Jill Watson is an employee of Telecommunication Company and has been working for the company for approximately 7 years. Within the past few years, Jill has organized numerous health-fairs as well as countless health help sessions. She also regularly posted information on the company central bulletin boards about health and well-being. Moreover, she assists in providing screening program for many sick people. The goal of her health promotion is to enhance positive lifestyles and behavioral changes for people. Despite her promotional effort, many people still engage in smoking habits, do not engage in physical exercise, and are still overweight. While health promotion may be essential, however, providing health information is not sufficient to facilitate positive lifestyle or behavioral changes.
The objective of this study is to use the self-determination theory to assist Jill to understand the strategy to facilitate positive behavioral or lifestyles changes among her clients.
Theory is a set of related concept and document that explains or describes phenomena in a systematic method. However, nursing theory can be defined as definitions, concepts, relationships, proposition or assumptions that are derived from nursing models and designed from concepts for the purpose of prescribing, explaining, or predicting. A nursing theory is also being referred as a body of knowledge that nursing professionals use to support their practice. In other word, nursing theory is an organized body of knowledge that assists in explaining phenomena. The middle range theory is a nursing theory that focuses on human reality, human experience as well as number of concepts. In essence, nursing theory is an autonomy that reinforces nursing practice, education and nursing research.
Self-determination Theory and its Relevance to Clinical Scenario
SDT (self-determination theory) focuses on the social environment that influences human values, attitudes, motivations, as well as human behaviors. In essence, the SDT shows that human organisms are inherently active, motivated and develop naturally over time through an integrative process. This development plays a central and critical role in human learning. In essence, the SDT argues that human being requires particular nutriments such as psychological and biological nutriments used in achieving the psychological well-being and health development. However, if the nutriments are lacked, human heath will be impaired resulting in exhibiting less than optimal behavior. (Deci, & Ryan, 2013). The SDT also believes in human motivation that focuses on behaviors that originate from oneself (autonomous behavior) rather than the controlled behavior or behavior being pressured by the interpersonal forces.
In essence, SDT offers a comprehensive approach to study a healthy behavior and is appropriate in a clinical scenario because it assists in optimal human development. Moreover, the SDT assists in understanding the psychological needs that makes human in demonstrating an effective behavior. Thus, the theory assists in understanding the particular nutriments that could assist human to achieve healthy development.
Ryan et al. (2008) argue that the SDT assists in enhancing a greater understanding of the health related behaviors that may be intrinsic motivated or extrinsic motivated since motivation can facilitate a healthy behavior. In essence, motivation is a psychological force that impels an individual towards a specific goal. For example, most of the health related behaviors such as physical activity or quitting smoking are extrinsic motivated. Thus, individuals are to be trained to value such behaviors if a health provider intends to enact such behavior successfully.
Patrick & Williams (2012) in their argument shows that several health behaviors such as physical activity, tobacco abstinence, and nutrition can have effect on health outcomes and STD can assist in understanding healthy behavioral interventions that can be used to make people conduct in healthy related behaviors. Moreover, human behaviors can affect mortality, morbidity rates as well as health care costs. In effect, chronic diseases can develop from behaviors such as poor diet, and physical inactivity.
Thus, "five key lifestyle behaviors (eliminating tobacco exposure, body mass index
(BMI) < 25, engaging in 30 minutes of physical activity or more per day, consuming alcohol in moderation, and eating a healthy diet) reduced coronary events by 62% over
16 years in a cohort of 42,000 U.S. adult men." (Patrick & Williams, 2012 p 1).
Thus, an individual adopting in two of these lifestyle behaviors will record 27% lower risks in cardiovascular compared to people who do not adopt the lifestyles. Moreover, lifestyle behaviors account for the 40% of the mortality rates in developed countries and contribute to the two third of all cancer cases. Lifestyle behaviors also account for the management of diabetes, obesity, stroke, cardiovascular disease, and heart attacks. Given the importance of lifestyle behaviors, developing a rigorous health behaviors can assist in achieving a prolong quality of life.
2. Evaluation Model (criteria) to critique the SDT
This study uses the RCT (randomized controlled trial) to evaluate the SDT. The rational for using the RCT model is that it eliminates bias in the overall clinical results since the RCT selects people randomly for the clinical experiment. Typically, the RCT is very effective in testing the effectiveness or efficacy of medical interventions and social science research. The RCT divides the experimental population in control and non-control groups where the control groups receive experimental treatments where non-control group receive no treatment. The essence of the RCT is to assess whether the SDT is useful in explaining and facilitating health behavioral changes for the obesity.
In essence, the SDT provides theoretical insights on the reasons some people engage in certain behaviors and motivations involved in self-regulation behaviors. Typically, obesity is notoriously difficult to manage and indulging in physical activity is an effective strategy to manage obesity. Silva, Markland, Minderico, et al. (2008) uses the RCT to evaluate the SDT utility in explaining and facilitating health behavioral change with reference to obesity management. Typically, the RCT assists in enhancing a better understanding of motivations behind carrying out the physical exercise for obese people. Despite the benefits of RCT in enhancing a greater understanding on the strategy that can be used to manage obesity, however, the STD is only useful to manage the obesity for a short period. Based on the outcomes of the evaluation of the RCT model, the STD can only be used to achieve a little weight loss when using the theory for a long period. Patrick et al. (2008) also use RCT model to evaluate the efficacy of the SDT on the intervention on dental hygiene, physical activity, and tobacco dependence. The benefit of using the RCT for the evaluation of the SDT is that the model is considered the most reliable method in conducting experimental research in healthcare because it assists in eliminating bias and causality.
3. Evaluation Results
This section provides the origin of the theory and key concepts associated to the theory. The section also discusses the strengths and limitation of the theory based on the evaluation results.
3a.Origin of SDT, Key Concepts and their Relationships
The STD was developed in 1970s to compare intrinsic and extrinsic motivation. Although, there was a general understanding during the period that the intrinsic motivation dominated human behaviors, however, it was in 1980s that STD was formally accepted as an effective and sound empirical theory. Since 2000s, the STD has been applied in a clinical setting, and Deci & Ryan (2013) point out that "SDT evolved out of research on the effects of extrinsic rewards on intrinsic motivation." (p 5). For example, college students were being paid for carry out a work on intrinsically interesting puzzles; however, monetary rewards derived from the work undermined the activity's intrinsic motivation. Deci et al. (2013) further confirm that rewards undermine intrinsic motivation because they do not enhance motivation for subsequently persistence.
The SDT defines motivation as an intention of an individual to engage in a specific behavior. The theory also distinguishes between the intrinsic motivation and extrinsic motivation, where an extrinsic motivation is a kind of behavior to achieve behavioral outcome that is difference from a self-behavior. Thus, the concept extrinsic motivation occurs when people act because they are compelled or pressured to carry out certain behavior. However, the SDT identifies intrinsic motivation as the kind of behavior that people engage in order to derive satisfaction and enjoyment. Although, "intrinsic motivation is linked to greater productivity, creativity, spontaneity, cognitive flexibility, and perseverance, however, most human behaviors are not intrinsically motivated." (Silva, Markland, Minderico, et al. 2008 pp2-3).
The SDT also divides extrinsic motivation into external regulation, identified regulation, introjected regulation, and integrated regulation. The external regulation shows that people engage in certain behaviors because they will drive rewards or punishment from such behaviors. However, introjected regulation is a moderately controlled motivation leading to ego involvement. The identified regulation reveals the importance of value, goal and regulation. However, integrated regulation reveals coherence between values, goal and regulation.
3b. SDT Innovative Diagram
The fig 1 reveals the three types of SDT motivations that include demotivation, extrinsic motivation and intrinsic motivation. As being revealed in the diagram, the extrinsic motivation is further divided into: