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There are no literature reviews that have examined the impact of health-domain interventions, informed by self-determination theory (SDT; Ryan & Deci, 2017), on SDT constructs and health indices. Our aim was to meta-analyze such interventions in the health promotion and disease management literatures. Studies were eligible if they used an experimen...
Contexts in source publication
Context 1
... two studies were excluded because the results were based on duplicated datasets in other included papers. Therefore, the final publication pool included 73 studies (there were no studies with multiple datasets); see Figure 1 for the PRISMA flowchart. ...
Context 2
... test the potential impact of outliers, analyses were repeated by removing outliers. After calculating Sample-Adjusted Meta-Analytic Deviancy (Huffcutt & Arthur, 1995) scores for each study, potentially outlying studies were detected on resulting scree-plots (see Supplementary File Figures S1-S22). This approach identifies the influence of each study on the overall effect size by calculating the effect size without the study present and takes into account the sample size of the study. ...
Citations
... Autonomy is the volitional feeling in one's choices that becomes an expression of intrinsic motivation supported by personal locus of control (Ryan and Deci, 2017;Fazey and Fazey, 2001). Relatedness is feeling accepted by one's social environment with a sense of belonging and responsiveness with and to others (Ryan and Deci, 2017;Ntoumanis et al., 2021). Self-regulation and behavioral change are linked by these constructs that implicate individuals as self-determined agents of their actions. ...
Introduction: The evolution of healthcare continues to display an incongruence between delivery and outcomes. Current healthcare paradigms for patient empowerment warrants analysis. A lacking operational application for and agree upon assessment of patient empowerment contributes to healthcare's incongruence. Interchangeable psychosocial concepts and specific patient contextual factors associated with health-related behavioral change have escaped an applicable definition of empowerment. The aim of this theoretical perspective review is to support a comprehensive and contextual understanding of patient empowerment that frames a definition for future consensus research.
Methods and mechanisms: A theoretical perspective review of patient empowerment including interchangeable concepts and patient contextual factors such as personal suffering and resilience; self-determined meaning and purpose; and autonomy, competence, and self-efficacy are critically analyzed. This analysis builds on adjacent concepts including therapeutic alliance, communication, motivation, and trust. The inclusion of specific patient contextual factors that relate to behavioral change elevate the need to reinforce coping and self-management skills as mechanism for patient empowerment. Practice gaps for those experiencing chronic disease, pain, and mental health disorders in rehabilitation setting are specific populations who benefit from healthcare providers unifying the variables associated with patient empowerment.
Results and discussion: The review of associated concepts synthesized an actionable definition of patient empowerment that serves as a foundation for future research. Behavior related changes occur through the evolution in one's identity, perceptions, and abilities. Interventions that inspire autonomy, competence, and relatedness with a renewed sense of purpose establish resilience and self-efficacy. The totality of this inspired self-determined plan of care establishes the mechanisms required for behavioral change and sustainable transformation. The cumulative experience becomes patient empowerment.
CITATION Varela AJ, Gallamore MJ, Hansen NR and Martin DC (2025) Patient empowerment: a critical evaluation and prescription for a foundational definition.
... Different types of work motivation predict different work outcomes (Ferraro et al., 2018). In environments where autonomous forms of work motivation predominate, employees are more likely to manifest better psychological health (Dagenais-Desmarais et al., 2018aNtoumanis et al., 2021), psychological well-being (Howard et al., 2016;Tang et al., 2021), job stability (Purohit et al., 2014), job satisfaction (Deci & Ryan, 2014), and job performance (Baard et al., 2004;Manganelli et al., 2017). On the one hand, by satisfying the intrinsic needs of competence, autonomy and relatedness, self-integrated motives related to money are positively related to well-being. ...
... The rapid proliferation of COVID-19 globally has altered prevalent patterns of social interaction and communication (Dagenais-Desmarais et al., 2018a. Quarantine measures and social distancing restrictions have increased feelings of loneliness (Ntoumanis et al., 2021), potentially leading to frustration (Tang et al., 2021). Research suggests that frustration is positively associated with amotivation, indicating feelings of discouragement and helplessness (Bartholomew et al., 2011a(Bartholomew et al., , 2011bHaerens et al., 2015;Jang et al., 2016). ...
During the COVID-19 pandemic, organisations globally shifted into an emergency mode, leading to significant changes in the labour market. In light of these developments, this study sought to examine how the COVID-19 pandemic context influenced employees' evaluations of the different states of work motivation, as outlined in the framework of the Self-Determination Theory. A sample of 243 Portuguese employees completed the Multidimensional Work Motivation Scale (MWMS) at two-time points (before and during the pandemic). Repeated‐measures univariate and multivariate analyses of variance (MANOVA) were used to examine differences in work motivation scores between Time 1 and Time 2, as well to analyse the interaction between time and sociodemographic and work-related variables in the same dimensions. The results showed a positive and significant effect of the COVID-19 pandemic context on the more autonomous states of work motivation, i.e., Identified Regulation and Intrinsic Motivation, and those related to the controlled states of motivation, mainly Extrinsic Material Regulation and Introjected Regulation. In addition, workers without higher education have benefited more in terms of identified regulation throughout the pandemic, suggesting that the pandemic context may have facilitated the internalisation of new values and meaning at work for this group.This two-wave study suggests that the pandemic context acts as a psychological determinant affecting how job resources contribute to fulfilling autonomous motivation. The internal factors driving employees' autonomous motivation are shaped by their perception of the job resources within the wider context. In times of crisis, it is vital to focus on work resources and psychological needs to maintain employee motivation. Organisations must adjust their strategies to offer adequate support and balance demands and resources, especially during crises such as the pandemic.
... Typically, this focuses on human to human interaction; however, there is an increasing realization of the importance of considering a person-centered intervention delivery style, which is reflective and empathetic when designing applications and their related content [104]. Consequently, the principles of SDT [85] were applied to the intervention, ensuring that BCTs and specific features used in the intervention mapped to the basic psychological needs of autonomy, competence, and relatedness proposed by SDT [105][106][107]. Indeed, there is a growing body of work highlighting how applications underpinned by the SDT principles can strengthen digital therapeutic alliance and increase engagement in behaviors such as PA [107,108]. ...
Background: Preteen girls of lower socioeconomic position are at increased risk of physical inactivity. Parental support, particularly from mothers, is positively correlated with girls' physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people's physical activity. However, the effects of these interventions on girls' physical activity are often inconsistent, with calls for more rigorous, theory-informed, and co-designed family-based interventions to promote physical activity in this cohort. Objective: This study aimed to use co-design methods to develop an evidence-and theory-informed mother-daughter mobile health intervention prototype targeting physical activity in preteen girls.
... According to data from the World Health Organization (WHO), non-communicable diseases (NCDs) such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes account for 71% of deaths worldwide. Among these causes of death, cardiovascular diseases dominate with a contribution of 44%, followed by cancer (22%), chronic respiratory diseases (9%), and diabetes (4%) [1]. This data shows that health problems are not only an individual issue but also a systemic challenge that requires serious attention from various parties. ...
... Cancer survivors encounter multifaceted physical and psychological challenges during the phases of active therapy, recovery, and follow-up, which significantly affect their fundamental health needs [2]. An expanding body of health literature highlights the strong association between individuals' psychological needs, intrinsic motivation, and their capacity to navigate life's complexities, underscoring the importance of addressing these diverse needs [3]. Empirical research further demonstrates the pivotal role of psychological needs in enhancing health outcomes for cancer survivors [4][5][6][7]. ...
... The current study confirmed the convergent validity of the K-BPNSFS by demonstrating that satisfaction and frustration in each of the BPN are associated with psycho-cognitive constructs in directions that are both theoretically and empirically supported [3][4][5][6][7][8]. Specifically, higher levels of satisfaction in needs for autonomy, relatedness, and competence were associated with greater self-acceptance, family interaction, and self-efficacy, respectively. ...
Background/Objectives: Basic psychological needs are essential for fostering motivation, self-regulated behaviors, and overall well-being. For cancer survivors, fulfilling these needs is crucial for coping with the various challenges of survivorship and for enhancing psychosocial health. This study aimed to assess the validity and reliability of the Korean version of the Basic Psychological Needs Satisfaction and Frustration Scale (K-BPNSFS) in a cancer survivor population. Methods: A cross-sectional design was employed, involving 367 community-dwelling cancer survivors. Construct validity was assessed using confirmatory factor analysis with multiple fit indices, while convergent validity was examined through Pearson’s correlation coefficients. Reliability was evaluated using internal consistency, inter-item correlations, and item-total correlations. Results: The findings confirmed a robust six-factor structure of the K-BPNSFS, which includes satisfaction and frustration dimensions corresponding to autonomy, relatedness, and competence needs. Convergent validity was supported by significant correlations with relevant constructs, aligning with the scale’s theoretical underpinnings. Reliability analysis demonstrated high internal consistency across all dimensions, with strong Cronbach’s alpha values and substantial item-total and inter-item correlations. Conclusions: This study establishes the K-BPNSFS as a valid, reliable, and culturally relevant instrument for assessing the basic psychological needs of Korean cancer survivors. Application of this scale provides critical insights into the unique psychological needs of this population, supporting the development of targeted healthcare strategies to enhance intrinsic motivation, self-care, and overall quality of life.
... Moreover, Ke and Huang [85] studies have shown that TL positively correlates with student physical activity adherence. However, research by Ntoumanis et al. [86] indicates that intrinsic motivation is crucial in student engagement. This underscores the need for a holistic approach to educational leadership that fosters intrinsic motivation alongside transformational strategies, inspiring and motivating the audience. ...
Transformational leadership in higher education plays a crucial role in shaping institutional culture and driving positive change by inspiring faculty and students to achieve shared goals and embrace continuous improvement. The scoping review investigates the application and impact of transformational leadership in higher education institutions. By employing a systematic methodology, the study synthesizes literature published between 2019 and 2024, utilizing databases such as Google Scholar, ResearchGate, Europe PMC, ScienceDirect, CORE, and Scopus. The findings reveal that transformational leadership positively influences vital organizational outcomes, including job satisfaction, employee performance, and innovation within higher education institutions. However, challenges such as shared governance and academic autonomy hinder its implementation. This review highlights the fragmented literature and identifies essential themes, gaps, and future research directions, emphasizing the urgent need for a more comprehensive understanding of transformational leadership tailored to the unique dynamics of higher education. Future studies should explore adaptive strategies for implementing transformational leadership in diverse HEI contexts and investigate its long-term effects on institutional change and performance, highlighting the importance of continued research in this field.
... As a result, FoMO can be both a cause and an effect of excessive social media use [1]. According to the self-determination theory (SDT), one of the three innate psychological needs that drive human motivation is the desire for autonomy (the desire to feel connected to others) [12,13]. FoMO can lead to a dependence on external validation and a need for social approval, which can impair a person´s sense of connectedness [12][13][14]. ...
... According to the self-determination theory (SDT), one of the three innate psychological needs that drive human motivation is the desire for autonomy (the desire to feel connected to others) [12,13]. FoMO can lead to a dependence on external validation and a need for social approval, which can impair a person´s sense of connectedness [12][13][14]. ...
... FoMO can disrupt the fundamental psychological requirements outlined by the SDT, which may lead to a vicious cycle of overcommitment, worry, and disconnectedness from others [12,13]. The COVID-19 pandemic exacerbated these problems [18]. ...
Background/Objectives: The increased use of social media in Mexico has given rise to the “fear of missing out” (FoMO) phenomenon, especially among adolescents. This study aimed to measure the extent of FoMO among junior high school students in the metropolitan area of Guadalajara, Mexico, during the COVID-19 pandemic. Additionally, this study explored the association between FoMO levels and demographic characteristics, as well as the type and frequency of social media use. Methods: A cross-sectional survey was conducted from November 2021 to January 2022 in four junior high schools. A total of 1264 students (656 females and 608 males) aged 11–16 years completed the Fear of Missing Out Scale, adapted to the Mexican context. Data on demographics, social media usage, and school shifts were collected. Statistical analyses were performed using t-tests, ANOVA, and correlation coefficients. Results: The mean FoMO score was 1.79 ± 0.64, with higher scores observed in females (p < 0.001) and students attending morning shifts (p = 0.001). Significant associations were found between higher FoMO scores and the use of social media platforms like Instagram, TikTok, and Pinterest (p < 0.001 for each). The most frequently used social media platforms were WhatsApp (1093), TikTok (828), and Instagram (583). Participants who used social media all week exhibited significantly higher FoMO scores than those who used it only on weekends (p < 0.001). Conclusions: FoMO is a significant phenomenon among junior high school students in Guadalajara, Mexico, particularly among females and those who use multiple social media platforms. The findings suggest a need for interventions to manage social media use and mitigate FoMO-related negative health outcomes in this population.
... However, more research has focused on autonomous motivation because it is considered more critical for adopting specific health behaviours. Vaccination behaviour driven by autonomous motivation means "I want to be vaccinated" rather than "I have to be vaccinated" (Ntoumanis et al., 2021). It was found that individuals' perceptions of the diseasepreventive value of the HPV vaccine were key factors driving their decision to vaccinate (Thompson et al., 2018a). ...
Purpose
Autonomous motivation is critical to motivating individuals to adopt healthy behaviours. While many studies have explored the medical factors that influence women’s autonomous motivation to receive HPV vaccination, sociocultural factors have received less attention. Therefore, this study analyses women’s autonomous motivation for HPV vaccination from a sociocultural perspective to gain insight into the generation of women’s health decisions.
Methods
This study conducted in-depth interviews with 19 women at their peak age of infection who had been vaccinated against HPV to examine the socio-cultural factors that drove them to receive HPV vaccination. It used NVivo12 to analyse qualitative data obtained from interviews.
Results
The results showed that (1) Demonstrating Personal Independence, (2) Asserting Reproductive Autonomy, (3) Acknowledging Sexual Needs, and (4) Showcasing Health Literacy, Economic Power, and Social Connections were autonomous motivations for women to receive HPV vaccination.
Conclusions
Based on these motivations, future vaccine promotion programmes should demonstrate the role of the HPV vaccine for women to become autonomous individuals, as well as clear up misconceptions between the HPV vaccine and sexual shame and reduce the monetary burden of the vaccine to build a friendly and egalitarian vaccination environment.
... Refusal to consent led to exclusion of the study. All data were anonymous and analysed according to the rules of the Iranian Privacy Com-taking responsibility, and mentally reviewing events (Ntoumanis et al., 2021). In addition, extroversion is associated with a decrease in the risk of psychopathology, including depression and anxiety (Yu & Hu, 2022), while the level of depression and anxiety of people with visual impairment is higher than other people. ...
Self-determination and personality traits play a special role in goal setting and action. This study aimed to investigate the effect of self-determination training on personality traits in adolescents with visual impairment. The current study was a randomized controlled trial design. Twenty adolescents with visual impairment took part in this study. They were randomly selected from rehabilitation centers and were placed in intervention and control groups, each comprised of 10 students. The intervention group took part in the 10-session self-determination training, while the control group did not participate in the intervention. All participants filled out the NEO Five-Factor Inventory (NEO-FFI) pre-test and post-test. The scores were analyzed using the Multivariate Analysis of Covariance (MANCOVA). The findings suggested that self-determination training significantly and positively influenced personality traits in students with visual impairment (p =.001). This study indicates that self-determination can improve personality traits in these participants. Therefore, the present research emphasizes that self-determination has favorable consequences in the daily life of adolescents with visual impairment.
... Autonomous motivation means that people regulate themselves by self-endorsed reasons and behaviors that fit what they enjoy (intrinsic motivation), matches their core values (integrated motivation), or from that they expect a benefit that is personally relevant (identified regulation). In contrast to controlled motivation in which people feel internally pressured (introjected motivation), or are pressured from outside (external regulation), more autonomous forms of regulation change health behavior more effectively and sustainably (e.g., Ntoumanis et al., 2021). In Sheeran et al. (2021) metaanalysis, for example, autonomous motivation was found to lead to a medium change in health behaviors. ...
Self-enactable behavior change techniques (Knittle et al., 2020), are active components of interventions that individuals can also employ on their own. The study explored the frequency of self-enactable behavior change techniques (SE-BCTs) usage, their psychometric structure, and their association with physical activity and healthy nutrition. To evaluate SE-BCTs, Abraham & Michie’s (2008) 26-BCT taxonomy was translated into a SE-BCT questionnaire and administered to 504 participants via a web survey. Participants reported self-enacted goals in physical activity (PA) and healthy nutrition (NUT), along with their importance, difficulty, and progress. Physical activity and healthy eating questionnaires served as indicators of successful behavior change. Using Bayesian statistics, we found variations in the usage intensity of SE-BCTs. Similarities and differences emerged between PA and NUT domains. For example, “time management” was commonly used in both, while “information seeking” was more prevalent in NUT. For some SE-BCTs, weak evidence emerged for gender differences and age effects. SE-BCTs formed clusters similar to BCTs, supported by Bayesian psychometric network analyses. Tests for potential preconditions and consequences of SE-BCTs revealed moderate-to-strong support for positive relations with goal importance, and strong support for positive relationships of SE-BCTs with behavior change. Moreover, PA was best predicted by a combination of the SE-BCTs “time management” plus “detailed plans,” whereas for NUT, a complex pattern of six SE-BCTs was the best-fitting predictive model. We discuss the potential of SE-BCTs for promoting physical activity and healthy eating add what is still needed to make them work efficiently.
