Nutrition; Fitness Goal Setting as a Strategy for Dietary ... setting review pdf.pdf · Nutrition Department at the University of California, Davis. Send reprint requests to Marilyn

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November/December 2004, Vol. 19, No. 2 81

T H E S C I E N C E O F H E A L T H P R O M O T I O N

Nutrition; Fitness

Goal Setting as a Strategy for Dietaryand Physical Activity Behavior Change:A Review of the LiteratureMical Kay Shilts, PhD; Marcel Horowitz, MS, CHES; Marilyn S. Townsend, PhD, RD

Abstract

Objective. Estimate effectiveness of goal setting for nutrition and physical activity behaviorchange, review the effect of goal-setting characteristics on behavior change, and investigate effec-tiveness of interventions containing goal setting.

Data source. For this review, a literature search was conducted for the period January 1977through December 2003 that included a Current Contents, Biosis Previews, Medline, PubMed,PsycINFO, and ERIC search of databases and a reference list search. Key words were goal, goalsetting, nutrition, diet, dietary, physical activity, exercise, behavior change, interventions, andfitness.

Study inclusion and exclusion criteria. The search identified 144 studies, of which 28 metinclusion criteria for being published in a peer reviewed journal and using goal setting in anintervention to modify dietary or physical activity behaviors. Excluded from this review werethose studies that (1) evaluated goal setting cross-sectionally without an intervention; (2) usedgoal setting for behavioral disorders, to improve academic achievement, or in sports perfor-mance; (3) were reviews.

Data extraction and synthesis. The articles were categorized by target audience and second-arily by research focus. Data extracted included outcome measure, research rating, purpose,sample, sample description, assignment, findings, and goal-setting support.

Results. Thirteen of the 23 adult studies used a goal-setting effectiveness study design andeight produced positive results supporting goal setting. No adolescent or child studies used thisdesign. The results were inconclusive for the studies investigating goal-setting characteristics (n5 7). Four adult and four child intervention evaluation studies showed positive outcomes. Nostudies reported power calculations, and only 32% of the studies were rated as fully supportinggoal setting.

Conclusions. Goal setting has shown some promise in promoting dietary and physical activi-ty behavior change among adults, but methodological issues still need to be resolved. The litera-ture with adolescents and children is limited, and the authors are not aware of any publishedstudies with this audience investigating the independent effect of goal setting on dietary orphysical activity behavior. Although, goal setting is widely used with children and adolescentsin nutrition interventions, its effectiveness has yet to be reported. (Am J Health Promot 2004;19[2]:81–93.)

Key Words: Goal Setting, Review, Nutrition, Physical Activity, Prevention Research

Mical Kay Shilts, PhD, is an Assistant Professor of Nutrition and Foods/Dietetics in theFamily and Consumer Sciences Department, California State University, Sacramento, Califor-nia. Marcel Horowitz, MS, CHES, is a Staff Research Associate at the University of Califor-nia, Davis. Marilyn S. Townsend, PhD, RD, is a Cooperative Extension Specialist in theNutrition Department at the University of California, Davis.

Send reprint requests to Marilyn Townsend, Nutrition Department, 3135 Meyer Hall, One ShieldsAvenue, Davis, CA 95616-8783.

This manuscript was submitted July 17, 2003; revisions were requested January 27, 2004; the manuscript was acceptedfor publication March 9, 2004.

Copyright q 2004 by American Journal of Health Promotion, Inc.0890-1171/04/$5.00 1 0

INTRODUCTION

The rate of obesity is increasing,and a substantial body of researchlinks poor diet and physical activityhabits to obesity and many chronicdiseases.1,2 Producing sustainable die-tary and physical activity behaviorchange to influence this rate of obe-sity has proven to be a challenge.3,4

Research has shown that the mosteffective behavior change from nutri-tion education interventions occurswhen the interventions are behavior-ally focused and theory driven.3 TheSocial Cognitive Theory, widely usedfor understanding and researchingbehavior change, specifies goal set-ting as an important strategy.5 Lee,Locke, and Lantham6 define a goalas, ‘‘that which one wants to accom-plish; it concerns a valued, futureend state.’’ Although goal-setting re-search in workplace settings has beenproliferating over the past 30 years, itis only during the past decade thatnutrition educators have begun tosystematically test its effects in com-munity health promotion interven-tions. Recently, Cullen et al.7 devel-oped a four-step goal-setting process,based on Locke’s work, to help dieti-tians use goal-setting strategies in nu-trition counseling by (1) recognizinga need for change, (2) establishing agoal, (3) adopting a goal-directed ac-tivity and self-monitoring it, and (4)self-rewarding goal attainment.

Goal CharacteristicsThe extensive research conducted

in the field of industrial and organi-zational psychology on the effects of


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Table 1

Goal Properties and Components From the Industrial Psychology Literature

Description Practical Application

Goal properties

Difficulty To induce effort, a goal should be difficult yet attainable. Difficultgoals require more effort to achieve than easy goals. As goaldifficulty increases, so does the required effort and consequentlyperformance, assuming the goal is reasonable to achieve.11

Eating four servings of dairy a day could constitute adifficult but appropriate goal if the individual is cur-rently consuming two servings daily.

Specificity A specific goal provides a clear and narrow target and designatesthe type and amount of effort necessary to accomplish the goal;general goals provide little basis for regulating one’s effort.12

A specific goal would be, ‘‘Walk 1 mile during lunchthree times this week with Anne,’’ compared with thegeneral goal, ‘‘Exercise more often.’’

Proximity Goals can be set at a proximal (short-term) or distal (long-term)level. Proximal goals mobilize effort now. In contrast, distalgoals make it easy to postpone efforts.12

A proximal goal would be, ‘‘Eat five servings of fruit andvegetables today: one at breakfast, one at lunch, twoat dinner and one for snack,’’ compared with the distalgoal, ‘‘Eat more fruits and vegetables this month.’’

Goal components

Feedback Feedback can be described as knowledge of personal statusabout one’s selected goal. Feedback enhances goal achieve-ment and should be provided regularly.11,13

Having participants track their goal progress can func-tion as feedback. An educator can review participant’sgoal progress and provide individual feedback.

Rewards Rewards function as a motivator to continue goal progress. Theycan be internal (i.e., pride in accomplishment) or external (i.e.,recognition).11

For goal progress, provide participants with raffle ticketsto be drawn for prizes. For goal achievement, presentthe participant with a certificate of achievement.

goal setting on work task perfor-mance provides important back-ground for this review. The literaturehas examined three goal characteris-tics: properties, components, andtype. In 99 of 110 workplace studiesreviewed by Locke et al.,8 proximal,specific, difficult yet attainable goals re-sulted in higher task performancecompared with ‘‘no goal’’ or ‘‘easygoals.’’ In addition, adding feedbackand rewards to the goal-setting pro-cess increased motivation and taskperformance.9,10 These goal proper-ties (proximity, specificity, difficulty) andcomponents (feedback, rewards) (Table1) are vital to making goal-setting ef-fective in promoting motivation, self-efficacy, and, ultimately, behaviorchange in adults.11–14 Goal type, an-other important characteristic of goalsetting, clarifies the role of the user.Three types of goal setting have beeninvestigated extensively with adults:self-set, assigned/prescribed, and par-ticipatory/collaborative (Table 2).11,24

The research results did not provideclear evidence to suggest one goaltype is preferred, although it seemslogical that certain types might bemore appropriate than others forparticular audiences and situations.

Researchers have reported on seg-ments of a continuum for a goal-set-ting theoretical framework.5,6,11,25–28

With the use of those segments, wehave generated one continuum (Fig-ure 1). Self assessment precedes goalsetting and is followed by a commit-ment to the goal. If a person is notcommitted to (i.e., trying for) thegoal, there will be no goal effect and,consequently, no behavior change.11

According to this framework, goalfeedback and tracking focuses on ac-complishments, resulting in en-hanced self-efficacy for the goal.14 Fi-nally, goal persistence is likely to re-sult in goal attainment. In the case ofnutrition and physical activity, goalattainment is synonymous with behav-ior change.

ObjectiveGoal setting has the potential to

be an important facilitator of behav-ior change. Setting specific goals pro-vides a potential strategy for organiz-ing nutrition and physical activity in-formation and skills into practicaland manageable steps.7,14,17 However,the majority of goal-setting researchon task performance has been in theworkplace. Therefore, the main pur-

pose of this review was to examinegoal-setting research specific to dietand physical activity among adults,adolescents, and children. The pri-mary objective was to determine theeffectiveness of goal setting as a strat-egy for changing nutrition and physi-cal activity behaviors. The secondaryobjective was to review the effect ofgoal-setting characteristics (types,components, and properties) on be-havior change. The tertiary objectivewas to summarize the effectiveness ofinterventions containing a goal-set-ting component.

METHODS

Data SourcesFor this review, a literature search

was conducted for the period Janu-ary 1977 through December 2003that included a Current Contents,Biosis Previews, Medline, PubMed,PsycINFO, and ERIC search of data-bases and a reference list search.Keywords used were goal, goal setting,nutrition, diet, dietary, physical activity,exercise, behavior change, interventions,and fitness. The search produced1912 titles of papers and abstractsfrom electronic databases and refer-




Table 2

Five Proposed Goal-Setting Types, Description, Target Audience, and Examples in the Nutrition and Physical ActivityBehavior Change Literature

Type DescriptionTarget

Audience Examples in References

Self-set Goals are designed and chosen by the par-ticipant.

Adults Annesi15

Mazzeo-Caputo et al.16

Assigned/prescribed Goals are designed and chosen by thepractitioner without input from participant

Adults Schnoll and Zimmerman17

Duncan and Pozehl18

Alexy19

Lutz et al.20

Baron and Watters21

Participatory/collaborative Goals are designed and chosen jointly bypractitioner and participant.

Adults Alexy19

Schultz22

Stenstrom23

Guided* The practitioner designs multiple goal choic-es and the participant chooses one goal.

AdolescentsAdults

No studies foundNo studies found

Group-set* Goals are designed and chosen either bypractitioner or group and goal attainmentis contingent on the performance of thegroup.

Children No studies found

* Proposed by authors.

ence list searches, producing 144 pa-pers for full review. These articleswere reviewed by each author, and28 were selected by using inclusion/exclusion criteria described below.

Inclusion and Exclusion CriteriaFor this review, peer reviewed

studies of goal setting in an interven-tion to modify dietary or physical ac-tivity behaviors were included. Stud-ies that were experimental, quasi-ex-perimental, or pre-experimental wereincluded. Those studies that evaluat-ed goal setting cross-sectionally, with-out an intervention or a cell size ofless than five, were excluded. Articleswere excluded that used goal setting(1) as a form of treatment for behav-ioral disorders (i.e., eating or person-ality disorders), (2) to improve aca-demic achievement, or (3) in com-petitive athletics or sports perfor-mance. Program descriptions thatused goal-setting strategy, but includ-ed no evaluation component, wereexcluded. In addition, one article wasexcluded because the goal-settingmethodology was not defined for thetreatment group.29

Data Extraction and SynthesisGoal setting is an abstract con-

cept. Adolescence is the period when

abstract thought is developing30;thus, it is the authors’ opinion thatgoal setting might have different ef-fects at different stages of develop-ment. Therefore, the articles werecategorized by age of target audience(adult $ 20 years, adolescent 12–19years, children , 12 years).

Each article was evaluated formethodological quality with a four-letter rating system. One letter wasassigned for each of the researchqualities: experimental design withrandom assignment to groups (E),sample size calculations reported (S),cell size of 30 or greater (C), andgoal setting fully supported by theeducation intervention (G).

RESULTS

Data SynthesisThe 28 articles meeting inclusion

criteria fell into three distinct catego-ries of research foci: (1) goal-settingeffectiveness, 2) goal-setting charac-teristic effectiveness, and 3) goal-set-ting intervention evaluation (Table3).

These studies used goal setting tovarying degrees. This lack of consis-tency of goal-setting support had thepotential to confound the outcomeof our review. Consequently, each

study was rated for level of goal-set-ting support. Three levels were iden-tified and defined as follows.

Minimal Support. Goal was set and nofurther support was provided regard-ing goal feedback or goal attainment.No goal-setting theory was men-tioned as a guide to the goal-settingprocess.

Moderate Support. Goal was set andsome but not all aspects of goal set-ting were supported (i.e., feedback,barriers, and goal attainment). Goal-setting theory was used to formulatethe goal.

Full Support. A majority of the inter-vention was focused on goal settingand attainment, with extensive andappropriate support provided (i.e.,feedback, contracting, barriers coun-seling, goal attainment, and skills de-velopment). Goal-setting theory wasused to formulate the goal and planand develop the lessons.

Of the 28 studies, 23 targetedadults, 1 targeted adolescents, and 4targeted children. Table 4 presentsthe 28 studies grouped by target au-dience and secondarily by researchfocus. Authors, outcome measure,publication year, research rating, pur-




Figure 1

Proposed Theoretical Framework for the Goal-Setting Process

pose, participant description, groupassignment, findings, and goal-settingsupport are identified.

Adults

Goal-Setting Effectiveness. This focuscompared an intervention with goalsetting to the same intervention inthe absence of goal-setting strategiesand was appropriate for determiningthe effect of goal setting on dietaryor physical activity behavior change.Thirteen studies were in this catego-ry.15,17–23,31–34,35

The first eight studies support theeffectiveness of goal setting amongadults (Table 4).15,17–19,22,23,31,32 Sixstudies focused on physical activi-ty15,18,22,23,31,32 and two on nutri-tion.17,19 Seven of the eight studiesrandomly assigned participants tocondition (i.e., treatment and controlor multiple treatments).15,17–19,22,23,32

Sample sizes of groups varied from 6participants18 to 93 participants.31 Werated four of the eight studies as‘‘fully’’ supporting goal set-ting.15,17,18,22

The remaining five studies withthis focus did not produce resultsthat supported the use of goal set-ting.20,21,33–35 Three focused on nutri-tion20,21,33 and two on physical activi-ty.34,35 The five studies randomizedparticipants to condition. Sample siz-es varied from 15 participants21 to151 participants.20 We described onestudy as ‘‘fully’’ supporting goal set-ting.33

Goal-Setting Characteristic Effectiveness.The second category included six

studies that examined the effective-ness of goal-setting characteristics(i.e., types [self-set, assigned, participato-ry/collaborative],16 components [re-wards or feedback],36 or properties[proximity, specificity, difficulty])9,12,37,38

on dietary activity, physical activity, orboth behavior changes. Of the sixstudies, one focused on physical ac-tivity.37 All six studies randomizedparticipants to groups, and samplesize of groups ranged from 7 partici-pants37 to 22 participants.36 Two stud-ies were rated as ‘‘fully’’ supportinggoal setting.16,36

‘‘Assigned’’ goal setting was foundto be more effective than ‘‘self-set’’goals at maintaining the measuredoutcomes.16 The addition of goal at-tainment strategies (knowledge andskills) to a nutrition intervention didnot enhance the goal-setting out-come.36 Four studies compared theuse of proximal vs. distal goals. Onestudy found that distal goals facilitat-ed greater weight loss compared withproximal goals but had a higher at-trition rate.9 The remaining threestudies found no difference on mea-sured outcomes from proximal ordistal goals.12,37,38 However, the resultsof one study might have been con-founded because half of the subjectsin the distal goal group self-set proxi-mal goals.12

Goal-Setting Intervention Evaluation.The third category included fourstudies that examined the effect ofan education intervention focusedon goal setting compared to a ‘‘usualcare or no intervention’’ control.39–42

Studies that used this focus cannotdetermine whether behavior changesare due to goal setting. Instead, theycan determine whether interventionswith goal setting are effective at facil-itating a desired behavior change.

These interventions produced pos-itive outcomes. Two studies evaluatednutrition interventions,39,42 and twoevaluated nutrition and physical ac-tivity interventions.40,41 Three studiesrandomized participants to condi-tion.39–41 Sample size of groupsranged from 94 participants39 to 901participants.40 We rated no interven-tions as ‘‘fully’’ supporting goal set-ting.

Adolescents and Children

Adolescents 12–19 Years. One study in-vestigated the effect of a goal charac-teristic with an adolescent audience(Table 4).43 The study randomizedsix high schools to condition. Samplesize of groups ranged from 50 to 58participants. Incorporation of a gen-eral knowledge component to nutri-tion education intervention with goalsetting did not generate additionalbehavior gains. Participants who setgoals improved nutrient intake; how-ever, the nutrient data for treatmentparticipants were not compared withthe data for the ‘‘no intervention’’control group.43

Children Younger Than 12 Years. Fourstudies that used goal setting withchildren have been reported (Table4).44–47 The four studies evaluatedthe effectiveness of an interventionwith goal setting but did not investi-




Table 3

Three Research Foci Used in Goal-Setting Studies in the Nutrition and Physical Activity Behavior Change Literature

Study Focus Research Focus Outcome Measure Adult Studies Adolescent Studies Child Studies

Goal-setting effec-tiveness

Intervention withgoal-setting vs.intervention with-out goal setting

Effectiveness of goal-setting on physical ac-tivity and/or dietarybehavior change.

Annesi15,31

Schnoll and Zimerman17

Duncan and Pozehl18

Alexy19

Lutz et al.20

Baron and Watters21

Schultz22

Stenstrom23

Bandura and Cervone32

Mann and Sullivan33

McKay et al.34

Cobb et al.35

No studies found No studies found

Goal-setting char-acteristic effec-tiveness

Intervention withgoal-setting char-acteristic A vs. in-tervention withgoal-setting char-acteristic B or nocharacteristic

Effectiveness of goal-setting characteristicssuch as (1) types(self-set, assigned,participatory), (2) com-ponents (feedback, re-wards) or (3) proper-ties (proximity,specificity, difficulty)on dietary and/orphysical activity be-havior change.

Zegman and Baker9

Bandura and Simon12

Mazzeo-Caputo et al.16

Berry et al.36

Martin et al.37

Dubbert and Wilson38

White and Skinner43 No studies found

Goal-setting inter-vention evalua-tion

Intervention withgoal setting vs.usual care (nogoal setting) orno intervention

Effectiveness of an inter-vention with goal set-ting on dietary and/orphysical activity be-havior change.

Glasgow et al.39

Mayer et al.40

Burke et al.41

Boeckner et al.42

No studies found Sallis et al.44

Howison et al.45

Coates et al.46

Ma and Contento47

gate the independent effect of goalsetting. The four interventions wereschool-based and conducted withfourth and fifth graders. One studywas conducted in Taiwan.47 Two stud-ies randomized classrooms or schoolsto condition,44,47 and the remainingtwo studies did not have a compari-son group.45,46 Sample size of groupsranged from 161 participants nestedin two schools46 to 955 participantsnested in seven schools.44 Each studyreported improved outcomes on thebasis of the interventions. We ratedtwo of the four studies as ‘‘fully’’ sup-porting goal setting.44,46

Randomization and Sample Size Consid-erations. For the five adolescent andchild goal-setting studies in this re-view, randomization was conducted atthe school or classroom level, where-as unit of analysis was the partici-pant. However, data were analyzed

with classroom nested within treat-ment. As a result, the denominatordegrees of freedom were based onthe number of classrooms, not thenumber of participants, and the actu-al denominator itself reflects the be-tween-classroom variability, not thebetween-student variability.

Constraints of school-based inter-vention studies often necessitate ran-domization at the school or class-room level because of the difficultyof randomization by participant in aschool setting. Randomization byclassroom makes it difficult to ac-count for differences between groupswithout the use of a large number ofparticipating classrooms. If this typeof design is used, we advise, first, thatsample size calculations definitelytake the design into account andshould involve calculating the num-ber of classrooms needed, as well asthe number of students needed in

each classroom. Second, emphasisshould be placed on additional class-rooms instead of additional studentsto account for between-classroom var-iation.

DISCUSSION

The primary objective of this re-view was to determine the effective-ness of goal setting as a strategy forchanging dietary and physical activitybehaviors. Of the 28 studies meetinginclusion criteria, only 13 investigat-ed the effectiveness of goal setting,and these 13 studies targeted adults.No goal-setting effectiveness studieshave been reported with adolescentand child audiences.

Goal Setting Studies With Adults

Goal-Setting Effectiveness. Eight of 13studies, with an appropriate research




Table 4

Dietary and Physical Activity Goal-Setting Studies With Adults, Adolescents, and Children, 1977 to 2003

TargetAudience

Research Focus/Outcome Measure

Study/Research Rating* Purpose

Number ofParticipants and

DescriptionGroup Assignment/

Sample Size FindingsGoal-Setting

Support

Adult Effectiveness ofgoal setting (In-tervention withgoal setting vs.intervention with-out goal setting)

Schnoll and Zim-merman17

E, G

Evaluate goal settingand self-monitoring toenhance dietary fiberself-efficacy and con-sumption.

113 Students in anintroductory col-lege nutritioncourse.

Random assignment: (1)goal setting (n 5 29),(2) self-monitoring (n5 29), (3) goal settingand self-monitoring (n5 29), or (4) no goalsetting or self-monitor-ing (n 5 26)

Subjects who setgoals consumed91% more fiberand scored 15%higher on a die-tary self-efficacyscale than sub-jects who did not.

Full

Annesi15

E, C, G

Evaluate effect of agoal-setting protocolon exercise mainte-nance.

100 Members ofan Italian fitnessclub, age 20–60.

Random assignment: (1)goal setting (n 5 50)or (2) no goal settingcontrol (n 5 50)

The goal-settinggroup had signifi-cantly less drop-out and signifi-cantly betterexercise atten-dance comparedwith the controlgroup.

Full

Duncan and Po-zehl18

E, G

Investigate a goal-set-ting intervention tosupport exercise ad-herence.

13 Patients withheart failure in aclinic setting.

Random assignment: (1)exercise with goalsetting (n 5 7) or (2)exercise only (n 5 6)

The exercise inter-vention with goal-setting groupdemonstratedhigher exerciseadherence andgreater confidenceto continue exer-cising in the fu-ture.

Full

Shultz22

E, G

Determine the differencebetween an educa-tional intervention andan educational inter-vention plus goal-set-ting strategies onknowledge of andparticipation in an ex-ercise program.

54 Participantswere recruitedfrom a primarilyoutpatient diag-nostic centershowing no evi-dence of cardio-vascular dis-ease.

Random assignment: (1)exercise strategies in-tervention (n 5 26) or(2) exercise strategiesintervention plus goal-setting strategies(goal setting, self-monitoring, rewarding)(n 5 28)

The exercise strate-gies plus goal set-ting was more ef-fective thaneducational strate-gies alone in im-proving exercisefrequency at 6weeks, but no dif-ference was foundat 12 weeks.

Both interventionssignificantly im-proved exerciseknowledge, fre-quency, and dura-tion.

Full

Alexy19

E, C

Determine the effect ofgoal setting and goaltype in a health riskreduction intervention.

152 Participantsrecruited fromthree industrialor corporate set-tings.

Random assignment: (1)participatory goal set-ting (n 5 54), (2) as-signed goal setting (n5 52), or (3) no goal-setting control (n 5

46)

Both types of goalsetting were supe-rior to the no-goalsetting group, yetgoal type did notinfluence goalachievement. Inselected subsam-ples, assignedgoals producedhigher programsuccess.

Minimal




Table 4, continued

TargetAudience






Support

Adult Bandura and Cer-vone32

E

Investigate the effect ofgoal setting and feed-back on exercise per-formance motivation.

90 Subjects weredrawn from anintroductory psy-chology course.

Random assignment: (1)goals with feedback(n 5 20), (2) goalsalone (n 5 20), (3)feedback alone (n 5

20), (4) neither goalsnor feedback control(n 5 20), or (5) self-judgment control (n 5

10)

The goal-setting andgoal-setting withfeedback groupshad significant im-provement in ex-ercise self-efficacyand performancecompared with thegroups withoutgoal setting.

Minimal

Stenstrom23

E

Evaluate effect of add-ing a goal-settingcomponent to homeexercise program.

42 Rheumatoid ar-thritis patientsfrom Swedishmedical facility.

Random assignment: (1)goal setting (n 5 22)or (2) pain attention(n 5 20)

The goal-settinggroup had signifi-cantly larger de-creases in painrating and in-creases in exer-cise load.

Minimal

Annesi31

C

Test the effects of acomputer feedbackand goal-setting sys-tem on exercise be-havior.

164 Participantswere new mem-bers of a privatefitness center.

Convenience assign-ment: (1) computer-based system withenhanced tracking,goal setting, andfeedback (n 5 93) or(2) standard exercisetracking and feedback(n 5 71)

The computer feed-back/goal-settinggroup had higherattendance, longeradherence, andlower dropoutrates comparedwith the standardfeedback group.

Moderate

McKay et al.34

E, C

Evaluate the effect of anInternet-based inter-vention with goal-set-ting strategies onphysical activity lev-els.

78 Sedentaryadults with type-2 diabetes re-cruited via diabe-tes-specific Websites.

Random assignment: (1)intervention (n 5 38)or (2) information-onlycontrol (n 5 40)

Increased physicalactivity levelswere observed inboth groups, butno significant dif-ferences werefound betweengroups.

Moderate

Cobb et al.35

E, S

Determine the effect ofgoal setting on exer-cise adherence.

104 Students in acommunity col-lege fitness pro-gram.

Random assignment: (1)goal setting (n 5 28),(2) health and fitnessreading (n 5 33), or(3) control (n 5 43)

No significant differ-ences among thethree groups inexercise adher-ence.

Moderate

Mann and Sulli-van33

E, G

Determine the effect ofgoal setting on a hy-pertension reductionintervention.

66 Participants re-cruited at ateaching hospitalclinic.

Random assignment: (1)task-centered inter-vention (n 5 19), (2)task-centered inter-vention plus goal set-ting and self-monitor-ing (n 5 19), or (3)no intervention control(n 5 18)

Both interventiongroups performedsignificantly betterthan the controlgroup in achievingreduced dietarysodium intake;83% of goals setwas achieved, butno support wasfound for addinggoal setting andself-monitoring.

Full




Table 4, continued

TargetAudience






Support

Adult Baron and Wat-ters21

E

Evaluate the effects ofgoal setting and goallevel on weight losswith restraint monitor-ing (not carrying outan intention to eat).

60 Recruitedthrough adver-tisement in col-lege newspaper.

Random assignment: (1)no goal setting (n 5

15), (2) low goal level(n 5 15), (3) moder-ate goal level (n 5

15), or (4) high goallevel (n 5 15)

Goal setting andgoal level had nodifferential effecton weight loss. Allgroups lost aboutthe same amountof weight.

Minimal

Lutz et al.20

E, C

Evaluate the effects ofcomputer-tailored nu-trition newsletters toimprove number andvariety of fruits andvegetables.

Health mainte-nance organiza-tion members re-cruited via amailed survey.

Random assignment: (1)computer-tailorednewsletter with tai-lored goal setting (n5 146), (2) nontai-lored newsletter (n 5

140), (3) computer-tai-lored newsletter (n 5

136), or (4) control (n5 151)

All interventiongroups had higherintake and varietyscores comparedwith the controlgroup. No signifi-cant differenceswere found amonginterventiongroups, but atrend of improvedintake and varietywas found with theaddition of eachnewsletter element(tailored or tailored1 goal setting).

Moderate

Effectiveness of agoal-settingcharacteristic (In-tervention withgoal-settingcharacteristic Avs. interventionwith goal-settingcharacteristic Bor no character-istic)

Bandura and Si-mon12

E

Investigate the effect ofgoal setting on weightloss and the effect ofproximal vs. distalgoal setting on weightloss.

66 Self-selected in-dividuals wererecruited throughan advertisementin a communitynewspaper.

Random assignment: (1)distal self-monitoring(n 5 13), (2) proximalself-monitoring (n 5

13), (3) distal goalsetting (n 5 13), (4)proximal goal setting(n 5 13), or (5) no in-tervention control (n5 13)

Goal setting en-hanced reductionin weight loss. Nodifferences be-tween the distaland proximalgoal-settinggroups were de-tected.

Minimal

Dubbert and Wil-son38

E

Evaluate proximal (dai-ly) vs. distal (weekly)goal setting and lev-els of couple involve-ment in a weight lossprogram.

47 Overweightmarried coupleswere recruitedthrough newspa-per and radioadvertisements.

Random assignment: (1)distal goals/couples (n5 12), (2) proximalgoals/couples (n 5

12), (3) distal goals/individual (n 5 12), or(4) proximal goals/in-dividual (n 5 12)

All participants lostsignificant amountsof weight (17 lbs),but weight lossesfor the two goal-setting conditionsand two spousetreatments did notdiffer.

Moderate

Berry et al.36

E, G

Evaluate addition ofgoal attainment strate-gies (knowledge andskills) to a goal-set-ting intervention to im-prove nutrition-relatedbehaviors.

60 Military person-nel recruited at ateaching hospi-tal.

Random assignment: (1)goal setting 1 knowl-edge and skills (n 5

19), (2) goal settingonly (n 5 13), or (3)no intervention control(n 5 22)

Goal setting 1

knowledge andskills group hadsignificantly highernutrition behaviorscores than thecontrol group. Thegoal setting–onlygroup was notsignificantly differ-ent from the othergroups.

Full




Table 4, continued

TargetAudience






Support

Adult Mazzeo-Caputo etal.16

E, G

Evaluate effects of twoteaching strategies ondietary change, whichincluded participantsreceiving assignedgoals or self-setgoals.

56 College womenenrolled in an in-troductory nutri-tion course.

Random assignment: (1)assigned goal setting(n 5 22), (2) self-setgoal setting (n 5 17),or (3) no interventioncontrol (n 5 17)

Both interventiongroups significant-ly decreased theirintake of caloriesand total grams offat and polyunsat-urated fats com-pared with control.Only the pre-scribed diet groupmaintained chang-es throughout theexperiment.

Full

Zegman and Bak-er9

E

Evaluate proximal vs.distal goals on adher-ence to prescribedcalorie intake.

34 Military person-nel recruitedthrough basenewspaper.

Random assignment: (1)proximal goal setting(n 5 19), or (2) distalgoal setting (n 5 15)

The distal goal groupachieved greaterweight losses atcost of more depri-vation and higherattrition.

Minimal

Martin et al.37

E

Evaluate effect of distalvs. proximal goal-set-ting strategies on ex-ercise adherence.

34 Sedentaryadults enrolled ina free exercisecourse at a com-munity college.

Random assignment: (1)proximal goal setting,1-week intervals or(2) distal goal setting,5-week intervals

Proximal goal partici-pants had meanclass attendance of71%, and distalgoal participantshad a mean classattendance of 83%.The difference wasnot statistically sig-nificant (p 5 0.07).

Moderate

Effectiveness of in-tervention withgoal setting (In-tervention withgoal setting vs.usual care [nogoal setting] orno intervention)

Mayer et al.40

E, C

Evaluate goal settingand counseling onhealth behaviors ofolder adults.

1800 Subjects whoare members ofhealth mainte-nance organiza-tions were re-cruited.

Random assignment: (1)goal setting and coun-seling intervention (n5 899) or (2) usualcare/control (n 5 901)

Intervention partici-pants had signifi-cant increases inactivity level andselected nutritionbehaviors relativeto control sub-jects.

Moderate

Burke et al.41

E, C

Evaluate an interventionwith a goal-settingcomponent to encour-age physical activity,a healthy diet, andweight control.

137 Couples livingtogether lessthan 2 years.

Random assignment: (1)high level (half of theintervention was inperson and half bymailings) (n 5 47couples), (2) low level(intervention primarilyby mailings) (n 5 47couples), or (3) usualcare (n 5 43 couples)

Intervention partici-pants decreasedfat intake and in-creased physicalactivity and fitnesscompared with theusual care partici-pants.

Moderate

Boeckner et al.42

C

Evaluate nutritioncourse to reduce riskof coronary heart dis-ease, cancer, osteo-porosis, and obesity.

142 Participantsrecruited via ad-vertisement fromseven countiesin Nebraska.

None—interventiongroup only

Participants madesignificant positivechanges in foodpractices (de-creased selectionof high-fat chees-es, regular redmeats, sodium-richproducts, etc.).

Moderate




Table 4, continued

TargetAudience






Support

Adolescent Effectiveness of agoal-settingcharacteristic (In-tervention withgoal-settingcharacteristic Avs. interventionwith goal-settingcharacteristic Bor no character-istic)

White and Skin-ner43

E, C

Evaluate the addition ofa knowledge compo-nent to a nutrition andgoal-setting interven-tion for high schoolhealth classes.

159 Ninth- andtenth-grade stu-dents in 12classrooms fromsix high schools.

Random assignment: (1)goal-setting interven-tion (n 5 2 schools,51 students), (2) goalsetting 1 knowledgeintervention (n 5 2schools, 58 students),or (3) no interventioncontrol (n 5 2schools, 50 students)

The addition of theknowledge compo-nent to the nutri-tion and goal-set-ting interventiondid not producesignificant differ-ences comparedwith the goal set-ting–only group;67% of interven-tion participantsreported improvedintake of the nutri-ent they selectedas a goal.

Moderate

Children Effectiveness of in-tervention withgoal setting (In-tervention withgoal setting vs.usual care [nogoal setting] orno intervention)

Coates et al.46

C, G

Evaluate effectivenessof a school-based in-tervention with SocialLearning Theory inchanging eating andexercise habits.

161 Fourth- andfifth-grade stu-dents from twoschools.


Compared with pre-test, studentsmade significanteating behaviorand knowledgechanges. Chang-es in exercisewere minimal.

Full

Howison et al.45

C

Develop and evaluate anutrition educationprogram focusing onfood selection behav-ior and nutritionknowledge.

934 Fifth-gradestudents in 37classrooms.


Students significant-ly increased nutri-tion knowledgescores and num-ber of daily serv-ings in each ofthe four foodgroups.

Moderate

Sallis et al.44

E, C, G

Evaluate effect of physi-cal education programon physical activityduring school andoutside of school.

955 Fourth- andfifth-grade stu-dents from sev-en schools.

Seven schools werestratified by ethnicityand randomly as-signed to: (1) PE spe-cialist–implementedintervention, (2)trained teacher inter-vention, or (3) usualcare control

Students in bothtreatment groupsspent more timebeing physicallyactive in schoolcompared with thecontrol group. Thebehaviorally fo-cused (goal set-ting) aspect of theintervention hadno effect on out-side activity.

Full

Ma and Conento47

E, C

Develop and evaluate anutrition educationcurriculum for Taiwa-nese children in anafter-school setting.

262 Fifth-gradestudents in eightclassrooms.

Two schools randomlyselected from 78schools in low-incomedistricts. Four classesrandomly selectedfrom the two schools.Classes randomly as-signed to: (1) interven-tion group (n 5 4classrooms) or (2) nointervention controlgroup (n 5 4 class-rooms)

Intervention groupscored higher forknowledge, atti-tudes and skills.No differences be-tween groupswere found forfood choice inten-tions and intake oflow-fat foods.

Moderate

* Methodological quality rating: E, experimental design with random assignment to groups; S, sample size calculations reported; C, cell size .30;and G, goal setting fully supported by study.




focus to investigate the effect of goalsetting, showed goal setting had a sta-tistically significant positive effect oneither dietary or physical activity be-haviors.15,17–19,22,23,31,32 A possible lackof statistical power might contributeto the inconsistent findings. No stud-ies reported power calculations, limit-ing our interpretation of results. Oneauthor mentioned sample size with-out providing relevant details to de-termine power calculations.22 Lack ofreported power calculations for iden-tification of adequate sample size wasa weakness of all 28 studies in this re-view.

Goal-Setting Characteristic Effectiveness.An examination of goal type foundthat assigned goal setting was themost common type of goal settingused among the adult stud-ies.17,18,20,21,38 Participatory or collabo-rative goal setting was used in threestudies,22,23,33 and self-set goal settingwas used in four studies.15,16,34,35 Goaltype could not be determined in onestudy.41 Only two studies comparedthe effect of different goal types ongoal attainment.16,19 On the basis ofthe results of these studies, a singletype of goal setting cannot be deter-mined as superior. It is the authors’belief that many factors (age, readi-ness to change, type of behavior be-ing targeted, respect for the educa-tor) can influence appropriateness ofgoal type. Further research is war-ranted to determine which type is su-perior for a particular audience.

Compared with distal goals, proxi-mal goals might be assumed to bemore effective at promoting behaviorchange. They are considered to bemore tangible and more difficult topostpone with more immediate re-wards from goal accomplishment.However, the four studies in the die-tary and physical activity fields pro-duced inconclusive results.9,12,37,38

Goal-Setting Intervention Evaluation. Ofthe four intervention evaluation stud-ies with adults, all showed positive ef-fects on dietary, physical, or both ac-tivity behaviors attributable to the in-tervention, although none were ratedas fully supporting goal setting.39–42 Itappears that interventions with goalsetting can facilitate dietary and

physical activity behavior change withadults.

Expanded Discussion of Sample Size. Ofthe 23 adult studies reviewed, nonepresented any information aboutsample size determination. There-fore, it is impossible to know whetherthe reason for no difference betweengroups was because of the lack of sta-tistical power or whether there trulywas no difference between groups.For example, Mann and Sullivan,33

using a research design appropriatefor testing goal-setting effectiveness,conducted a study that appeared tospend adequate time on goal-settingactivities. No statistically significantresults were found between the twogroups, although results showed apositive trend. The lack of statisticallysignificant findings was possibly a re-sult of small cell size (,20). Threeadditional studies had small cell sizes(n 5 13–26), and all had minimaldetection of significant differencesbetween groups.12,21,23 Attentionshould be given to the inclusion ofsample size calculations and the useof appropriate sample sizes in goal-setting research.

Goal-Setting Support. We evaluatedeach study for level of goal-settingsupport. Looking specifically at thestudies that used the goal-setting ef-fectiveness focus (n 5 13), five adultstudies were rated as having full goal-setting support. Four of the five stud-ies showed a significant goal-settingeffect.15,17,18,22 The study that did notmight have had a statistical powerproblem with a cell size of 19.33

Three of the four studies with amoderate level of support did notshow significant goal-setting ef-fects,20,34,35 whereas one did.31

In one of the studies providingfull goal-setting support, Schnoll andZimmerman17 found a strong goal-setting effect on dietary behaviors.The goal-setting procedures usedwere (1) self assessment at the begin-ning of the goal-setting process, (2)the use of proximal goals, and (3)frequent goal progress tracking. Inaddition to providing full goal-settingsupport, this study had a robust sam-ple size. Few studies, such as this ex-ample, support the effectiveness of

goal setting to promote dietary andphysical activity behavior change inadults. Maximizing the ability to ob-serve a positive goal-setting effect in-cludes designing a study with the fol-lowing components: goal-setting ef-fectiveness research focus, fully sup-ported goal setting, ample samplesize supported by power calculation,and use of goal-setting theory to de-sign goal-setting support.

Goal Setting Studies WithAdolescents (12–19 Years)

We found only one study withhigh school adolescents meeting ourcriteria for this review.43 We foundno studies with middle school adoles-cents. The research focus did not al-low for testing the differential effectof goal setting on behavior change.However, an important contributionof this study was the new knowledgethat high school adolescents wereable to set a dietary goal and makeprogress toward achieving it. Theparticipating adolescents made desir-able dietary changes on the basis oftheir personal goals.

O’Hearn and Gatz48 investigatedthe effect of a primary preventionprogram promoting positive mentalhealth with the use of goal settingamong middle school adolescents. Al-though not exclusively investigatingthe effect of goal setting on nutritionand physical activity behaviors, thisstudy found that middle school stu-dents could learn some goal-settingskills, set a goal, and make progresstoward achieving this goal.48 Al-though the students showed signifi-cant increases in goal-setting knowl-edge, O’Hearn and Gatz48 expressedthat the students did not master asubstantial amount of the programcontent. We conclude that age-appro-priate goal-setting methodological re-search is needed.

Youths 12 to 14 years old are be-ginning to understand abstract con-cepts, relate to nutrition concepts,and understand causality (e.g., what Ieat affects my health, growth, weight,etc.).49 They are moving from theconcrete operational stage of cogni-tive development, thinking logicallyabout concrete objects and places, tothe formal operational stage with log-ical thought about abstractions.50




Goal setting is an abstract concept. Ifyouth 12 to 14 years of age have notdeveloped the ability to think logical-ly about abstractions, attempting tochange dietary and physical activitybehaviors through self-set goalswould theoretically be futile.

The question of youth aged 12 to14 years having the ability to under-stand and apply goals arises is impor-tant. Instead of expecting theseyouth to develop and set their owngoals, the authors of this review haveproposed ‘‘guided goal setting’’ as anew goal type (Table 2). Guided goalsetting encourages youth to choosefrom a variety of structured goals de-veloped by the practitioner, thusmaintaining the adolescent’s autono-my.51,52 This menu approach to goalsetting eliminates the possibility ofinappropriate goals (i.e., goals thatare unattainable, distal, or too gener-al) yet ensures that the goal choicesare attainable, proximal, specific, anddifficult. We recommend that thistype of goal setting be studied for ap-propriateness and effectiveness withyouth aged 12 to 14 years.

Goal Setting Studies With Children(,12 Years)

No studies investigating the inde-pendent effect of goal setting withthis age group were identified in ourliterature search. However, four inter-ventions with goal setting have beenevaluated. At the same time, we havenoticed that many nutrition andphysical activity programs targetingchildren have incorporated goal set-ting into their content as a behaviorchange strategy. If goal setting is tobe used with children, we recom-mend that it be used with prudenceuntil research is conducted to deter-mine its effectiveness and appropri-ateness. We propose the use of anage-appropriate type of goal setting—classroom-level or group-level insteadof individual-level goal setting (Table2). With this method, children agreeon one goal for the group as op-posed to having each student set apersonal goal. The educator guidesthe group in setting an appropriategoal, and the class works towardachieving the group goal. We recom-mend this group-set method of goalsetting for children under 12 years of

age because formulating a goal re-quires complex skills these childrenpossibly have yet to master. However,it is most important to reiterate thatno evaluation on types of goal settingwith children have been reported inthe literature on dietary and physicalactivity behavior change.

Limitations of the StudyAlthough the authors used a sys-

tematic framework to evaluate eachstudy, this review is both qualitativeand quantitative, and findings mustbe interpreted with this in mind.Also, despite a thorough attempt toinclude every study meeting inclu-sion criteria, some studies might havebeen unintentionally overlooked. Fi-nally, judgments were made on thebasis of what was reported in the arti-cles reviewed, not necessarily what ac-tually occurred.

SO WHAT? Implications forHealth Promotion Practitionersand Researchers

On the basis of these findings,moderate evidence indicates thatimplementing goal setting as a di-etary or physical activity behaviorchange strategy is effective withadults, and those studies that fullysupported goal setting were morelikely to produce positive results.No studies investigated the effectof goal setting among adolescentsand children. On the basis ofthese findings, practitionersshould apply goal-setting strategiesfully when promoting dietary andphysical activity behavior changewith adults. In addition, thesefindings suggest that researchersshould conduct experimental stud-ies with attention paid to powercalculations, fully supported goalsetting, and the appropriate re-search focus to establish efficacywith adolescents and children.Goal-setting methodologies, whichmight vary by age of target audi-ence and the intervention setting,need to be studied for all agegroups.

CONCLUSION

We conclude that goal setting hasshown promise in promoting dietary

and physical activity behavior changeamong adults. The 13 adult studiesinvestigating the effect of goal settingon dietary and physical activity be-haviors provide a reference pointfrom which to direct future studies.Researchers should consider themethodological issues raised here inplanning future studies. The litera-ture on goal setting with adolescentsand children is limited, and to theauthors’ knowledge, no research hasbeen conducted investigating the in-dependent effect of goal setting ondietary or physical activity behaviorof youth. Because goal setting is usedin many nutrition and physical activi-ty programs in all age categories, werecommend that research employingthe requisite methods be conductedto determine the effectiveness ofgoal setting in the nutrition andphysical activity fields, particularlywith adolescents and children.

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