Author's School

School of Medicine

ORCID

https://orcid.org/0000-0001-7657-9221

Author's Department/Program

Rehabilitation and Participation Science

Language

English (en)

Date of Award

5-15-2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Erin R. Foster

Committee Members

M. Carolyn Baum, Lisa Tabor Connor, Ashley J. Housten, Allison King

Abstract

Adults with chronic conditions experience limited participation in personally meaningful activities and roles. Chronic conditions can present challenges across personal factors such as cognitive, psychological, physiological, or neurobehavioral functions. These personal factors then dynamically interact with environmental factors, occupation, and performance, ultimately hindering adults with chronic conditions in achieving their goals to fully participate in meaningful activities and roles.

Goal setting and goal management has evolved from diverse theories including Social Cognitive Theory, Self-Determination Theory, and The Theory of Intentional Action Control. These theories emphasize the importance of addressing influential theoretical constructs such as self-efficacy and outcome expectancy but also the active engagement of the person to promote the individual’s goal achievement. Hence, theory-based, client-engaged goal setting and goal management is suggested as necessary for adults with chronic conditions to effectively guide them to improve or manage their personal and environmental factors, and ultimately achieve their personally meaningful goals in everyday life contexts.

However, theory-based, client-engaged goal setting and goal management is not yet widely implemented in community-based rehabilitation. There have been calls for developing comprehensive and engaging goal setting and goal management approaches and translating them into practice to improve participation and health among adults with chronic conditions. This dissertation addresses this important research and clinical priority by developing, examining, and refining a theory-based, client-engaged goal setting and goal management system along with implementation strategies for occupational therapists (OTs) to support effective implementation in community-based rehabilitation practice. The process was guided by Intervention Mapping and Implementation Mapping in collaboration with clients and OTs.

The aims of this dissertation were to (1) develop a new goal setting and goal management system, (2) develop and evaluate the feasibility of implementation strategies for OTs to support delivery of this goal setting and goal management system for adults with chronic conditions in community-based rehabilitation, (3) evaluate the feasibility of the goal setting and goal management system in adults with chronic conditions.

This dissertation developed a new theory-based goal setting and goal management system, MyGoals, and its implementation strategies with clearly defined mechanisms of action. OTs perceived MyGoals and its implementation strategies as feasible and promising for use with adults with chronic conditions in community-based rehabilitation settings. Adults with chronic conditions also viewed MyGoals as feasible, engaging, and person-centered.

Taken together, these dissertation studies establish a rigorous foundation for theory-based, client-engaged goal setting and goal management for adults with chronic conditions in community-based rehabilitation. In using a rigorous, implementation science approach, this work may bridge a major research-practice gap in the field and improve rehabilitation practice, goal achievement, participation, and health for this population. Future studies should explore the efficacy and effectiveness of this new theory-based, client-engaged goal setting and goal management system and its implementation strategies.

DOI

https://doi.org/10.48765/tfwx-5586

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