Assessment Methods

Self-Monitoring: Influencing Effective Behavior Change in Your Clients,” article below

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





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







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






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





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.







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.






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:// 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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