I thought it worth spending a little time considering goals because so many of us work to help people generate goals – but how many are completed? I’m sure I could lay money on the table that most of us have failed to persist with a goal when we’ve set one, and it’s no surprise that many of our patients also struggle to focus on a goal, even when it’s clear that it’s important!
Many of the people I work with haven’t really set goals in their lives, and although some are quite familiar with the concept of working towards something important ‘other things’ seem to get in the way of them. This study, which isn’t recent, examined goal intentions – or ‘what people want to do within a certain time period’ – and implementation intentions – or ‘action plans’ refer in more detail to the when, where, and how of future action. People do not forget their implementation intentions easily when they are specified in a when, where, and how manner, and an implementation intention is thought to be more proximal to (ie occur closer to the time when) behaviour or action than goals.
The setting for this study was an outpatient physiotherapy centre where patients were attending daily treatment sessions with the expectation of returning to full fitness. Participants had a range of musculoskeletal conditions, and were assessed for this study after completing a 3-week outpatient orthopedic rehabilitation programme. Two further follow-ups were carried out using a postal survey each time. A total of 371 participants provided complete data, around 58% of the original sample. After reviewing the non-responders, no significant differences were found, so we can probably rely on this data. Remember that it’s self-report, so is potentially inaccurate, but because each questionnaire was coded rather than named, hopefully some of the response bias was reduced.
Cutting to the chase, participants were asked several questions about their goal intentions and their implementation intentions.
Goal intentions to perform physical activities were assessed with three
items: “I intend to exercise as part of my daily routine,” “I intend to
exercise as part of my daily locomotion (e.g., cycling),” and “I intend to
exercise as part of my leisure time.” Implementation intentions were
measured with the three items: “I have already planned precisely when to
exercise,” “I have already planned precisely where to exercise,” and “I
have already planned precisely how to continue exercising even when I feel
limited by poor health.”
The findings suggested that over time, actual activity levels increased but intentions (whether goal or implementation) actually decreased. The authors suggest that this may occur because people have to use less conscious thought as habits are formed and behaviours become automatic. That’s good – less thinking!
The second finding was that implementation intentions (those much more specific statements) predicted activity level more than goal intentions. Now this is important – as Ziegelmann et al. point out, ‘levels of exercise behavior may still depend somewhat on planning even after the behavior becomes more routinized in the year after rehabilitation.’
They add that ‘it is possible that, at the stage when behavior becomes routine, planning still predicts exercise behavior, as planning leads to mastery of the behavior, or conversely, that lack of planning results in the failure to exercise.’
What this means for me is that when I’m working with someone who is in the ‘action’ phase of the stages of change, I need to help them make specific and quite detailed plans about when, where, and how they are going to carry out activities that need to become habitual. Especially for times when they are at ‘high risk’ of not persisting with an activity – for example, on days when pain levels are high, when they’re feeling less positive, when they have other competing priorities.
Of course, it doesn’t help me with someone who isn’t yet at the ‘action’ phase, but it does start to help specify the conditions under which someone is more likely to carry out an activity. This is important because so often we are asking people to do things and ‘hoping’ they will do them – yet how many times have you and I stopped doing exercises, or changing our eating patterns, or even using relaxation because we ‘haven’t got time’. What we mean is we haven’t planned the specifics of how we are going to implement our actions.
I’m guessing that tailoring behaviours such as exercise plans to individual lifestyles is a big part of helping someone develop specific implementation intentions. Simply giving someone a sheet of exercises isn’t going to work unless that person is especially able to engage in a new behaviour without guidance. I don’t think that happens very often in this line of work!
Ziegelmann, J., Luszczynska, A., Lippke, S., & Schwarzer, R. (2007). Are goal intentions or implementation intentions better predictors of health behavior? A longitudinal study in orthopedic rehabilitation. Rehabilitation Psychology, 52 (1), 97-102 DOI: 10.1037/0090-5518.104.22.168