Goal management: how do patients with rheumatoid arthritis maintain, adjust or disengage from personal goals?

Background: Personal goals motivate and structure individual behaviour. In addition to this essential function, the way individuals manage their goals (e.g. whether they maintain or adjust their goals, disengage from goals or re-engage in new goals) is highly associated with subjective well-being. Having a chronic disease challenges the goal management of patients. For patients with RA we do not know in which domains they adjust their personal goals, which goals are maintained and whether they formulate new goals adapted to their disease. Objectives: To explore goal management strategies in patients diagnosed with RA. Leading research questions were: How important is goal management? Which strategies were used? Did the strategies differ in different domains? Were the same goal management strategies used in middle and late adulthood and by men and women? Methods: Semi-structured face-to-face interviews were conducted with 19 patients diagnosed with RA (9 men, 10 women; 6 patients in the age range 25 – 50 years, 13 patients in the age range 51 – 85 years). The interviews were tape-recorded and transcribed word for word. The interview scheme and coding scheme for the analysis of the transcripts were developed based on concepts of the two-process framework (Brandtstädter & Rothermund, 2002) and ideas on adaptive self-regulation (Wrosch et al., 2003). This theoretically deduced coding framework was complemented by additional themes that emerged from the interviews. All transcripts were read by three researchers and final coding was reached by consensus between them. Results: Maintenance of goals was mainly found in the domain of social relations. Patients experienced the majority of their social goals as ''not threatened''. Goal adjustment was found in two forms: goals were set lower (e.g. take more time for an activity as dressing) or were compensated with other goals in the same domain (e.g. singing in a choir as compensation for playing guitar). Goal adjustment was mainly found in the domains of independence, day structure and leisure time. Disengagement of goals without reengagement in compensating goals was reported with regard to work. Participants older than 50 years evaluated more goals as unthreatened, compensated for goals more often, however set goals lower less often compared to younger participants. In general, women reported to engage in goal management more often in comparison with men. Conclusion: Goal management is important in dealing with RA. The reported forms of goal management seem to be domain specific. Formulating new goals only infrequently came to the fore. The relationship of different goal management strategies with subjective well-being in patients with RA should be investigated as a next step.