Defense Date


Document Type


Degree Name

Doctor of Philosophy


Social and Behavioral Health

First Advisor

Jennifer Elston Lafata


Introduction: The potential benefits of collaborative goal setting in the clinical setting have been shown. However, we have a limited understanding about what needs to have transpired between a patient and his or her clinician for them to report that they engaged in collaborative goal setting. Therefore, our ability to monitor and foster collaborative goal setting remains limited. Methods: My three-manuscript dissertation used a mixed-methods approach utilizing both qualitative and quantitative research methods. The aims of my study were to: (1) develop a conceptual model of collaborative goal setting as perceived by patients; (2) generate a list of survey items for possible inclusion in a measure of collaborative goal setting, using results from patient focus groups and input from an expert panel; and (3) administer the collaborative goal setting measure to a sociodemographically diverse sample of patients with diabetes and test the psychometric properties of the measure. Results: Study 1 found that patients described collaborative goal setting as containing four distinct domains that occurred within the context of a caring relationship with their health care provider: (1) listen and learn from each other; (2) share ideas honestly; (3) agree on a measurable objective; and (4) support for goal achievement. Patients also articulated clear responsibilities for themselves and their clinicians within each domain and described collaborative goal setting as a process that occurs over time. Study 2 found that the second-order factor analysis supported the proposed measurement structure of a 37-item measure of patient-perceived collaborative goal setting. Overall model fit of the first-order model was good (χ = 4366.13, p<.001; RMSEA = .08). The internal consistency of the second-order model scales [caring relationship, listen and learn, share ideas, agree on a measurable objective, and support for goal achievement] were very high (α = .89-.94) as was the reliability (Mcdonald’s Ώ = .819). Study 3 found that the only significant pathway was the relationship between collaborative goal setting and self-management, which was partially mediated by self-efficacy (p<.05). After controlling for a variety of socio-demographic characteristics, the partial mediation model with self-efficacy was no longer significant (p=.055), however, the direct effects remained significant: self-management and collaborative goal setting (p<.001) and self-efficacy (p<.001), as well as self-efficacy on collaborative goal setting (p<.05). Discussion: Findings from these three studies support the new measure of collaborative goal setting developed from patient perceptions of this process.


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