Self-Determination Theory in Health Promotion Nursing

Introduction

Jill Watson is an employee of a Telecommunication Company and has been working there for approximately seven years. Within the past few years, Jill has organized numerous health fairs and health help sessions. She also regularly posts information on the company's central bulletin boards about health and well-being, and she assists in providing screening programs for many people. The goal of her health promotion efforts is to enhance positive lifestyles and behavioral changes. Despite her efforts, many people still smoke, do not engage in physical exercise, and remain overweight. While health promotion is essential, providing health information alone is not sufficient to facilitate positive lifestyle or behavioral changes.

The objective of this paper is to use Self-Determination Theory (SDT) to help Jill understand strategies for facilitating positive behavioral and lifestyle changes among her clients.

Theory is a set of related concepts and propositions that explain or describe phenomena in a systematic way. Nursing theory can be defined as the definitions, concepts, relationships, propositions, or assumptions derived from nursing models and designed to prescribe, explain, or predict phenomena. A nursing theory is also described as a body of knowledge that nursing professionals use to support their practice — an organized framework that assists in explaining phenomena. The middle range theory is a nursing theory that focuses on human reality, human experience, and a number of specific concepts. In essence, nursing theory is an autonomous discipline that reinforces nursing practice, education, and nursing research.

Self-Determination Theory and Its Relevance to the Clinical Scenario

SDT focuses on the social environment that influences human values, attitudes, motivations, and behaviors. The theory holds that human organisms are inherently active and motivated, developing naturally over time through an integrative process. This development plays a central and critical role in human learning. SDT further argues that human beings require particular nutriments — psychological and biological — to achieve psychological well-being and healthy development. When these nutriments are absent, human health is impaired, resulting in less than optimal behavior (Deci & Ryan, 2013). SDT also emphasizes human motivation, distinguishing behaviors that originate from within the individual (autonomous behavior) from those driven by interpersonal pressure or external control.

SDT offers a comprehensive approach to studying healthy behavior and is appropriate in a clinical scenario because it supports optimal human development. Moreover, SDT assists in understanding the psychological needs that lead individuals to demonstrate effective behavior, and the particular nutriments that can help human beings achieve healthy development.

Ryan et al. (2008) argue that SDT enhances understanding of health-related behaviors that may be intrinsically or extrinsically motivated, since motivation can facilitate healthy behavior. Motivation is a psychological force that drives an individual toward a specific goal. For example, most health-related behaviors such as physical activity or quitting smoking are extrinsically motivated. Therefore, individuals must be trained to value such behaviors if a health provider intends to enact them successfully.

Patrick & Williams (2012) argue that several health behaviors — such as physical activity, tobacco abstinence, and nutrition — affect health outcomes, and that SDT can assist in understanding healthy behavioral interventions that motivate people to engage in health-promoting conduct. Human behaviors can also affect mortality, morbidity rates, and healthcare costs. Chronic diseases can develop from behaviors such as poor diet and physical inactivity.

Research has shown that "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). An individual adopting two of these lifestyle behaviors will record a 27% lower risk of cardiovascular disease compared to those who adopt none. Moreover, lifestyle behaviors account for 40% of mortality rates in developed countries and contribute to two-thirds of all cancer cases. They also play a role in the management of diabetes, obesity, stroke, cardiovascular disease, and heart attacks. Given the importance of lifestyle behaviors, developing rigorous health behavior interventions can assist in achieving a prolonged quality of life.

Evaluation Model: Using the RCT to Critique SDT

This paper uses the randomized controlled trial (RCT) to evaluate SDT. The rationale for using the RCT model is that it eliminates bias in clinical results by selecting participants randomly. The RCT is highly effective in testing the efficacy of medical interventions and social science research. It divides the experimental population into control and non-control groups, where the control group receives the experimental treatment and the non-control group receives no treatment. The purpose of using the RCT here is to assess whether SDT is useful in explaining and facilitating health behavioral changes with particular reference to obesity.

SDT provides theoretical insights into why some people engage in certain behaviors and the motivations involved in self-regulation. Obesity is notoriously difficult to manage, and engaging in physical activity is an effective strategy for doing so. Silva, Markland, Minderico, et al. (2008) use the RCT to evaluate SDT's utility in explaining and facilitating healthy behavioral change in the context of obesity management. The RCT assists in enhancing understanding of the motivations behind carrying out physical exercise for obese individuals. Despite the benefits of the RCT in providing insight into obesity management strategies, SDT has been found to be most useful for short-term management. Based on the evaluation outcomes, SDT can achieve only modest weight loss when applied over a long period. Patrick et al. (2008) also use the RCT model to evaluate the efficacy of SDT interventions related to dental hygiene, physical activity, and tobacco dependence. The benefit of using the RCT for SDT evaluation is that it is considered the most reliable method of conducting experimental research in healthcare, as it assists in eliminating bias and establishing causality.

References

Deci, E. L., & Ryan, R. M. (2013). Handbook of theories of social psychology: Volume 1, self-determination theory. SAGE Publications Ltd.

Ng, J. Y. Y., Ntoumanis, N., & Thogersen-Ntoumani, C. (2012). Self-determination theory applied to health contexts: A meta-analysis. Perspectives on Psychological Science, 7, 325–340.

Niemiec, C. P., & Ryan, R. M. (2009). Autonomy, competence, and relatedness in the classroom: Applying self-determination theory to educational practice. Theory and Research in Education, 7, 133–144.

Patrick, H., & Williams, G. C. (2012). Self-determination theory: Its application to health behavior and complementarity with motivational interviewing. International Journal of Behavioral Nutrition and Physical Activity, 9, 18.

Ryan, R. M., Patrick, H., Deci, E. L., & Williams, G. C. (2008). Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. The European Health Psychologist, 10, 2–5.

Silva, M. N., Markland, D., Minderico, C. S., et al. (2008). A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: Rationale and intervention description. BMC Public Health, 8, 234.