Goal Setting and Attainment in a Randomised Controlled Trial of Digital Health-Assisted Lifestyle Interventions in People with Kidney and Liver Disease

Abstract

Introduction: Goal setting is an effective strategy in altering fitness and dietary behaviours. The goal attainment scale (GAS) is a patient-reported outcome measure that can be used to quantify goal achievement. The GAS has not been extensively assessed in lifestyle intervention trials. This study aimed to describe the goal setting process and assess the impact of a digital exercise and diet service and self-efficacy on goal attainment in people with chronic disease and at increased cardiometabolic risk.

Methods: This study presents a single-centre, 26-week, randomised controlled trial (RCT) comparing standard care to digital health technologies (text messages, nutrition/exercise app, video consultations with dietitian and/or exercise physiologist). The comparator group was offered dietitian review (per standard care), and both groups received a wearable activity monitor. Individualised goal setting was facilitated prior to randomisation. Goal importance, performance measures, and self-efficacy were determined by participants. Goal outcome and 'Change in GAS' scores, reflecting the difference between baseline and follow-up performance, were calculated using validated formulae.

Results: Goal setting was completed and reviewed by 66 participants, with a median age of 51 years and 56% being male. The most common goals related to weight loss (46%), fitness (29%), and diet (15%). Most participants (62%) reported improvements in their goals, with most improvements in dietary (71%), fitness (52%), and weight loss (39%) goals. There was no significant difference in goal outcomes between intervention and comparator groups (p = 0.99). There was, however, a significant correlation between nutrition self-efficacy and dietary goal achievement (p = 0.04).

Conclusions: The novelty and feasibility of goal setting and attainment were demonstrated in this RCT of lifestyle interventions in people with chronic disease. Though the intervention did not significantly improve goal attainment, most participants reported improvements in their lifestyle goals. There were greater improvements in dietary goals than in fitness or weight loss goals. Participant-led goal setting with GAS and participant self-efficacy has potentially important applications in future lifestyle modification research and clinical implementation endeavours.

Keywords: diet; exercise; goal attainment scale; metabolic syndrome; randomised controlled trial.

Figure 1

Participant flow.

Figure 2

Goal attainment scale (GAS) formula as proposed by Kiresuk and Sherman [4]. wi = weight score assigned to the goal. Weight scores are added together if more than 1 goal. xi = performance score achieved (i.e., between −2 and +2). r = expected correlation of the goal scales, approximating to 0.3 [4].

Figure 3

Lifestyle goal categories across groups. Glycaemic—improve glycaemic control; Pain—reduce pain; Sleep—improve sleep; Fatigue—reduce fatigue; Body Comp—body composition.