal characteristics with the SMART goals methodology enables care teams to facilitate a genuinely personalized approach and prepare patients for success.

In addition to guiding patients to make their goals SMART – Specific, Measurable, Achievable, Realistic, and Time-bound – they’re also helping patients build mastery, perform better, and develop greater capacity for seeing their action plans through to fruition.

In these ways, clinicians and care managers empower patients to set meaningful, engaging, and realistic goals for health behavior change. 

ThoroughCare helps patients set SMART goals  

ThoroughCare’s comprehensive care coordination platform has embedded SMART Goal features to make goal setting, progress tracking, and follow-up easy. 

Our intuitive software platform helps providers collaborate and deliver digital care coordination and chronic care management, including:

  • Streamlining development of patient care plans 
  • Supporting staff workflows with guided, validated assessments
  • Motivating patients through clinical recommendations and SMART goals
  • Analyzing patient risk factors and generating clinical recommendations
  • Identifying behavioral health conditions
  • Monitoring key performance metrics to spot gaps in care
  • Tracking and logging services for an audit-proof record of care

Additionally, ThoroughCare supports comprehensive integration with leading EHRs, health information exchanges, remote devices, and advance care plans while helping providers visualize and interpret patient and operational data through analytics

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