Goal setting within cardiac care: the effect of linking life goals to health goals on intention to change lifestyle in patients
Authors: Ijzerman R , Janssen V , Van Der Vaart R , Van Den Broek I , Dusseldorp E , Kraaijenhagen R , Reijnders T , Scholte Op Reimer W , Evers A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation and ZonMw
Goal setting within cardiac care: the effect of linking life goals to health goals on intention to change lifestyle in patients.

Background
Initiating and maintaining a healthy lifestyle is difficult and often needs several attempts. Reaching health goals may become easier if linked to life goals (see Fig.1). Life goals, also described as abstract, long-term goals, reflect objectives that matter to people personally. Guidelines recommend goal setting to realise behaviour change in patients with cardiovascular disease (CVD). However, research is inconclusive about whether positive effects of lifestyle interventions can be attributed to linking life goals to health goals or to other intervention elements.

Purpose
This experimental study examines the effect of linking a life goal to a health goal on intention to change lifestyle in patients with CVD.

Methods
Research panel members of a CVD patient association were recruited for the online study via advertisement on the association’s website. Patients were randomised and controlled into two groups: setting a health goal (HG) and setting a health goal linked to a life goal (+LG). Based on the Theory of Planned Behavior (see Fig.2) and previous research, main outcome measure ‘intention to change lifestyle’ was assessed using a visual analogue scale ranging 0-10 (low to high). Effect of group (HG vs +LG) on intention to change lifestyle (high vs low) was analysed using logistic regression. Gender, age, education level, and type of CVD were entered as possible effect modifiers.

Results
Patients (N=628) were mostly male (61%), with a mean age of 69±35 years, and medium (33%) or high (47%) education level. In both groups, HG and +LG, 47% of the patients expressed high intention to change lifestyle. Logistic regression showed no effect of group (HG vs +LG) on intention, OR:0.98 (95%CI: 0.72–1.35, p=0.92). Only education level appeared to be an effect modifier, X²(2):8.2, p=0.02; showing that linking a life goal to a health goal was effective in patients with a high education level. Contrary to this, setting a life goal negatively affected intention in patients with a low education level. Among patients with a high education level, percentage of 'high intention' was higher in the +LG group (57%) than in the HG group (45%). In contrast, among patients with a low education level, percentage of 'high intention' was higher in the HG group (48%) than in the +LG group (36%).

Conclusions
This study showed no main effect of linking a life goal to a health goal on patients’ intention to change lifestyle. Education level was found to be a significant effect modifier. Patients with a high education level significantly benefitted from linking a life goal to a health goal. Patients with lower education levels benefitted most from setting only a health goal. In conclusion, within practice, health care providers may personalise their approach towards goal setting based on patients’ education level.