As nutrition counselors, our goal is to help people attain better health through diet changes. We do this by engaging, focusing, evoking and planning. In Tip #118, we looked at the planning process, which involves guiding them toward short-term behavioral goals that will lead to success. Here we look in more detail at effective goals.
While we wait for tomorrow,
we must act for today.Mani Sivasubramanian
The teacher who is indeed wise does not bid you
to enter the house of his wisdom but rather
leads you to the threshold of your mind.Khalil Gibran
In many fields, including health care, education and business, the acronym SMART is used to help us remember the characteristics of effective goals. There are many ways these letters are used. Here are some examples:
Specific, simple, significant
Measurable, meaningful, manageable, motivational
Achievable, attainable, ambitious, action-focused, appropriate
Relevant, realistic, resonant, results-oriented
Timely, time-framed, time-bound, time-limited, tangible
As you can see, which words we choose to associate with the letters will affect how we look at behavioral goals. Here is the list as it is generally used in health goal-setting.
Specific: This means that both you and the client know clearly what the behavior is. “Exercise more” is not specific. “Work out at the gym at work twice a week” is specific.
Measurable: A goal is measurable if it is possible to know for sure whether it was achieved. For example, it is clear whether a person went to the gym twice a week, and adding “walk on the treadmill at 3.6 miles per hour for 30 minutes” makes it even more measurable.
Attainable: This refers to how realistic the goal is for this person at this time. The client may want to go to the gym six days a week but realize that what is attainable is two times a week.
Relevant: Here there is sometimes an interesting split between the client and us about what is relevant. As health professionals, we focus on a goal’s relevance to evidence-based outcomes. A SMART goal must also be relevant in the client’s mind (i.e., it is linked to a larger goal). In this example, the client has said he wants to have better stamina and knows that by walking on the treadmill, his stamina will indeed improve. In the professional’s mind, the exercise goal may be linked to its effect on blood sugar. Fortunately in this case, the goal is relevant for both the counselor and the client.
Timely: Goals are more apt to be achieved when they have a time attached. For example, this client might enter “gym” in his calendar at a specific time on Mondays and Thursdays.
A few people may enjoy setting goals and even like to be aware of the elements of SMART to check themselves against them. However, with most of our clients, if we talk explicitly about “specific, measurable, etc.,” their eyes will glaze over or we will evoke resistance. These words may remind them too much of school. Until you know your client’s preference, it’s best to stay with a conversational style. This will mean keeping the elements of SMART in your head and using them to guide the planning process.
Here is an example of a planning conversation that begins with a vague goal and moves toward a smarter one. Reflections and open questions guide the client’s process.
Client: They have a gym at work.
Counselor: So your thought is to use the office gym to work on your stamina. Tell me how that will fit in your week.
Client: Well, on Mondays and Thursdays, my son is at school late with play practice, so I have some time to kill after work before picking him up. I could go over to the gym then.
Counselor: So on those days you’ll head to the gym. What do you see yourself doing during that time?
Client: I want to do some cardio, and they have plenty of treadmills. I’ll do that
Counselor: Your plan is to get on a treadmill on Mondays and Thursdays. How do you see the amount of time and your pace?
Client: When I’ve done it before, I put the ramp up a bit and kept it at a decent walking pace. It’s easier on my knees than running. I could probably start with 20 minutes.
Counselor: You’re going to begin with walking with an incline for 20 minutes and then go from there. How confident are you on a scale of 0 to 10 that you will do that for the next two weeks where 0 means you know you won’t do it and 10 means you are sure you will?
Client: Oh, I’m pretty sure, maybe an 8. I have that time anyway, I’ve done it before, and I know I’ll feel stronger pretty soon.
At this point, the counselor would summarize the goal and ask for confirmation. If the client’s confidence had been below 7, this would have been a clue that the goal might not be realistic enough and the counselor would ask what might need to be different for the number to be higher. Once a realistic goal is agreed upon, the counselor summarizes.