Lesson Plan—Coaching Session #9

Staying Healthy Through Education and Prevention (STEP)

Review of Self-Monitoring and Setting Goals

Introduction

This session is the last of nine behavior coaching sessions in the STEP program. The session reviews many aspects of the previous 9 weeks of coaching and introduces concepts related to short- and long-term goal setting. The session concludes with a discussion of goal setting and a handout designed to assist participants in defining short- and long-term physical activity goals.

Preparation

  • Staff must be familiar with:
    • Content of entire STEP behavioral program.
    • Definitions of goals and objectives.
    • Concepts related to short-and long-term goal setting.
    • REACT framework for goal setting.
  • Print/copy Take-Home Challenge.

Session Objectives

Participants will be asked to:

  • Review content of Session 8.
  • Review major concepts from behavior sessions 1-8, including self-monitoring, social support, FITT principle, STEP program goals, and barriers to physical activity.
  • Discuss REACT and goal setting.
  • Wrap up behavior sessions with a discussion about short- and long-term goal setting.

Session Outline

  1. Greeting/Review
  2. Review of Self-Monitoring and Other Strategies
  3. Goal Setting
  4. Review of Final Take-Home Challenge
  5. Questions and Wrap-Up

Session Content and Sample Scripts

I. Greeting/Review

  • Review progress in self-monitoring.

SCRIPT:

Welcome to your final STEP coaching session. Even though you will continue your strength classes, walking, and balance exercises, our coaching sessions are ending. Congratulations to all of you for completing this part of the program! We will restart the cycle of coaching sessions on [date], so if at any point you want to refresh your skills on a particular topic or stop in to participate in a discussion, feel free. Our formal time together is over, but you can continue to seek support from each other, from these coaching sessions, and from me when I see you at STEP strength classes or at other times.

The first thing I want to do on our last day is review your physical activity logs. For the past couple of months, you have been recording the minutes you were physically active and the type of activity you were doing. Now is a great time to revisit those 9 weeks of exercise and assess our progress. [Note: If you have planned a party or reward, or set a group goal, update everyone on your collective progress and discuss when you will meet to celebrate.] The main purpose of the tracking sheets was to help you all become more aware of what you do or don't do on a regular basis and to help you increase your physical activity.

Let's take some time to think about what we found out. Think about your physical activity time on the tracking sheets and consider a few things: On average, how many days were you physically active? How has your physical activity time changed since the beginning? Are you on the right path? Are you meeting the STEP program goal of 150 minutes per week? What days seem to be the best days for you to get in your activity? What are your biggest exercise barriers and how are you working to overcome them? [Note: Allow people individual time to look at their progress and assist them as needed. Then engage participants in a group discussion.]

  • Review content of Session 8 and the Take-Home Challenge.

Let's move on and review last session's assignment. At our last meeting, we talked about identifying social support contacts and the kind of support you need, and then approaching people for support. Everyone, take out your handouts and the Take-Home Challenge and let's talk about how the exercise went. Were you successful in identifying and seeking support? Did you run into any barriers along the way? If so, what actions did you take to address these barriers? [Engage the group in discussion.]

[Note: Summarize their ideas and emphasize the importance of social support. Encourage problem solving during the group discussion and allow participants time to work through any barriers they encountered. The next time that they encounter these problems, they will need to rely on the skills they've learned and the social network they've built. Make the most of this opportunity to reinforce the material you've covered in the past 9 weeks.]

II. Review of Self-Monitoring and Other Strategies

  • Transition from social support to goal setting.

SCRIPT:

Social support is going to be very important as we end the formal behavior coaching sessions and move into the maintenance phase of the STEP program. Let's review the concept of self-monitoring and discuss the various strategies you have learned to help you self-monitor. Then we will talk about how this knowledge will help you to set effective and realistic goals.

  • Facilitate a group discussion about their successes and challenges with self-monitoring and their status regarding home-based activities (self-monitoring, tracking sheets, balance exercises, etc.). You should also discuss:
    • FITT principle in the context of self-monitoring (review FITT acronym).
    • Where participants are in terms of the STEP goal of 150 minutes total per week.
    • What benefits STEP has provided to participants.
    • How these achievements have motivated participants to stay active.
  • Review the topics, skills, and strategies covered in the previous eight sessions:

Session 3

  • Review your motivations for pursuing an active lifestyle.
  • Remember the importance of avoiding physical limitations and increasing function.
  • Review your written strategies for decreasing physical decline.

Session 4

  • Keep up your self-monitoring activities by maintaining your physical activity logs and your exercise feelings tracking sheets, as well as your record of your ankle weights and repetitions.
  • Practice self-awareness by reviewing these logs and records and reflecting on your progress.

Session 5

  • Acknowledge the effects of your feelings on your behavior and address your feelings honestly.

Session 6

  • Stay aware of positive versus negative self-talk:
  • Identify the negative thoughts and STOP them.
  • Analyze the associated feelings.
  • Convert negative thoughts into positive thoughts.

Session 7

  • Recognize barriers and prevent lapses.
  • Review your worksheet about counteracting barriers.

Session 8

  • Maintain and expand your social support networks.
  • Reflect on your needs.
  • Identify appropriate people.
  • Ask for help.
  • Reflect, discuss, and maintain.

Session 9

  • Set short-term and long-term goals.
  • REACT.

III. Goal Setting

  • Define short- and long-term goals and introduce the REACT framework.

SCRIPT:

Does this sound familiar? "For my New Year resolution, I'd like to lose weight, stop smoking, and get healthy "At one time or another, we've all made a worthwhile resolution that never became a reality. Chances are it didn't come to pass because it was too broad and undefined. The key is to look at your aspirations and then define them in terms of concrete, attainable goals that you can act on. Once you set a goal, you need a plan. Not a general plan like "walk more"or "eat better"; your plan has to have specific steps and strategies, as well as short- and long-term goals.

You all have experience with this approach through the STEP program. We have been working on the huge goal "to live healthier lives"by defining it in terms of smaller, more specific goals, strategies for reaching them, worksheets and logs to track them, and people to help us reflect on them. As the behavior sessions end and you move forward, I want you to make sure you recognize all we've accomplished and continue to use the skills we've been practicing. As you move forward, you may also need to redefine your goals, adjust your habits, and set new goals, so let's talk about how to do this.

What is a goal? A goal is a desired outcome or end we plan to achieve, often with great effort. Let me point out three keywords I know you're all familiar with: desire, plan, and effort.

There are two types of goals: Long-term goals (such as losing weight or reducing your blood pressure) and short-term goals (exercising three times this week). Long-term goals are worthwhile, but often they involve a general desire that is too broad to act on. You need smaller goals and a specific plan to achieve them. Short-term goals have numerous benefits: you stay goal oriented (constantly reevaluating your progress and striving for improvement), you create opportunities for success (small victories each week boost your confidence and keep you motivated), and you achieve the long-term goal through incremental steps and continuous effort (which is how most big changes have to be made—gradually).

Here are some tips for effective short-term goal setting. An effective goal should be:

  • Realistic: The goal should be reasonable, not excessive or extreme.
  • Evaluable: You should be able to determine whether you met your goal.
  • Attainable: You should be able to accomplish your goal with the right steps.
  • Challenging: Your goal should require you to work for it.
  • Time based: For right now, your goals should involve only the next week (this interval may increase as you become more experienced).

It is very important to remember that your goals can be flexible. You should be able to revise your goals so that you can avoid failure and respond to unexpected changes, such as a change in your schedule due to a vacation or a temporary illness. The next assignment takes you through the process of setting your first short-term goal in relation to your physical activity habits. Let's try this out.

[Note: You can do an example as a class or split people into small groups to focus on their individual goals. Either way, make sure they use the REACT principle and set short-term goals that will help them achieve their long-term goals. This is your last (scheduled) chance to reinforce their understanding. You can use the worksheet for this exercise.]

IV. Review of Final Take-Home Challenge

  • Highlight the importance of setting goals to which participants can commit and at which they will succeed.
  • Participants must feel confident in their goals and optimistic about their eventual success to carry out the necessary steps and to do so independently.

SCRIPT:

The last Take-Home Challenge involves setting a specific short-term goal that will help you to increase and maintain your physical activity. You will try to achieve this goal over the next week and then repeat this process in subsequent weeks, setting and achieving new short-term goals, evaluating them, and beginning again. As you approach this task, let's think about a few questions:

  • What is one of your most important long-term goals?
  • What is your biggest weakness right now in terms of your physical activity program? (Think about the physical activity recorded on your tracking sheet from this past week.) Is it how many days you exercise, how long your physical activity sessions are, or your intensity of exercise?
  • What is the first thing that you want to work on improving right now: your time, your days, or your intensity?

At this point in the STEP program, you have progressed into a maintenance phase. The behavior classes are ending and you should be approaching your goal of 150 minutes of exercise per week, including the STEP strength classes, which will continue as usual. Therefore, you will need to continually reevaluate and modify your goals based on your progress and ultimately be responsible for maintaining the changes that you have made. Here are some examples of goals that other people have set during this phase of the program.

  • Before STEP, Betty wasn't walking at all. Currently, she is walking 1 or 2 days per week. Therefore, she is not getting in the total minutes that she should be. Betty has set a goal to walk 4 days this coming week. This means that she will strive to be physically active more days each week.
  • Maggie was always a slow walker before participating in the STEP program. But now that she knows about perceived exertion (RPE) from STEP, this week Maggie is going to increase the intensity of her walking from an 11 to a 12.
  • Phyllis currently exercises 3 times a week for 30 minutes each time. Now that she understands the importance of physical activity, she is going to set a goal of walking 4 times per week and she will try to take the stairs instead of the elevator some of the time.

In setting your goal for this week, you may choose to increase any component of your activity program: frequency, intensity, or time. Just remember never to exceed an RPE of 13 when walking or doing other aerobic activities. Also, never exercise to the point of pain.

V. Questions and Wrap-Up

  • Encourage participants to continue their walking and strength classes and to engage in ongoing assessment of their goals and progress in the STEP program.
  • End behavioral coaching sessions on a very positive, upbeat note and explain that although they have completed the formal coaching sessions, you will be there to assist participants as they continue working toward their goals and using all the behavioral strategies they learned and practiced in the coaching sessions.
  • Suggest participants keep a dedicated journal or notebook where they can store their worksheets and handouts and record new self-monitoring activities. Arrange to have copies of certain worksheets available (for example, the physical activity log and handouts in Sessions 7 and 9, which they will continue to need), or suggest they record this information in their notebooks.
  • The STEP strength classes will continue, so they will have access to you if questions arise. Make yourself available to discuss ongoing goals and review concepts from the coaching sessions. Also let them know when (and if) you will be restarting the coaching session cycle and encourage them to drop into sessions if they need a skill refresher.
  • Congratulate yourself and them on a job well done! They have acquired many important skills to support their efforts at maintaining physical health and they could not have done it without you and the group environment you have created.
Page last reviewed February 2011
Internet Citation: Lesson Plan—Coaching Session #9: Staying Healthy Through Education and Prevention (STEP). February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/stepmanual/stepcoach9.html