Self‐determination theory: the role of the health care professional in promoting mindfulness and perceived competence

The purpose of the current study was to predict mindfulness and perceived competence using self‐determination theory (SDT ). Within SDT , we specifically examined basic needs theory via global basic needs (i.e., competence, autonomy, and relatedness) and two domain specific basic needs (i.e., exercise & health care) settings. One hundred and thirty‐one college students from a Midwest urban university participated in this study. Using multiple regression analyses, we predicted 22% and 36% of the variance in mindfulness and perceived competence, respectively. Meeting basic needs in exercise settings and perceiving that autonomous exercise behaviors were supported by health care practitioners predicted variance in participants’ mindfulness and perceived competence beyond the variance accounted for from global basic needs satisfaction. More specifically, findings supported the importance of competence satisfaction in general settings and exercise settings. In addition, students who perceived that their health care practitioners supported their autonomy in pursuing exercise also exhibited more mindfulness and had stronger perceived competence for exercise compared to students who viewed their health care practitioners as less autonomy supportive. Health care professionals should be cognizant that their interactions with patients about exercise have the potential to influence patient's mindfulness and perceived competence.     

Examining exercise dependence symptomatology from a self-determination perspective

Background Pulling from Self-Determination Theory (SDT; Deci & Ryan, 1985), this study examined whether individuals classified as 'nondependent-symptomatic' and 'nondependent-asymptomatic' for exercise dependence differed in terms of reported levels of exercise-related psychological need satisfaction, self-determined versus controlling motivation and exercise behavior. In addition, we examined the type of motivational regulations predicting exercise behavior among these different groups, and their role as mediators between psychological need satisfaction and behavioral outcomes. Methods Participants (N = 339) completed measures of exercise-specific psychological need satisfaction, motivational regulations, exercise behavior and exercise dependence. Results Nondependent-symptomatic individuals reported higher levels of competence need satisfaction and all forms of motivational regulation, compared to nondependent-asymptomatic individuals. Introjected regulation approached significance as a positive predictor of strenuous exercise behavior for symptomatic individuals. Identified regulation was a positive predictor of strenuous exercise, and completely mediated the relationship between competence need satisfaction and strenuous exercise behavior, for asymptomatic individuals. Conclusions The findings reinforce the applicability of SDT to understanding the quantity and quality of engagement in exercise.     

Self‐Determination Theory and Well‐Being in the Health Care Profession

In the current study, we predicted two forms of well‐being using basic needs theory (BNT). We examined domain‐specific (i.e., exercise) and global basic needs satisfaction (e.g., competence). One‐hundred twenty‐one pharmacists and nurses from eight hospitals in a large Midwest inner city participated. We predicted 24% and 44% of the variance in mindfulness and vitality, respectively, with basic needs in exercise and life in general making significant contributions. Our findings supported the importance of competence satisfaction as the most critical basic need compared to autonomy and relatedness. Regular physical activity alleviates negative psychological states but can also potentially enhance positive mood states such as mindfulness and vitality if the exercise setting promotes a need satisfaction for competence.     

A Path‐Analytic Model of Self‐Determination Theory in a Physical Activity Context

This study examines Self‐Determination Theory (SDT) in a physical activity context, using a prospective design to predict leisure time physical activity. We expected need satisfaction and self‐determined motivation to predict physical activity 1 month later. One hundred sixteen undergraduate students completed two questionnaires, 1 month after the other. As anticipated, a path analysis revealed the proposed model to fit the data. Specifically, each psychological need positively predicted self‐determined motivation, and competence negatively predicted nonself‐determined motivation. Self‐determined motivation was then found to predict physical activity 1 month later, while nonself‐determined motivation was not a significant predictor. These findings support the theoretical model proposed by SDT and the implications of these findings are discussed.     

A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective

A systematic review and meta-analysis was conducted of the techniques used to promote psychological need satisfaction and motivation within health interventions based on self-determination theory (SDT; Ryan &; Deci, 2017. Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Press). Eight databases were searched from 1970 to 2017. Studies including a control group and reporting pre- and post-intervention ratings of SDT-related psychosocial mediators (namely perceived autonomy support, need satisfaction and motivation) with children or adults were included. Risk of bias was assessed using items from the Cochrane risk of bias tool. 2496 articles were identified of which 74 met inclusion criteria; 80% were RCTs or cluster RCTs. Techniques to promote need supportive environments were coded according to two established taxonomies (BCTv1 and MIT), and 21 SDT-specific techniques, and grouped into 18 SDT based strategies. Weighted mean effect sizes were computed using a random effects model; perceived autonomy support g?=?0.84, autonomy g?=?0.81, competence g?=?0.63, relatedness g?=?0.28, and motivation g?=?0.41. One-to-one interventions resulted in greater competence satisfaction than group-based (g?=?0.96 vs. 0.28), and competence satisfaction was greater for adults (g?=?0.95) than children (g?=?0.11). Meta-regression analysis showed that individual strategies had limited independent impact on outcomes, endorsing the suggestion that a need supportive environment requires the combination of multiple co-acting techniques.     

Predicting Objectively Measured Exercise Participation from Motivation and Basic Needs Satisfaction: Does a Mediational Model Exist?

This study (a) explored whether relationships exist between objectively assessed exercise participation and both controlled extrinsic motivation and amotivation, and (b) investigated the possible mediation of the relationships between satisfaction of the basic needs and objectively assessed exercise participation. Participants (n = 162) were members of a worksite wellness program. Before beginning the program, participants completed a 33‐item survey measuring the constructs of self‐determination theory. Objectively assessed exercise participation was measured via attendance. Path analysis revealed that the net effect of external regulation on attendance was positive. Of the basic needs, only autonomy was a significant predictor of attendance, with no mediation of this relationship. Appealing to participants' external regulation and need for autonomy may enhance exercise participation.     

Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians

There is considerable variation in care provided to patients with diabetes related to metabolic control, preventive services, and degree of patient-centered support. This study evaluates the relation of self-determination theory (SDT) constructs of clinician autonomy support, and patient competence to glycemic control, depressive symptoms, and patient satisfaction from baseline surveys of 634 patients of 31 Colorado primary care physicians participating in a program to improve diabetes care. Spearman correlations of autonomy support from one's clinician with patient competence, HbA1c, depressive symptoms and satisfaction were significant (R = -0.11 to 0.55, P < 0.005). Structural equation modeling demonstrated that autonomy support was significantly related to perceived competence, depressive symptoms, patient satisfaction, and indirectly to glycemic control. Perceived competence was significantly related to depressive symptoms, patient satisfaction and glycemic control. Further, the motivation constructs from SDT accounted for 5% of the variance in glycemic control, 8% of the variance in depression, and 42% of the variance in patient satisfaction. Quality improvement efforts need to pay greater attention to patient competence, satisfaction, and depression, in addition to glycemic control. Clinician autonomy support was found to be reliably measured and moderately correlated with psychosocial and biologic outcomes related to diabetes self-management. These results suggest training clinicians to increase their support of patient autonomy may be one important avenue to improve diabetes outcomes.     

The Cardiff dental study: A 20‐year critical evaluation of the psychological health gain from orthodontic treatment

Objectives. Despite the widespread belief that orthodontics improves psychological well‐being and self‐esteem, there is little objective evidence to support this ( Kenealy et al., 1989a ; Shaw, O'Brien, Richmond, & Brook, 1991 ). A 20 year follow‐up study compared the dental and psychosocial status of individuals who received, or did not receive, orthodontics as teenagers. Design. A prospective longitudinal cohort design with four studies of the effect of orthodontic treatment. Secondary analysis of outcome data incorporated orthodontic need at baseline and treatment received in a 2 × 2 factorial design. Methods. A multidisciplinary research programme studied a cohort of 1,018, 11–12 year old participants in 1981. Extensive assessment of dental health and psychosocial well‐being was conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pre‐treatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow‐up 337 (30–31 year olds) were re‐examined in 2001. Results. Participants with a prior need for orthodontic treatment as children who obtained treatment demonstrated better tooth alignment and satisfaction. However when self‐esteem at baseline was controlled for, orthodontics had little positive impact on psychological health and quality of life in adulthood. Lack of orthodontic treatment where there was a prior need did not lead to psychological difficulties in later life. Dental status alone was a weak predictor of self‐esteem at outcome explaining 8% of the variance. Self‐esteem in adulthood was more strongly predicted (65% of the variance) by psychological variables at outcome: perception of quality of life, life satisfaction, self‐efficacy, depression, social anxiety, emotional health, and by self‐perception of attractiveness. Conclusion. Longitudinal analysis revealed that the observed effect of orthodontic treatment on self esteem at outcome was accounted for by self esteem at baseline. Prior need for treatment assessed in childhood made a small contribution to the prediction of self‐esteem 20 years later in adulthood. Dental status in adulthood, whilst statistically significant, appeared to be of minor importance in a model that included other psychological variables. When prior need for treatment was taken into account there was little objective evidence to support the assumption that orthodontics improves long‐term psychological health.     

Understanding the influence of resilience for people with a lived experience of mental illness: A self‐determination theory perspective

Behaviors associated with resilience can be seen as tantamount to coping with stress and vulnerability. This is important for people who live with mental illness. This study aimed to determine whether key basic psychological needs influence resilience among people with a lived experience of mental illness. A total of 159 consumers with a lived experience of mental illness completed self‐report surveys measuring resilience and the basic psychological needs (autonomy, competence, and relatedness) espoused in self‐determination theory. A 2‐step analysis was conducted, including Pearson product correlations and stepwise multiple regression. Higher levels of relatedness significantly predicted resilience. Competence and autonomy did not have a significant influence on resilience. Reconnecting or establishing social relationships within ones community is important for people living with mental illness. The link between resilience and relatedness ought to be considered in treatment plans.     

Exercise behaviour change in 40 to 65‐year‐old women: The SWEAT Study (Sedentary Women Exercise Adherence Trial)

Objective: The purpose of this study was to examine the relation between self‐reported psychological processes and changes in exercise behaviour in an 18‐month longitudinal stage‐based intervention trial in 115 initially sedentary women aged 40‐65 years. Design: A two‐way factorial design was used. Methods: Participants were assigned randomly to either moderate or vigorous and either home or centre‐based exercise. After six months, all participants exercised at home. Participants completed questionnaires at baseline, six, 12 and 18 months which assessed stage of exercise behaviour, self‐efficacy, decisional balance and processes of change. Results: 28 patterns of stage change were identified across the 18 months with 6.1% remaining sedentary and 45% demonstrating linear movement from contemplation to action to maintenance to continued maintenance. Two interpretable clusters were identified within both the contemplation (at baseline) and action (at six months) stages. Cluster membership, however, did not influence behaviour change. For participants demonstrating a linear pattern of change, self‐efficacy for overcoming barriers and behavioural processes increased from contemplation to action. Self‐efficacy for exercise competence increased from contemplation to action but was more pronounced for the vigorous exercise groups. Decisional balance showed a three‐way interaction and there was no change for experimental processes. There was no change in any variable from action to maintenance. Conclusions: The intervention was seen to be effective regardless of location or intensity of exercise. The relevance of substages is questionable in stage‐based interventions as women with a profile suggesting less readiness to change or sustain change were just as likely to adopt or maintain exercise.     

Physical Exercise in Chinese Older Adults: A Transtheoretical Model1

Physical exercise has a positive impact on physical and mental health among older adults. This study identifies significant correlates of exercise behavior among Hong Kong Chinese older adults under the transtheoretical model. The data came from a survey of a representative community sample of 425 elderly respondents in Hong Kong. Using multiple regression models, the authors found that perceived benefits of exercise and self‐efficacy for exercise were related significantly to exercise behavior, and their effects on exercise were mediated completely through the stages of changes in exercise. Although perceived barriers to exercise are significantly and negatively associated with exercise behavior, this relationship disappeared in multiple regression analysis after controlling demographic and several health‐related variables. Findings suggest that perceived benefits and self‐efficacy on exercise should be strengthened to motivate older adults to engage in a more active lifestyle.     

Integrating the theory of planned behaviour and self‐determination theory in health behaviour: A meta‐analysis

Purpose A meta‐analysis of studies integrating the theory of planned behaviour (TPB) and self‐determination theory (SDT) in health contexts is presented. The analysis aimed to provide cumulative empirical support for a motivational sequence in which self‐determined motivation from SDT predicts the proximal predictors of intentions and behaviour from the TPB. Methods A literature search identified 36 integrated studies providing 45 tests of effects between TPB and SDT variables. Hunter and Schmidt's (1994) methods of meta‐analysis were used to correct the effect sizes across the studies for statistical artifacts. Age (old versus young), publication status (published versus unpublished), study design (correlational versus experimental/intervention), and behaviour type (physical activity versus other health‐related behaviours) were evaluated as moderators of the effects. A path‐analysis using the meta‐analytically derived correlations was conducted to examine the proposed motivational sequence. Results Statistically significant corrected correlations were evident among the perceived autonomy support and self‐determined motivation constructs from SDT and the attitude, subjective norms, perceived behavioural control, intention, and health‐related behaviour constructs from the TPB. Only six of the 28 effect sizes were moderated by the proposed moderators. Path analysis revealed that the significant effects of self‐determined motivation on intentions and behaviour were partially mediated by the proximal predictors from the TPB. Conclusions Evidence from this synthesis supported the theoretical integration and proposed motivational sequence. Results are discussed with reference to the complementary aspects of the TPB and SDT and the need for integrated experimental or intervention studies on a broader range of health behaviours.     

Leadership competence and political control: The influential factors

This study considers the impact of social support upon the psychological empowerment of community activists. Although it has been clearly shown that the human and personal resources that individual activists bring to their voluntary activity and the inputs of the agencies and associations in which they are active both contribute to the activists' empowerment, little research has considered the effect of the support given by family, friends, and significant others. One hundred twenty‐two community activists in the lower socioeconomic neighborhoods of a city in the center of Israel filled in questionnaires at the conclusion of a year's training program. The questionnaires included scales of social support (family and friends), satisfaction with the course (practical and learning), leadership competence, policy control, self‐esteem, and mastery. The variables were of importance in their contribution to leadership competence and policy control, but in different ways. Both forms of satisfaction from the course, self‐esteem, and family support, contributed to leadership competence, while both mastery and self‐esteem, and the support of friends contributed to policy control. The differences between leadership competence and policy control are discussed in the light of these findings. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 371–381, 2003.     

RELATIONSHIPS BETWEEN GLOBAL AND DOMAIN‐SPECIFIC SELF‐EVALUATIONS AND TYPES OF OFFENDING IN COMMUNITY BOYS AND GIRLS

This study investigates age‐ and gender‐specific relationships between global and domain‐specific self‐evaluations and types of offending in school‐going adolescents. A self‐report survey was administered to 710 boys and girls, using the Dutch version of the Self‐Perception Profile for Adolescents and an offending questionnaire. Property‐only (vs. non‐) offending is related to low perceived behavioral conduct. Violent‐only (vs. non‐) offending is negatively related to perceived behavioral conduct in both boys and girls. In addition, violent‐only (vs. non‐) offending is related to low perceived scholastic competence in girls but high perceived scholastic competence in boys. Both property and violent (vs. non‐) offending is related to low perceived behavioral conduct but high perceived close friendship. The findings generally support the view that low rather than high self‐evaluation is related to offending. This relation differs according to the subscale of self‐evaluation, the type of offending, only marginally according to gender, and not at all according to age.     

EFFECTIVE YOUTH MENTORS: THE RELATIONSHIP BETWEEN INITIAL CHARACTERISTICS OF COLLEGE WOMEN MENTORS AND MENTEE SATISFACTION AND OUTCOME

To optimize the effectiveness of youth mentoring it is important to begin to identify specific preexisting characteristics of mentors that lead to positive experiences for adolescent mentees. College women mentors, aged 18 to 22 years, were paired with middle school girls, aged 11 to 14 years, for weekly one‐on‐one and group mentoring in an 8‐month, school‐based youth mentoring program. For the sampled 142 mentor‐mentee dyads participating in the program, mentor's reported academic self‐worth, parent relationship, and not being too autonomous were important preexisting characteristics related to mentee satisfaction. Mentor's initial level of depression was negatively correlated with mentee's self‐reported improvement in competence, while mentor anxiety was positively correlated. Finally, the relationship between mentor's autonomy (negative) and ethnocultural empathy (positive) and mentee outcomes were stronger for cross‐race versus same‐race pairs. Implications for mentoring programs that use college students as youth mentors are discussed.     

Success in Weight Management Among Patients with Type 2 Diabetes: Do Perceived Autonomy Support,Autonomous Motivation,and Self-Care Competence Play a Role?

Based on self-determination theory (SDT), this study investigated whether the three central SDT variables—perceived autonomy support (from a physician), autonomous motivation and self-care competence—were associated with success in weight management (SWM) among primary care patients with type 2 diabetes when the effect of other important life-context factors was controlled for. Patients participated in a mail survey in 2011. Those who had tried to change their health behavior during the past two years in order to lose weight, either with or without success (n = 1433, mean age 63 years, 50% men), were included in this study. The successors were more autonomously motivated and energetic than the non-successors. Moreover, male gender, younger age, taking oral medication only, and receiving less social support in diabetes care predicted better success. Autonomous motivation predicted SWM; self-care competence also played a role by partly mediating the effect of autonomous motivation on SWM. These results support the idea of SDT that internalizing the value of weight management and its health benefits is necessary for long-term maintenance of health behavior change. Perceived autonomy support was not directly associated with SWM. However, physicians can promote patients' weight management by supporting their autonomous motivation and self-care competence.     

What motivates girls to take up exercise during adolescence? Learning from those who succeed

Objectives. The present study explored factors that underpin increased internalization (i.e., perceived autonomy) in motivation towards exercise over a 1‐year period in adolescent girls. Design. A mixed methods prospective study. Methods. A total of 107 girls (mean age = 13.28 years) reported their exercise behaviour, exercise goals, and a multidimensional measure of motivation towards exercise on two occasions, 1 year apart. Ten girls reporting increased autonomous motivation were then interviewed. Results. Two themes were extracted; growing up and seeking challenge. Most participants reported being more interested in exercising for their health as a result of growing up, through having greater understanding of the health‐behaviour link and willingness to act now for future health gain. However, their motivation appeared to be only partially internalized, as health was still viewed primarily as a value promoted by respected others (parents, teachers, media). Furthermore, as many girls conflated being healthy with being thin, health for appearance‐related weight control was experienced as an extrinsic (controlling) goal. The second theme was more suggestive of autonomous motivation; girls reported valuing exercise for the opportunity it provides to set and achieve personally meaningful challenges, facilitating a sense of competence and achievement. Conclusions. The findings may have a useful application in suggesting how exercise settings could be manipulated to increase enjoyment and participation during adolescence. In particular, the findings suggest that means of increasing the salience of the rewarding nature of setting and reaching personal challenges in an exercise setting are investigated.     

Attributional biases in subclinical depression: A schema‐based account

Non‐depressed individuals exhibit a self‐serving attributional bias, taking more credit for success than for failure. Clinically and subclinically depressed people are less self‐serving, often to the point of making similar attributions (explanations) for successes and failures. The present studies evaluated a schematic account of these distinct attributional biases. Subclinically depressed and non‐depressed participants completed measures of attributional bias (the relative strength of ability attributions for success versus failure), schema‐based optimism (the relative expectedness of success versus failure) and self‐schemas of competence. Two studies evaluated a hypothesis derived from the schematic account: the greater the perceived competence and optimism, the more self‐serving the attributional bias. As predicted, (a) attributional bias scores covaried with optimism and competence scores in both magnitude and valence (or direction), (b) depressed‐non‐depressed differences in attributional biases paralleled differences in competence and optimism and (c) when attributional bias scores were adjusted for the effects of optimism or competence, depressed–non‐depressed differences in attributional biases were eliminated. The schematic account raises questions about the common assumptions that attributional patterns are traits, and that they play a central role in the aetiology and treatment of depression. Copyright © 2007 John Wiley & Sons, Ltd.     

Volunteer motivation: A field study examining why some do more,while others do less

In nonprofit organizations, motivating volunteers for particular activities is challenging because they can take place in unstructured environments. Therefore, members are disengaged despite their initial commitment to the cause. An important opportunity in the literature is to examine motivation from the perspective of the volunteer; and, more specifically, to test for the differential impact that self‐efficacy, collective efficacy, and perceived organizational support have on three motivational outcomes: effort, performance, and satisfaction. Our focus is on volunteer motivation to support a specific event or project. Teasing out the impact of one's efficacious beliefs about their group at the individual level is an important contribution that has yet to be examined. Using data from 285 volunteers, results indicate that collective efficacy and perceived organizational support positively influence volunteer satisfaction. An important contrast we confirmed, unlike self‐efficacy and perceived organizational support, was collective efficacy's negative relationship to effort, which in turn affected performance. We were able to isolate the unique relationships, corroborating extant research with respect to self‐efficacy and perceived organizational support. As a result, the potential for spurious relationships was ruled out, adding credibility to the new findings.