Open Access Research article

Measuring the quality of Patients’ goals and action plans: development and validation of a novel tool

Cayla R Teal3, Paul Haidet4, Ajay S Balasubramanyam1, Elisa Rodriguez1 and Aanand D Naik12*

Author Affiliations

1 Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA

2 Department of Medicine, Section of Health Services Research, Baylor College of Medicine, MEDVAMC HSR&D Center of Excellence, 2002 Holcombe Blvd. (152), Houston, TX, 77030, USA

3 Department of Medicine, Section of General Medicine, and the Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX, USA

4 The Office of Medical Education and the Departments of Medicine and Humanities, The Pennsylvania State University College of Medicine, Hershey, PA, USA

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BMC Medical Informatics and Decision Making 2012, 12:152  doi:10.1186/1472-6947-12-152

Published: 27 December 2012



The purpose of this study is to develop and test reliability, validity, and utility of the Goal-Setting Evaluation Tool for Diabetes (GET-D). The effectiveness of diabetes self-management is predicated on goal-setting and action planning strategies. Evaluation of self-management interventions is hampered by the absence of tools to assess quality of goals and action plans. To address this gap, we developed the GET-D, a criteria-based, observer rating scale that measures the quality of patients’ diabetes goals and action plans.


We conducted 3-stage development of GET-D, including identification of criteria for observer ratings of goals and action plans, rater training and pilot testing; and then performed psychometric testing of the GET-D.


Trained raters could effectively rate the quality of patient-generated goals and action plans using the GET-D. Ratings performed by trained evaluators demonstrated good raw agreement (94.4%) and inter-rater reliability (Kappa = 0.66). Scores on the GET-D correlated well with measures theoretically associated with goal-setting, including patient activation (r=.252, P<.05), diabetes specific self-efficacy (r=.376, P<.001) and inverse relationship with depression (r= −.376, P<.01). Significant between group differences (P<.01) in GET-D scores between goal-setting intervention (mean = 7.33, standard deviation = 4.4) and education groups (mean = 4.93, standard deviation = 3.9) confirmed construct validity of the GET-D.


The GET-D can reliably and validly rate the quality of goals and action plans. It holds promise as a measure of intervention fidelity for clinical interventions that promote diabetes self-management behaviors to improve clinical outcomes.

Trial registration Identifier: NCT00481286

Goal-setting; Diabetes; Self-management; Goals; Action plans; Measurement