JMIR Publications

ABSTRACT

Background:

Background:

Digital interventions are effective in promoting healthy behaviors and are recognized as one of many potential strategies for achieving healthier populations. These interventions often include goal-setting, but the practical application and fidelity of goal setting, especially when targeting multiple health behaviors in a digital intervention, have not been thoroughly examined. In a factorial randomized trial, we included goal-setting as one of six behavior change components in the digital intervention ‘Buddy’ targeting college and university students’ alcohol, diet, physical activity and smoking behaviors. However, we found no strong and consistent evidence of an effect of goal-setting alone on any of the outcomes, highlighting the need to investigate how participants used this component.

Objective:

Objective:

This case study of Buddy aimed to gain insight into participants’ interactions with the goal-setting component. The specific objectives were to identify the characteristics of those who interacted with the component and to analyze participants’ self-authored content.

Methods:

Methods:

This study combined findings of fidelity and effectiveness and involved 1704 participants from 19 colleges and universities in Sweden. We analyzed participants’ self-authored goals using summative content analysis. Logistic and negative binomial regression analyses were conducted to estimate the odds of setting a goal, selecting or self-authoring a challenge, to estimate the odds of setting a goal with respect to a specific behavior, and to estimate the frequency of selecting or self-authoring different behavioral challenges.

Results:

Results:

Access to the goal setting and challenges component was given to 850 participants, of whom 427 (50%) set at least one goal and 403 (47%) selected or self-authored at least one challenge. A total of 607 goals were set by 427 participants, with most setting one goal (79%). Goals were primarily for physical activity (n=302), dietary behavior (n=140), and multiple health behaviors (n=53), typically combining physical activity with other behaviors like diet, alcohol, smoking, and sleep. Other goals included study performance, mental health, sleep, or mobile phone use (n=73). Fewer goals concerned alcohol (n=19) or tobacco (n=17). Participants selected 1506 challenges from 41 pre-made challenges, with dietary behavior challenges being the most popular (44%). An additional 170 challenges were self-authored. Participants’ baseline characteristics were associated with the odds of setting goals targeting specific behaviors and the frequency of selecting or self-authoring challenges targeting specific health behaviors.

Conclusions:

Conclusions:

Our analyses suggest that, while goal-setting is theoretically grounded, and the component was used as intended, this did not translate to measurable behavior change in the study population. The self-authored content showed how participants utilized the component and provided insights into how they articulate behavior change in terms of personal goals, challenges, strategies for action, motivation plans, and rewards. Future research should explore the conditions under which goal-setting may be more or less effective, to better understand its nuances and potential benefits. Clinical Trial: Trial Registration: ISRCTN23310640.