Disentangling self-management goal setting and action planning: A scoping review

PLoS ONE

Volumn 12, Issue 11, 2017, Pages

  Lenzen, Stephanie Anna ^a,b   Daniëls, Ramon ^a   Van Bokhoven, Marloes Amantia ^b   Van Der Weijden, Trudy ^b   Beurskens, Anna ^a,b  

^a ZUYD UNIVERSITY OF APPLIED SCIENCES   (Netherlands)

^b MAASTRICHT UNIVERSITY   (Netherlands)

Author keywords

[No Author keywords available]

Indexed keywords

CONCEPTUAL FRAMEWORK; EMPOWERMENT; GOAL ATTAINMENT; HEALTH BEHAVIOR; HEALTH CARE PERSONNEL; HEALTH CARE PLANNING; HEALTHY LIFESTYLE; HUMAN; MEDICATION COMPLIANCE; PATIENT AUTONOMY; PATIENT CARE PLANNING; PATIENT EDUCATION; PATIENT PARTICIPATION; PATIENT PREFERENCE; PERSONAL AUTONOMY; PHYSICAL ACTIVITY; QUALITY OF LIFE; REVIEW; SELF CARE; SHARED DECISION MAKING; WELLBEING; FOLLOW UP; META ANALYSIS; MOTIVATION;

FOLLOW-UP STUDIES; GOALS; HEALTH PLANNING; HUMANS; SELF-MANAGEMENT;

EID: 85035769266     PISSN: None     EISSN: 19326203     Source Type: Journal    
DOI: 10.1371/journal.pone.0188822     Document Type: Review

References (108)

1. World Health Organization. Global status report on noncommunicable diseases. 2014. http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1
2. Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Von Korff M. Finding common ground: Patient-centeredness and evidence-based chronic illness care. J Altern and Complement Med. 2005; 11(Suppl 1): 7–15.
3. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, et al. The expanded Chronic Care Model: An integration of concepts and strategies from population health promotion and the Chronic Care Model. Hosp Q. 2003; 7(1): 73–82. PMID: 14674182
4. Bodenheimer T, MacGregor K, Sharifi C. Helping Patients Manage Their Chronic Conditions. 2005. California Health Care Foundation. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20H/PDF%20HelpingPatientsManageTheirChronicConditions.pdf
5. Lorig KR, Holman HR. Self-Management Education: History, Definition, Outcomes and Mechanisms. Ann Behav Med. 2003; 26(1): 1–7. PMID: 12867348
6. Lawn S, Schoo A. Supporting self-management of chronic health conditions: common approaches. Patient Educ Couns. 2010; 80(2): 205–211. https://doi.org/10.1016/j.pec.2009.10.006 PMID: 19931372
7. Corbin J, Strauss J. Unending work and care: Managing chronic illness at home. Jossey-Bass; San Francisco, CA: 1988.
8. Bodenheimer T, Grumbach K. Self-Management Support for People with Chronic Illness. In: Shanahan JF, Brown RY. Improving Primary Care—Strategies and tools for a better practice. New York: The MacGraw-Hill Companies; 2007. p.79–98.
9. Bodenheimer T, Hadley MA. Goal-setting for behavior change in primary care: An exploration and status report. Patient Educ Couns. 2009; 76(2): 174–180. https://doi.org/10.1016/j.pec.2009.06.001 PMID: 19560895
10. Lorig K. Action Planning: A Call To Action. J Am Board Fam Med. 2006; 19(3): 324–325. PMID: 16672687
11. Langford AT, Sawyer DR, Gioimo S, Brownson CA, O’Toole ML. Patient-centered goal setting as a tool to improve diabetes self-management. Diabetes Educ. 2007; 33(Suppl 6): 139–144.
12. DeWalt DA, Davis TC, Wallace AS, Seligman HK, Bryant-Shilliday B, Arnold CL, et al. Goal setting in diabetes self-management: taking the baby steps to success. Patient Educ Couns. 2009; 77(2): 218–223. https://doi.org/10.1016/j.pec.2009.03.012 PMID: 19359123
13. Thoolen BJ, de Ridder D, Bensing J, Gorter K, Rutten G. Beyond good intentions: The role of proactive coping in achieving sustained behavioral change in the context of diabetes management. Psychol Health. 2009; 24(3): 237–254. https://doi.org/10.1080/08870440701864504 PMID: 20204991
14. Scobbie L, Dixon D, Wyke S. Goal setting and action planning in the rehabilitation setting: development of a theoretically informed practice framework. Clin Rehabil. 2010; 25(5): 468–482. https://doi.org/10.1177/0269215510389198 PMID: 21131335
15. Rutten GEHM, de Grauw WJC, Nijpels G, Gouds-Waard AN, Uitewaal PJM, van der Does FEE, et al. [Dutch College of General Practitioners—Guidelines for Diabetes Mellitus Type 2]. Huisarts Wet. 2006; 49(3): 137–152. (Dutch). https://www.nhg.org/standaarden/volledig/nhg-standaard-diabetes-mellitus-type-2
16. The National Collaborating Centre for Chronic Conditions. Rheumatoid Arthritis—National clinical guideline for management and treatment in adults. 2009. London. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009576/pdf/PubMedHealth_PMH0009576.pdf
17. Parry RH. Communication during goal-setting in physiotherapy treatment session. Clin Rehabil. 2004; 18(6): 668–682. https://doi.org/10.1191/0269215504cr745oa PMID: 15473119
18. Blakeman T, Macconald W, Bower P, Gately C, Chew-Graham C. A qualitative study of GP’s attitudes to self-management of chronic disease. Br J Gen Pract. 2006; 56(527): 407–414. PMID: 16762121
19. MacGregor K, Handley M, Wong S, Sharifi C, Gjeltema K, Schillinger D, et al. Behavior-Change Action Plans in Primary Care: A Feasibility Study of Clinicians. I Am Board Fam Med. 2006; 19(3): 215–223.
20. Wade DT. Editorial: Goal setting in rehabilitation: an overview of what, why and how. Clin Rehabil. 2009; 23(4): 291–295. https://doi.org/10.1177/0269215509103551 PMID: 19293289
21. Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal-setting in stroke rehabilitation. Clin Rehabil. 2011; 25 (6): 1–14.
22. Young CA, Manmathan GP, Ward JC. Perceptions of goal-setting in a neurological rehabilitation unit: A qualitative study of patients, carers and staff. J Rehabil Med. 2008; 40(3): 190–194. https://doi.org/10.2340/16501977-0147 PMID: 18292920
23. Playford ED, Siegert RJ, Levack WMM, Freeman J. Areas of consensus and controversy about goal setting in rehabilitation: a conference report. Clin Rehabil. 2009; 23(4): 334–344. https://doi.org/10.1177/0269215509103506 PMID: 19449469
24. Levack WM, Taylor K, Siegert RJ, Dean SG, McPherson KM, Weatherall M. Is goal planning in rehabilitation effective? A systematic review. Clin Rehabil. 2006; 20(739): 739–755.
25. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8(1): 19–32.
26. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010; 5 (1): 1–9.
27. Calfas KJ, Sallis JF, Zabinski MF, Wilfley DE, Rupp J, Prochaska JJ, et al. Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults. Prev Med. 2002; 34(2): 153–161. https://doi.org/10.1006/pmed.2001.0964 PMID: 11817910
28. Cho MK. Effect of health contract intervention on renal dialysis patients in Korea. Nurs Health Sci. 2013; 15(1): 86–93. https://doi.org/10.1111/nhs.12003 PMID: 23107436
29. Estrabrooks PA, Nelson CC, Xu S, King D, Bayliss EA, Gaglio B, et al. The frequency and behavioral outcomes of goal choices in the self-management of diabetes. Diabetes Educ. 2005; 31(3): 391–400. https://doi.org/10.1177/0145721705276578 PMID: 15919639
30. Evans-Hudnall GL, Stanley MA, Clark AN, Bush AL, Resnicow K, Liu Y, et al. Improving secondary stroke self-care among underserves ethnic minority individuals: A randomized clinical trial of a pilot intervention. J Behav Med. 2014; 37(2): 196–204. https://doi.org/10.1007/s10865-012-9469-2 PMID: 23225167
31. Fuchs R, Goehner W, Seelig H. Long-term effects of a psychological group intervention on physical exercise and health: the MoVo concept. J Phys Act Health. 2011; 8(6): 794–803. PMID: 21832294
32. Glasgow RE, Christiansen SM, Kurz D, King DK, Woolley T, Faber AJ, et al. Engagement in a diabetes self-management website: usage patterns and generalizability of program use. J Med Internet Res. 2011; 13(1): e9. https://doi.org/10.2196/jmir.1391 PMID: 21371992
33. Glasgow RE, Toobert DJ, Hampson SE. Effects of a brief office-based intervention to facilitate diabetes dietary self-management. Diabetes Care. 1996; 19(8): 835–41. PMID: 8842601
34. Lyons KD, Svensborn IA, Kornblith AB, Hegel MT. A content analysis of functional recovery strategies of breast cancer survivors. OTJR (Thorofare NJ). 2015; 35(2): 73–80.
35. Steurer-Stey C, Storch M, Benz S, Hobi B, Steffen-Bürgi B, Steurer J, et al. Motivational training improves self-efficacy but nog short-term adherence with asthma self-management: A randomized controlled trial. Prim Health Care Res Dev. 2015; 16(1): 32–41. https://doi.org/10.1017/S1463423613000480 PMID: 24480615
36. Voils CI, Coffman CJ, Yancy WS Jr, Weinberger M, Jeffreys AS, Datta S, et al. A randomized controlled trial to evaluate the effectiveness of couples: a spouse-assisted lifestyle change intervention to improve low-density lipoprotein cholesterol. Prev Med. 2012; 56(1): 46–52. https://doi.org/10.1016/j.ypmed.2012.11.001 PMID: 23146744
37. Walker ER, Wexler B, Dilorio C, Escoffery C, McCarty F, Yeager KA. Content and characteristics of goals created during a self-management intervention for people with epilepsy. J Neurosci Nurs. 2009; 41(6): 312–21. PMID: 19998682
38. Arbour-Nicitopoulus KP, Ginis KA, Latimer AE. Planning, leisure-time physical activity, and coping self-efficacy in persons with spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2009; 90(12): 2003–2011. https://doi.org/10.1016/j.apmr.2009.06.019 PMID: 19969161
39. Lourenco LB, Rodrigues RC, Ciol MA, Sao-Joao TM, Cornelio ME, Dantas RA, et al. A randomized controlled trial of the effectiveness of planning strategies in the adherence to medication for coronary artery disease. J Adv Nurs. 2014; 70(7): 16–28.
40. Christiansen S, Oettingen G, Dahme B, Klinger R. A short goal-pursuit intervention to improve physical capacity: a randomized clinical trial in chronic back pain patients. Pain. 2010; 149(3): 444–452. https://doi.org/10.1016/j.pain.2009.12.015 PMID: 20199846
41. Luszczynska A. An implementation intentions intervention, the use of a planning strategy, and physical activity after myocardial infarction. Soc Sci Med. 2006; 62(4): 900–908. https://doi.org/10.1016/j.socscimed.2005.06.043 PMID: 16095786
42. Magar Y, Vervloet D, Steenhouwer F, Smaga S, Mechin H, Rocca Serra JP, et al. Assessment of a therapeutic education program for asthma patients: ‘Un soufflé nouveau’. Patient Educ Couns. 2005; 58(1): 41–46. https://doi.org/10.1016/j.pec.2004.05.016 PMID: 15950835
43. Nuovo J, Balsbaugh T, Levich B. Gender differences in the selection of an action plan for patients with type 2 diabetes mellitus. The patient: Patient-Centered Outcomes Research. 2009; 2(3): 203–208
44. Sniehotta FF, Scholz U, Schwarzer R, Fuhrmann B, Kiwus U, Völler H. Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. Int J Behav Med. 2005; 12(4): 244–255. https://doi.org/10.1207/s15327558ijbm1204_5 PMID: 16262543
45. Theunissen NCM, de Ridder DTD, Bensing JM, Rutten GEHM. Manipulation of patient-provider interaction: Discussing illness representations or action plans concerning adherence. Patient Educ Couns. 2003; 51(3): 247–258. PMID: 14630381
46. Corser W, Holmes-Rovner M, Lein C, Gossain V. A shared decision-making primary care intervention for type 2 diabetes. Diabetes Educ. 2007; 33(4): 700–708. https://doi.org/10.1177/0145721707304086 PMID: 17684171
47. Davis GC, White TL. A goal attainment pain management program for older adults with arthritis. Pain Manag Nurs. 2008; 9(4): 171–179 https://doi.org/10.1016/j.pmn.2008.02.007 PMID: 19041616
48. Holtrop JS, Corser W, Jones G, Brooks G, Holmes—Rovner M, Stommel M. Health behavior goals of cardiac patients after hospitalization. Am J Health Behav. 2006; 30(4): 387–399. PMID: 16787129
49. Pagels AA, Hylander B, Alvarsson M. A multi-dimensional support program for patients with diabetic kidney disease. J Ren Care. 2015; 41(3): 187–194. https://doi.org/10.1111/jorc.12114 PMID: 25739425
50. Schreurs KM, Colland VT, Kuijer RG, de Ridder DT, van Elderen T. Development, content, and process evaluation of ha short self-management intervention in patients with chronic diseases requiring self-care behaviors. Patient Educ Couns. 2003; 51(2): 133–141. PMID: 14572942
51. Becker H, Stuifbergen A, Taxis C, Beal CC, Pierini DM. The use of goal attainment scaling to facilitate and assess individualized change in a wellness intervention for women with fibromyalgia syndrome. J Holist Nurs. 2009; 27(4): 232–240. https://doi.org/10.1177/0898010109339525 PMID: 20009014
52. Naik AD, Palmer N, Petersen NJ, Street RL Jr, Rao R, Suarez-Almazor M, et al. Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Arch Intern Med. 2011; 171(5): 453–459. https://doi.org/10.1001/archinternmed.2011.70 PMID: 21403042
53. Stuifbergen AK, Becker H, Timmerman GM, Kulberg V. The Use of Individualized Goal Setting to Facilitate Behavior Change in Women with Multiple Sclerosis. Journal Neurosci Nurs. 2003; 35(2): 94–100.
54. Dickman K, Pintz C, Gold K, Kivlahan C. Behavior changes in patients with diabetes and hypertension after experiencing shared medical appointments. J Am Acad of Nurse Pract. 2012; 24(1): 43–51.
55. Glasgow RE, Toobert DJ, Hampson SE, Strycker LA. Implementation, generalization and long-term results of the “choosing well” diabetes self-management intervention. Patient Educ Couns. 2002; 48 (2): 115–122. PMID: 12401414
56. Wolever RQ, Dreusicke M, Fikkan J, Hawkins TV, Yeung S, Wakefield J, et al. Integrative health coaching for patients with type 2 diabetes: A randomized clinical trial. Diabetes Educ. 2010; 36 (4):629–639. https://doi.org/10.1177/0145721710371523 PMID: 20534872
57. Van der Wulp I, de Leeuw JRJ, Gorter KJ, Rutten GEHM. Effectiveness of peer-led self-management coaching for patients recently diagnosed with Type 2 diabetes mellitus in primary care: a randomized controlled trial. Diabetes Med. 2012; 29(10): 390–397.
58. Kroese FM, Adriaanse MA, Vinkers CDW, van de Schoot R, de Ridder DTD. The effectiveness of a proactive coping intervention targeting self-management in diabetes patients. Psychol Health. 2014; 29(1): 110–125.
59. Briggs Early K, Armstrong Shultz J, Evans M, Corbett CF, Nicholson Butkus S, Massey L. Dietary goal attainment measures and psychosocial factors among Mexican Americans and non-Hispanic whites with type 2 diabetes. Ecol Food Nutr. 2012; 51(3): 227–246. https://doi.org/10.1080/03670244.2012.674446 PMID: 22632062
60. Bearon LB, Crowley GM, Chandler J, Robbins MS, Studenski S. Personal functional goals: A new approach to assessing patient-centered outcomes. J Appl Gerontol. 2000; 19 (3): 326–344.
61. Harris JE, Eng JJ. Goal priorities identified through client-centered measurement in individuals with chronic stroke. Physiother Can. 2004; 56(3): 171–176. PMID: 23372280
62. Manson Lexell EM, Flansbjer UB, Lexell J. Self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis following interdisciplinary rehabilitation. Disabil Rehabil. 2014; 36(5): 373–378. https://doi.org/10.3109/09638288.2013.797506 PMID: 23735012
63. Murphy J, Boa S. Using the WHO-ICF with Talking Mats to Enable Adults with Long-term Communication Difficulties to Participate in Goal Setting. AAC. 2012; 28(1): 52–60. https://doi.org/10.3109/07434618.2011.653828 PMID: 22364538
64. Power E, Anderson A, Togher L. Applying the WHO ICF-framework to communication assessment and goal setting in Huntington’s disease: a case discussion. J Commun Disord. 2011; 44(3): 261–275. https://doi.org/10.1016/j.jcomdis.2010.12.004 PMID: 21272894
65. Toto PE, Skidmore ER, Terhorst L, Rosen J, Weiner DK. Goal Attainment Scaling (GAS) in geriatric primary care: a feasibility study. Arch Gerontol Geriater. 2014; 60(1): 16–21.
66. McConkey R, Collins S. Using personal goal setting to promote the social inclusion of people with intellectual disability living in supported accommodation. J Intellect Disabil Res. 2009; 54(2): 135–143. https://doi.org/10.1111/j.1365-2788.2009.01224.x PMID: 19874448
67. Tomori K, Uezu S, Kinjo S, Ogahara K, Nagatani R, Higashi T. Utilization of the iPad application: Aid for Decision-making in Occupation Choice. Occup Ther Int. 2011; 19(2): 88–97. https://doi.org/10.1002/oti.325 PMID: 21936012
68. Custer MG, Huebner RA, Freudenberger L, Nichols LR. Client-Chosen Goals in Occupational Therapy: Strategy and Instrument Pilot. Occup Ther Health Care. 2013; 27(1): 58–70. https://doi.org/10.3109/07380577.2012.747120 PMID: 23855538
69. Coote HM, Macleod AK. A self-help, positive goal-focused intervention to increase well-being in people with depression. Clin Psychol Psychother. 2012; 19(4): 305–315. https://doi.org/10.1002/cpp.1797 PMID: 22610936
70. Morganstern BA, Bochner B, Dalbagni G, Shabsigh A, Rapkin B. The psychological context of quality of life: a psychometric analysis of a novel idiographic measure of bladder cancer patients’ personal goals and concerns prior to surgery. Health Qual Life Outcomes. 2011; 9: 10. https://doi.org/10.1186/1477-7525-9-10 PMID: 21324146
71. Schneider JI, Hashizume J, Heak S, Maetani L, Ozaki RR, Watanabe DL. Identifying challenges, goals and strategies for success for people with diabetes through life coaching. Journal of Vocational Rehabilitation. 2011; 34(2): 129–139.
72. Zhang KM, Dindoff K, Arnold JMO, Lane J, Swartzman LC. What matters to patients with heart failure? The influence of non-health-related goals on patient adherence to self-care management. Patient Educ Couns. 2015; 98(8): 927–934. https://doi.org/10.1016/j.pec.2015.04.011 PMID: 25979423
73. Chunchu K, Mauksch L, Charles C, Ross V, Pauwels J. A patient centered care plan in the EHR: improving collaboration and engagement. Fam Syst Health. 2012; 30(3): 199–209. https://doi.org/10.1037/a0029100 PMID: 22866953
74. Tielemans NS, Schepers VPM, Visser-Meily JMA, van Erp J, Eijkenaar M, van Heugten CM. The Restore4Stroke self-management intervention ‘Plan ahead!’: rationale and description of the treatment protocol based on proactive action planning. Clin Rehabil. 2014; 28(6): 530–540. https://doi.org/10.1177/0269215513514460 PMID: 24452702
75. O’Connor J, Seeto C, Saini B, Bosnic-Anticevich S, Krass I, Armour C, et al. Healthcare professional versus patient goal setting in intermittent allergic rhinitis. Patient Educ Couns. 2007; 70(1): 111–117. https://doi.org/10.1016/j.pec.2007.09.004 PMID: 17997261
76. Tripicchio B, Bykerk K, Wegner C, Wegner J. Increasing patient participation: the effects of training physical and occupational therapists to involve geriatric patients in the concerns-clarification and goal-setting processes. J Phys Ther Educ. 2009; 23(1): 55–63.
77. Buchi S, Straub S, Schwager U. [Shared decision-making and individualized goal setting—a pilot trial using PRISM (Pictorial Representation of Illness and Self Measure) in psychiatric inpatients]. Praxis. 2010; 99(24): 1467–1477. German https://doi.org/10.1024/1661-8157/a000320 PMID: 21125532
78. Hart RR. Therapeutic Effectiveness of Setting and Monitoring Goals. J Consult Clin Psychol. 1978; 46 (6): 1242–1245. PMID: 730874
79. Mullis R, Hay EM. Goal scaling for low back pain in primary care: development of a semi-structured interview incorporating minimal important change. J Eval Clin Pract. 2010; 16(6): 1209–1214. https://doi.org/10.1111/j.1365-2753.2009.01296.x PMID: 20695953
80. Kjeken I, Berdal G, Bo I, Dager T, Dingsor A, Hagfors J, et al. Evaluation of a structured goal planning and tailored follow-up program in rehabilitation for patients with rheumatic diseases: Protocol for a pragmatic, stepped-wedge cluster randomized trial. BMC Musculoskelet Disord. 2014; 15:153. https://doi.org/10.1186/1471-2474-15-153 PMID: 24886382
81. Doughty C, Tse S, Duncan N, McIntyre L. The Wellness Recovery Action Plan (WRAP): workshop evaluation. Australas Psychiatry 2008, 16(6): 450–456. https://doi.org/10.1080/10398560802043705 PMID: 18608168
82. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.; 1986.
83. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2): 191–215. PMID: 847061
84. Leventhal H, Leventhal EA, Contrada R. Self-regulation, health, and behavior: A perceptual-cognitive approach. Psychol Health. 1998; 13(4): 717–733.
85. Aspinwall LG, Taylor SE. A stitch in time: self-regulation and proactive coping. Psychol Bull. 1997; 121 (3): 417–436. PMID: 9136643
86. Schwarzer R. Self-efficacy: Thought control of action. Washington DC: Hemisphere; 1992.
87. Deci El, Ryan RM. Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.
88. Aijzen I. The Theory of Planned Behavior. Organizational Behavior and Human Decision processes. 1991; 50(2): 179–211.
89. Locke EA, Latham GP. Building a practically useful theory of goal-setting and task motivation: A 35-year Odyssey. Am Psychol. 2002; 57(9): 705–717. PMID: 12237980
90. Thoolen BJ, de Ridder D, Bensing J, Gorter K, Rutten G. Beyond good intentions: The role of proactive coping in achieving sustained behavioral change in the context of diabetes management. Psychol Health. 2009; 24(3): 237–254. https://doi.org/10.1080/08870440701864504 PMID: 20204991
91. Glasgow Re, Emont S, Miller DC. Assessing delivery of the five ‘As’ for patient-centered counseling. Health Promot Int. 2006; 21(3): 245–255. https://doi.org/10.1093/heapro/dal017 PMID: 16751630
92. Bayliss EA, Edwards AE, Steiner JF, Main DS. Processes of care desired by elderly patients with multi-morbidities. Fam Pract. 2008; 25(4): 287–293. https://doi.org/10.1093/fampra/cmn040 PMID: 18628243
93. Rijken M, Bekkema N, Boeckxstaens P, Schellevis FG, de Maeseneer JM, Groenewegen PP. Chronic Disease Management Programs: an adequate response to patients’ needs? Health Expect. 2012; 17 (5): 608–621. https://doi.org/10.1111/j.1369-7625.2012.00786.x PMID: 22712877
94. Cramm JM, Nieboer AP. Disease management: The need for a focus on broader self-management abilities and quality of life. Popul Health Manag. 2015; 18(4): 246–255. https://doi.org/10.1089/pop.2014.0120 PMID: 25607246
95. Lenzen SA, Daniels R, van Bokhoven MA, Weijden T, Beurskens A. Setting goals in chronic care: Shared decision making as self-management support by the family physician. Eur J Gen Pract. 2014; 21(2): 138–144. https://doi.org/10.3109/13814788.2014.973844 PMID: 25541857
96. Barlow J, Edwards R, Turner A. The experience of attending a lay-led, chronic disease self-management program from the perspective of participants with multiple sclerosis. Psychol Health. 2009; 24 (10): 1167–1180. https://doi.org/10.1080/08870440802040277 PMID: 20204986
97. Brown VA, Bartholomew LK, Naim AD. Management of chronic hypertension in older men: An exploration of patient goal setting. Patient Educ Couns. 2007; 69(1–3): 93–99. https://doi.org/10.1016/j.pec.2007.07.006 PMID: 17890042
98. Lorig K, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999; 37(1): 5–14. PMID: 10413387
99. Peolsson M, Hyden LC, Satterlund Larson U. Living with Chronic Pain: a dynamic learning process. Scand J Occup Ther. 2000; 7(3): 114–125.
100. Keefe FJ, Lefebvre JC, Kerns RD, Rosenberg R, Beaupre P, Prochaska J, et al. Understanding the adoption of arthritis self-management: stages of change profiles among arthritis patients. Pain. 2000; 87(3): 303–313. PMID: 10963910
101. Jones H, Edwards L, Vallis TM, Ruggiero L, Rossi SR, Rossi JS, et al. Changes in diabetes self-care behaviors make a difference in glycemic control. Diabetes Care. 2003; 26(3): 732–737. PMID: 12610030
102. Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009; 23(4): 362–370. https://doi.org/10.1177/0269215508101742 PMID: 19179355
103. Carswell A, McColl MA, Baptiste S, Law M, Polataijko H, Pollock N. The Canadian Occupational Performance Measure: A research and clinical literature review. Can J Occup Ther. 2004; 71(4): 210–222. https://doi.org/10.1177/000841740407100406 PMID: 15586853
104. Miller WR, Rollnick S. Motivational Interviewing, Helping People Change. New York: The Guilford Press; 2013.
105. Sage N, Sowden M, Chorlonton E, Edeleanu A. CBT for Chronic Illness and Palliative Care—A Workbook and Toolkit. Southern Gate, Chichester: John Wiley & Sons Ltd, The Atrium; 2008.
106. Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J of Gen Pract. 1999; 49(443): 477–482.
107. Baker SM, Marshak HH, Rice GT, Zimmermann GJ. Patient Participation in Physical Therapy Goal Setting. J Am Phys Ther Assoc. 2001; 81(5): 1118–1126.
108. Plant SE, Tyson SF, Kirk S, Parson J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil. 2016, 30(9): 921–930. https://doi.org/10.1177/0269215516655856 PMID: 27496701