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.

While it is commonly understood by occupational therapy practitioners that collaborative goal setting leads to increased goal achievement (Sugavanam, Mead, Bulley, Donaghy, & van Wijck, 2013), the current literature shows that people with post stroke aphasia are not optimally involved in the collaborative goal setting process (Berg, Askim, Balandin, Armstrong, & By Rise, 2017; Berg, By Rise, Balandin, Armstrong, & Askim, 2016; Rohde, Townley-O’Neill, Trendall, Worrall, & Cornwell, 2012). This leads to reduced goal achievement (Sugavanam, Mead, Bulley, Donaghy, & van Wijck, 2013) and ultimately less leisure and social participation (Hilari, 2011; Eriksson, Aasnes, Tistad, Guidetti, & von Koch, 2012; Nätterlund, 2010). ClientCollab is a theory-based and evidence-driven online visual supplement to the Canadian Occupational Performance Measure (COPM), designed to reduce the cognitive and communication burdens of the COPM and assist the practitioner and client with aphasia in the goal setting process. ClientCollab is guided by research on reading and pictorial comprehension of people with aphasia as well as by the Universal Design of Learning (UDL) theory. The online program is available free of charge at www.clientcollab.net and is designed to be used in conjunction with the COPM to assist the occupational therapy practitioner and client in identifying occupational performance issues. The content of the program parallels the section and subsection breakdown of the COPM and is designed for use during step one of the COPM to assist in the identification of occupational performance issues. The objective of the program is to increase communication between client and practitioner during the goal setting process as well as to increase the number of goals developed with client input. ClientCollab is meant to act as a visual supplement to the goal setting section of the COPM, however it is not meant or able to fully replace the COPM, and must be used in conjunction with the paper or online version of the COPM. In conclusion, ClientCollab aims to decrease the cognitive and communication barriers limiting people with aphasia from completing the COPM in hopes of facilitating increased collaborative goal setting and ultimately increased goal achievement in this population.