Select a health behavior other than exercise.
Write a 1,200 word paper including the following:
- Develop your own self-monitoring scale for this health behavior.
- Explain how you would use this scale as an assessment tool in a behavioral health intervention.
- Summarize three current behavioral assessment techniques.
Include a minimum of three scholarly references. Use article below
Format your paper consistent with APA guidelines.
Self-Monitoring:Influencing
Effective Behavior Change
in Your Clients
by Melissa Burgard, B.S., and Kara I. Gallagher, Ph.D., FACSM
Learning Objective
To understand how to effectively use self-monitoring to
assist clients with behavior change and improve client
outcomes.
Key words: Behavior Change, Self-Monitoring, Weight
Loss, Feedback, Clients.
Behavior change is a difficult process. As a health/
fitness professional, assisting clients with behavior
change can be particularly challenging because client
interaction is often limited. Many times, these meetings
are not sufficient to target both eating and exercise behaviors
and address the many barriers clients face. Because many
health behaviors need to be targeted outside of these
meetings, finding ways to track progress also is necessary
to successfully provide clients with appropriate feedback
and direction. Thus, teaching clients to self-monitor is
an effective strategy for targeting both eating and exercise
behavior change. Self-monitoring allows you to review
your clients’ current eating and exercise behaviors, identify
what needs to be modified so clients can reach their personal
health/fitness goals, and provide feedback.
By definition, self-monitoring is ‘‘the systematic
observation and recording of target behavior’’ (1) and
has been described as the most effective technique and
the ‘‘cornerstone’’ of behavioral treatments for weight loss
(2). Self-monitoring increases a client’s self-awareness, and
this has been shown to positively influence eating and
exercise behaviors (3). Several weight loss studies have
shown that the more consistent participants were at
self-monitoring and the more self-monitoring diaries were
completed, the greater was the weight loss (4–6). In a
review of studies, D.S. Kirschenbaum, Ph.D., determined
that consistency is best defined as recording at least 75%
of eating and exercise behaviors (7). This relationship
also has been found in high-risk situations. In a study
examining weight change during the holiday season, only
the most consistent self-monitors lost weight (8). Although
self-monitoring is considered to be a valuable tool for
behavior change, it does require the consideration of
several factors to be applied and used appropriately with
your clients.
Teaching your client to effectively and consistently
self-monitor is a process that is dependent upon the client’s
personality, goals, and knowledge regarding his or her
behavior. Taking individual differences into account, your
goal as the health/fitness professional should be to ‘‘help
clients be the best self-monitors they can be’’ (8). As a guide,
you can use the following ‘‘Four Ps of Self-Monitoring’’
to determine the best self-monitoring fit for your clients.
Purpose of Self-Monitoring
It is helpful to explain the benefits of self-monitoring to your
clients so they understand the value and importance it has
in promoting behavior change. Self-monitoring can lead to
self-awareness regarding behaviors and can help the client
regulate behavior more effectively by avoiding and coping
with situations that often lead to failure. Self-monitoring
records can help identify the specific nature of these situations
by answering questions of how, what, when, where, and why.
For example, self-monitoring can provide information
regarding specific details of client behavior such as:
How many calories do they eat?
How much activity do they perform?
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What type of foods do they eat?
What foods do they tend to overeat?
What time of day are they most likely to exercise?
What types of exercise do they enjoy?
When do they eat the majority of their calories?
When are they most likely to miss a planned exercise
session?
Where do they make poor food choices?
Where do they have opportunities for exercise?
Why do they miss exercise sessions?
Why do they want to lose weight or begin an exercise
program?
By addressing the specific details of clients’ behaviors
that occur outside of in-person sessions, you can better assist
them with recognizing patterns of behavior that may
impact progress.
Personalized Approach
What to Monitor
Once you have explained to the client the underlying
purpose and benefits of self-monitoring, the next step is
to decide with the client what behaviors to monitor in
order to best reach their health/fitness goals. It is essential
to keep in mind that this should not be a one-size-fits-all
approach. Take a personalized approach to tracking
client behavior that is based upon personality, environment,
and individual characteristics and goals. For example, for
clients who wish to lose weight, monitoring both eating
and exercise information is the best way to determine
if they are on track. For other clients, eating behaviors may
be related to stressful situations, and thus, feelings of
stress may be an additional variable you may want to
monitor to assist with weight loss.
Collecting baseline data is an important component
of self-monitoring because it provides you with an
understanding of what your clients are currently doing,
which behaviors require minor modification, and which
behaviors you may need to target more heavily. More
information is helpful, but it is not necessary to have clients
heavily self-monitor at the beginning of a program. Rather,
collecting a typical weekday and a typical weekend day of
information may be sufficient to capture a snapshot of
current behaviors. Once this information is collected, it is
beneficial to discuss these initial self-monitoring records with
your clients. This will allow you to identify what areas or
behaviors they find to be most troublesome and to gain
greater insight into how they believe these behaviors can
be changed.
Amount of Detail
Some clients may prefer to keep highly detailed
self-monitoring records that include, for example, date,
time, place, mood, description of food, quantity of food,
calories, grams of fat, and hunger level (Figure 1). Others
will simply want to record whether they made healthy
eating choices at each meal. In determining the amount of
detail your clients should use, pay careful attention to
clients’ attitudes regarding monitoring, personalities, and
time constraints. For some, more will be better, and this
will provide you with ample information to offer feedback
and direction; others may become overwhelmed and
disheartened by trying to attend to too many variables.
There are pros and cons to having clients provide a large
amount of detail regarding behaviors. For example, although
measuring body weight can tell you whether a client is on
track, it does not provide you with any information on eating
and exercise behaviors. This type of self-monitoring may
work for an individual who is successfully losing weight. On
the other hand, for the individual who is struggling with
changing his or her body weight, you have very little
information to determine what is impacting weight loss and
will be limited in the amount of feedback you can provide.
Figure 1. Example of detailed self-monitoring.
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Thus, you need to discuss the optimal approach that allows
them to easily self-monitor, while still adequately describing
the behaviors at hand.
Regardless of the amount of detail provided, the
variables being monitored should be closely tied to the target
behavior of interest. For clients interested in weight loss, these
variables would include total food intake (including type,
calories, and quantity), fat intake, and amount of exercise
performed (5). If a client is unable or unwilling to provide
this amount of detail, monitoring fewer variables will still
increase awareness and serve to direct his or her attention
toward the targeted behavior. Abbreviated measures still
allow the client to track the behaviors he or she is interested in
changing. In addition, it also allows the client to modify the
type of recording to suit his or her personality and lifestyle.
Figure 2 provides examples of abbreviated types of selfmonitoring
that are based upon individual likes and needs.
Looking at the examples, ‘‘Sarah’’ prefers to keep track of
total calories but does not want to do so in an obvious way;
she simply tallies calories consumed throughout the day in
the margin of her day planner. ‘‘Jim,’’ on the other hand,
prefers to have an overall picture of how well he is doing; he
keeps track of his behaviors on a monthly calendar he posts
above his desk. Allowing your clients to determine the
optimal way they would like to monitor their eating
and exercise behaviors will improve compliance to the
self-monitoring process.
Frequency of Monitoring
Another factor that requires a personalized approach
when prescribing self-monitoring is how frequently
clients should record behavior. Unfortunately, there is no
clear formula for the optimal frequency of self-monitoring;
this will depend upon the client’s schedule and ability to
monitor, as well as the targeted behavior, how frequently
it occurs, and the degree of difficulty the client has
experienced while trying to change the behavior in the past.
For example, eating behaviors are best monitored every
time they occur. A client who chooses to self-monitor his
or her eating behaviors only at night will likely underestimate
this information because it is difficult to remember exactly
what and how much was eaten throughout the day. In
addition, the self-awareness that occurs at such a late hour
will do little good because the client cannot modify the
eating plan for that day if needed.
In general, the more frequently your clients monitor
behavior, the better. Frequency of monitoring, however,
should also be determined by how frequently the behavior
may change. For someone interested in weight loss,
weighing more than once per week is not necessary. In fact,
frequent weighing throughout the day or week may lead
to unrealistic expectations about how quickly weight loss
should occur and can ultimately lead to frustration and
disappointment. By selecting an appropriate frequency
of monitoring for the behavior at hand and discussing
individual preferences with your clients, you can maximize
the consistency and effectiveness of self-monitoring.
Pinpoint Method of Monitoring
Once you have discussed which behaviors to monitor,
the degree of detail, and monitoring frequency, the final
step is determining how the client should monitor his or
her behavior. With the increasing availability of health/
fitness information to the consumer, there are a number
of self-monitoring methods from which you can choose.
These vary from basic pen and paper methods such as
sticky notes, diaries, or calendars to more advanced
technologies such as pedometers, personal desk assistants
(PDAs), MP3 players, cell phones, and the Internet.
The most important determinant in which self-monitoring
method to recommend is that it is one the client is
willing and able to use.
The Internet is one avenue of self-monitoring that
is becoming increasingly popular and may be a viable
option for many clients. Many commercial Web sites offer
some form of self-monitoring for eating and exercise
behaviors, and many of these are free of charge. Using the
Internet for self-monitoring will depend upon the
Figure 2. Examples of abbreviated self-monitoring.
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availability and technologic expertise of your clients, but it
does allow for frequent and relatively easy monitoring of
eating and exercise behaviors. You also can have clients send
you electronic copies of these records and easily track
individual progress over time.
Not all clients will prefer to use technology. Some
individuals prefer to use a small notebook specifically for their
self-monitoring or will simply check off their behaviors as
they have met their goals (Figure 2). Whichever method is
decided upon should be matched to the client’s preference
for recording to enhance self-monitoring consistency.
To further determine which method is most
appropriate for your client, consider the following
questions:
1. Does monitoring the target behavior require
subjective or objective information? If you would
like your client to monitor moods, feelings, or ratings
of hunger or fatigue, then having the ability to record
more detailed information is important. Thus pen
and paper, e-mail, or a PDA may be good choices.
On the other hand, if you are only interested in objective
measures such as steps taken each day, a pedometer
can sufficiently provide the client with the information
he or she needs.
2. How does your client prefer to keep track of tasks?
Does your client prefer technology and the ease of modifying
entries by cutting, copying, and pasting, or does he or
she prefer writing things down using pen and paper?
3. What is the client’s technologic experience? Does
your client own a PDA or cellular telephone or have
Internet access? Do they have Internet access throughout
the day or only at limited times?
4. How frequently is your client willing to monitor?
If the behavior requires frequent monitoring, it is
important to find a tool that is readily available. If
your client does not have the self-monitoring tool
available at all times to record behaviors, determine a
method that is more appropriate.
Provide Feedback
Perhaps the biggest advantage of self-monitoring is that
it serves as an avenue for providing feedback to clients on
the behaviors they are attempting to change. Therefore, the
type and style of feedback you provide to clients is critical
for appropriately directing and supporting positive
behavior change. The feedback you provide will depend
upon the amount of detail the client has reported in his or
her self-monitoring records. For example, it is easier to
respond to clients if you have a clear and detailed
picture of the behaviors and choices they have made.
Nevertheless, even less detailed accounts can give you an
adequate indication of whether the client is on track.
When reviewing self-monitoring records, you should ask
the following questions:
What is the overall picture? If a goal was predetermined,
did the client meet his or her goal for the week?
What are some positive behaviors or changes the client
has made?
Are there any patterns of behavior? Do these patterns
support or interfere with the behavior change the client
would like to make?
Are there any additional factors to consider such as
vacation, family emergency, or odd work hours?
Once you have assessed the self-monitoring records,
you are then able to provide feedback to the client based
upon the previously outlined questions. Table 1 provides
step-by-step tips for providing feedback. In addition,
you also should consider the following strategies:
1. Use positive reinforcement. Positive reinforcement
refers to any factor that increases the probability that the
behavior will be repeated and can include encouraging
statements, recognition of progress, and celebration of
small yet meaningful changes. For example, if a client has
struggled with an afternoon snacking habit that has
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interfered with her weight loss, switching from cookies to
fruit is a meaningful change that should be encouraged
and rewarded.
2. Provide prompts for engaging in additional positive
behaviors and modifying negative behaviors. It is
important to try to determine challenging areas for
clients. This information can be learned from studying
patterns within self-monitoring records. Focus upon one
or two areas that the client can modify each week.
3. Modify the type of self-monitoring. Periodically,
you should modify self-monitoring assignments for
your clients based upon their progress, life events, and
personal health/fitness interests. As a client begins to
lose weight, for example, you may consider asking him
to record less information as he may already have a
certain amount of self-awareness regarding portion
sizes and calorie content. Other examples of situations
that require altering the type of self-monitoring
include a client who has decided to focus upon a
different health/fitness goal, a client whose schedule
will change drastically because of work schedule or
travel, or a client who begins to keep inconsistent
self-monitoring records.
Providing feedback to your clients allows you to extend
your personal interactions with them. As the client
begins to make (or not make) the necessary changes and
you begin to have a better understanding of the individual
personality type, you should modify your approach to
feedback so that it continues to remain interesting and
meaningful. Some clients will be driven by your feedback
to make the positive changes needed to be successful
and will enjoy receiving your comments. Others may
be more rebellious and will decide not to heed your
recommendations. By making proper adjustments to
monitoring assignments and the feedback you provide, you
can make self-monitoring a positive, effective tool to
promote the accomplishment of clients’ targeted goals.
Limitations of Self-Monitoring
As with any tool used to promote behavior change,
self-monitoring is not without limitations. First of all,
self-monitoring will not be an effective tool for your clients
unless they record honestly, frequently, and with enough
detail to become more self-aware to regulate the targeted
behavior. In addition, the mere act of recording behaviors
may not be enough to bring about behavior change. If a
client records eating and exercise behaviors but does not
understand the concept of energy balance and energy deficit,
then self-monitoring alone will not be a sufficient stimulus
to promote weight loss. Therefore, work with clients to
discuss areas that can be modified or targeted and educate
Table. Step-by-Step Tips for Providing Feedback
1. Start Positive. Regardless of how well your client managed the targeted behavior and/or kept self-monitoring records, your
first comment should be a positive one. This statement could be very general, (i.e. ‘‘Great job recording this week! I can see
you are trying to make changes in your diet.’’) or it may specifically refer to a behavior, such as ‘‘You did a fantastic
job reaching 150 minutes of physical activity this week!’’
2. Identify 1-2 Areas to Target. Next, provide 1 to 2 specific and meaningful recommendations or suggestions to help the client
make the necessary behavior changes. For instance, based on the self-monitoring records, you might suggest the client reduce
high fat/high calorie foods by substituting these foods with more fruits and vegetables. Or you may highlight situations
during the week where poor choices could have been linked to other factors (i.e. Friday dinner with out-of-town guest,
baseball game, etc.). Be sure to include at least one strategy for how the client can prepare for these situations in the future.
3. Offer Encouragement. Motivate your client by offering them words of encouragement. Although behavior change is highly
dependent on individual personalities, goals, personal barriers, etc., in general, clients respond more favorably to positive
comments than negative ones. Celebrate your clients’ small successes throughout the week by recognizing small changes in
an encouraging way. Offering a simple, ‘‘I know you can do this,’’ or ‘‘you are worth it’’ shows the client you understand
that behavior change requires effort.
4. Make it Meaningful. Try to avoid offering the same feedback to all clients or the similar feedback to the same client week
after week. The feedback you offer should be relevant to the target behavior and should offer clear direction for change.
If the client is unsuccessful, modify the feedback you provide as the client may simply have misunderstood the direction
you provided. When possible, discuss your feedback with the client in addition to giving them a written copy.
ACSM Photo/Don Distel
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them as to why these behavior modifications are important.
A common criticism of self-reporting is that clients often
underreport calories and food intake and overreport
behaviors such as physical activity or calories expended
(10, 11). Nonetheless, self-monitoring can still be a valid
tool for tracking behavior change as individuals most likely
under- or overreport such information on a consistent basis.
Self-monitoring is not for every client. Some clients
will feel burdened by tracking behaviors, and this may lead
to poor compliance to exercise and eating
recommendations. Thus, you need to be willing to modify
self-monitoring assignments or eliminate it altogether if
it begins to decrease, rather than promote adherence.
Summary
While the verdict may still be out on the ‘‘optimal’’ procedure
for self-monitoring, research does support consistency of
monitoring as a critical component of weight control and the
adoption and adherence of an exercise regimen. There are a
number of self-monitoring options available to you and your
client. Therefore, your goal should be to individualize the
assigned self-monitoring tasks to determine what works best
for the client to enhance consistency of self-monitoring and
promote favorable changes.
Melissa Burgard, B.S., is a Master’s candidate
and graduate research assistant in exercise
physiology at the University of Louisville
where her research focuses upon the role of
self-monitoring, feedback, and prompting
upon exercise adherence and weight loss.
Kara Gallagher, Ph.D., FACSM, is an
assistant professor in Exercise Physiology at
the University of Louisville where her research
focuses upon the role of exercise and behavior
change in weight control. She is a member
of the editorial board for ACSM’s Health &
Fitness Journal.1 She is ACSM Exercise
Specialist 1certified, ACE Group Exercise Instructor-certified,
and has worked in university and health/fitness settings for the
last 15 years.
References
1. Kanfer, F. H. Self-Monitoring: Methodological limitations and
clinical applications. Journal of Consulting and Clinical Psychology
35:148–152, 1970.
2. Wadden, T. A. The treatment of obesity: An overview. In: Obesity:
Theory and Therapy (2nd ed.), A. J. Stunkard and T. A. Wadden (Eds.).
New York: Raven Press, 1993, pp. 197–218.
3. Heesch, K. C., L. C. Masse, A. L. Dunn, et al. Does adherence
to a lifestyle physical activity intervention predict changes in physical
activity? Journal of Behavioral Medicine 26(4):333–348, 2003.
4. Boutelle, K. N., and D. S. Kirschenbaum. Further support for
consistent self-monitoring as a vital component of successful weight
control. Obesity Research 6(3):219–224, 1998.
5. Boutelle, K. N., D. S. Kirschenbaum, R. C. Baker, et al. How can
obese weight controllers minimize weight gain during the high
risk holiday season? By self-monitoring very consistently. Obesity
Research 6(3):219–224, 1998.
6. Tate, D. F., R. R. Wing, and R. A. Winett. Using internet technology
to deliver a behavioral weight loss program. Journal of the American
Medical Association 285(9):1172–1177, 2001.
7. Kirschenbaum, D. S. The Nine Truths about Weight Loss. New York:
Henry & Holt, 2000.
8. Baker, R. C., and D. S. Kirschenbaum. Weight control during the
holidays: The potentially critical role of self-monitoring. Presented
at the Meeting of the Association for Advancement of Behavior
Therapy, New York, November 1996.
9. Madden, M., America’s online pursuits: The changing picture of who’s
online and what they do. December 22, 2003. Available at http://
www.pewinternet.org/pfds/PIP_Online_Pursuits_Final.PDF. Accessed
Aug 8, 2005.
10. Horner, N. K., R. E. Patterson, M. L. Neuhouser, et. al. Participant
characteristics associated with errors in self-reported energy intake
from the Women’s Health Initiative food-frequency questionnaire.
American Journal of Nutrition 76:766–773, 2002.
11. Johansson, L.,K. Solvoll, G. E. Bjorneboe, et al.Under- and over- reporting
of energy intake related to weight status and lifestyle in a nationwide
sample. American Journal of Clinical Nutrition 68:266–274, 1998.
Condensed Version and
Bottom Line
Interactions between health/fitness professionals
and clients are often limited to face-to-face meetings
in the gym or health club. Many clients, however,
struggle with maintaining consistent healthy eating
and exercise behaviors outside of these interactions.
Self-monitoring allows you to monitor client progress
and identify areas that may hinder client success.
Self-monitoring also increases self-awareness of
behaviors and allows the client to become familiar with
other factors that are linked to the behaviors he or she
would like to change. By incorporating self-monitoring
into your interactions with clients and by providing
meaningful, directed feedback, you can increase the
likelihood that clients will successfully change eating
and exercise behaviors.
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