Supporting patient autonomy is critical to improving health

Even as we spend more on healthcare every year, the number of people with chronic health problems continues to rise in developed countries like the United States. Most of these chronic health problems – such as obesity, Type 2 diabetes, and cardiovascular disease – can be addressed through lifestyle changes. But knowing that we should make a lifestyle change to improve our health and actually making that lifestyle change are two very different things.

In a new article published in the July 2012 issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientist Johan Ng of the University of Birmingham and his colleagues investigate the factors that influence our motivation to engage in and adhere to behaviors that promote good .

According to the researchers, self-determination theory, a general theory of human motivation, is especially useful for understanding why we behave the way we do, especially in the context of health. Self-determination theory holds that there are three basic psychological needs that, when met, help us to initiate and maintain over the long-term. We have a need for autonomy, or feeling like we originate and control our own behaviors; we have a need for competence, or feeling effective; and we have a need for relatedness, feeling understood and care for by others.

"Although the framework of self-determination theory is frequently used by researchers within the health domain, to date no effort has been made to combine and compare research findings across the many sub-domains of this research," says Ng. Such a comparison could have important implications both for research and for health practitioners.

Using a technique called meta-analysis, the researchers were able to examine and analyze the entire body of research on self-determination theory in health contexts. After searching the literature, they identified 184 different sets of data that examined the influence that various factors may have on health behaviors such as physical activity, diabetes care, abstinence from tobacco, and weight control. The researchers were especially interested in looking at the relationships between the contextual and individual-level factors related to self-determination theory, including whether a climate is supportive of patient autonomy, whether participants' psychological needs are satisfied, and how participants think about the causes of their physical health status.

In line with the researchers' hypotheses, results from the meta-analysis showed that respect for patients' autonomy in health care settings was positively related to patients' feelings of autonomy, competence, and relatedness in relation to the target health behavior. Furthermore, satisfaction of the three psychological needs was positively related to patient well-being, including both improved mental and physical health.

When the researchers created a model that calculated the relative causal influence of various factors on health behaviors, they found competence to be a particularly important factor. These results suggest that patients' perception of effectiveness in their ability to change often ingrained health behaviors is critical to their ability to actually make that change.

Overall, the meta-analysis provides clear evidence for the importance of patient-centered healthcare. "Recently, patient autonomy has been identified as an important aspect of medical ethics. Our findings show that this focus on is, in fact, conducive to positive health changes," says Ng. "Our results showed that supporting patients' psychological needs is essential to practitioners in helping patients attain their health goals and outcomes.

Ng and his colleagues are hopeful that their research will have direct practical applications to healthcare. Educators, parents, employers, and public health policy makers, for example, can use principles from self-determination theory to inform their messages and promote healthy living. And health care practitioners, biomedical ethicists, health care educators, and insurers may find that self-determination theory provides useful guidelines about how interventions can be shaped to be more effective and more cost-effective at the same time.

"Future research in this area will provide a fuller understanding of the mechanisms of self-determination theory-based interventions and how they can help to improve the length and quality of individuals' lives," Ng concludes.

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