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Building healthcare partnerships by supporting autonomy: Promoting maintained behaviour change and positive health outcomes
... We collected self-reported data across 16 psychosocial constructs [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], which were drawn from behavioral theory and have been used extensively in the weight loss literature (Table 1). ...
... Treatment Self-Regulation Questionnaire (TSRQ) [24] 15-item measure, assesses degree of autonomy or control within an individual's motivation for eating a healthy diet. Contains the following 4 subscales: amotivation, autonomous motivation, controlled motivation, and a relative autonomy motivation index. ...
Objective
The objective of this study was to identify pretreatment predictors of weight loss in a 12‐month behavioral obesity treatment that restricted either fat or carbohydrates.
Methods
Participants were 436 adults with overweight or obesity from the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial. Signal detection analysis was used to identify which combinations of 51 pretreatment demographic, clinical, behavioral, and psychosocial variables, along with diet type (healthy low‐fat vs. healthy low‐carbohydrate), formed subgroups that varied in proportion of those achieving at least 5% weight loss at 12 months.
Results
Overall, 51% of participants achieved at least 5% weight loss at 12 months, with eight subgroups identified through signal detection. Diet type was not a key factor. Among racial and ethnic minority participants, the best predictors of weight loss were lower levels of emotional eating, less friend discouragement, and presence of metabolic syndrome. Among non‐Hispanic White participants, the best predictors were high confidence in participating fully in the intervention, more family encouragement, and lower outcome expectations.
Conclusions
We found that psychosocial and clinical factors, along with race and ethnicity, successfully differentiated subgroups that varied in their 12‐month weight loss. Given the heterogeneity in response to behavioral obesity treatment, these results can help generate hypotheses to move intervention science toward a precision medicine approach by matching individuals to their most suitable obesity treatments.
... Six hundred twenty-one subjects were recruited to the study during a 3-month online recruitment period; 174 were excluded from the analysis due to missing data on adherence, and 37 were excluded because they previously underwent surgery for IBD. Four hundred ten subjects with UC were included in the analysis, with a median age of subjects of 49 (Table 1). In the univariate model, younger patients and those diagnosed with UC at a younger age were significantly less adherent; however, no difference was identified in gender, number of medications, and other baseline characteristics. ...
... The concept of autonomous support of medical providers is also important, as a collaborative approach between the patient and provider leads to better outcomes. 49,50 Despite the important results of our study, there are several limitations we would like to address. We recognize that volunteers for an online study are self-selected and may systematically differ from UC patients in general. ...
Introduction:
Medication nonadherence in patients with ulcerative colitis (UC) can result in frequent relapses, severe disease, and higher risk of colorectal cancer. Behavioral models relying on motivation and perceived competence, like the self-determination theory (SDT), have been implicated in nonadherence; however, the SDT has not been evaluated in the adult UC population. We sought to examine the association between adherence to oral medications in patients with UC and psychological distress, relationship with health care providers, motivation, and competence.
Methods:
We performed a cross-sectional study within the Inflammatory Bowel Disease (IBD) Partners online registry in which participants completed a baseline survey including demographic information, IBD history, symptoms, medication adherence, and psychosocial factors. Members of the registry with a diagnosis of UC received an online follow-up survey that included baseline questionnaires and assessment of competence, motivation, and patient-physician relationship. Logistic regression models were performed to determine the relationship between psychosocial factors, adherence modifiers, and medication adherence.
Results:
Of the 410 UC patients included, 29% had low adherence to their medications, 36% had medium adherence, and 34% had high adherence. In the multivariable analysis, younger patients, those with a lower perceived competence, and those with worse relationship with their providers were more likely to have lower adherence to their medications.
Conclusions:
Poor adherence to oral medications in UC was associated with lower perceived competence and worse relationship with providers. Further interventions based on the SDT can potentially improve adherence and optimize patient care.
... SDT is usually adopted when the individuals being studied (business academics in this case) are intrinsically motivated as an outcome of external behaviour and/or attitude (meaningful work in this case) rather than being psychologically stimulated to exert effort to please, guide or help others (Ryan and Deci, 2000;Williams et al., 1998). This theory mostly elaborates on the quality of motivationthe extent to which an individual internalizes a specific behaviour and subsequently considers it as his/her self-concept, instead of the strength of the motivation (high or low) (Charng et al., 1988). ...
... Authors (e.g. Zuroff et al., 2007;Klag et al., 2010;Williams et al., 1998) assert a positive association between perceived autonomy and health-related feelings. ...
Purpose
Through addressing academics in four public business schools in Egypt, the authors of this paper aim to uncover how meaningful work might shape the mental health of the addressed academics post COVID-19.
Design/methodology/approach
The author employed a qualitative research method through semi-structured interviews with 44 academics from four business schools selected from among 25 public institutions of higher education in Egypt. The author subsequently used thematic analysis to determine the main ideas in the transcripts.
Findings
The authors’ findings show that business academics usually consider meaningful work as playing a major role in shaping their mental health, especially after a crisis. This indicates that the more they perceive their jobs as valuable and worthwhile, the more they can deal with limitations and mental health issues (e.g. anxiety, stress, inadequate sleep, etc.) that accompany crisis. The findings also show that during the time of the COVID-19 crisis, employees (business academics in this case) have not placed so much importance to their autonomy (ability to choose and/or participate in decision-making processes) in the workplace. Instead, they care more about their relatedness (sense of belongingness) and their level of competence (sense of capability). Accordingly, the authors show that having academics that develop a sense of purpose for their academic duties in a time of crisis has less mental health disorders. Subsequently, post crisis, business academics can feel a continuous sense of relatedness and find ongoing opportunities to work and learn.
Originality/value
This paper contributes by filling a gap in HR management, in which empirical studies on the relationship between mental health and meaningful work have been limited so far.
... Il s'agit ici d'étudier si les personnes âgées atteintes de MA se sont senties soutenues par les personnes encadrant les activités. Si une personne se sent soutenue dans son autonomie, cela signifie que les encadrants encouragent son initiative et prennent en considération son point de vue (WILLIAMS, DECI et RYAN, 1998). Le sentiment de compétence est induit quant à lui si les personnes encadrant les activités donnent des rétroactions positives sur le comportement des résidents. ...
Plusieurs types d’activités stimulantes sont proposés en institution aux personnes atteintes de la maladie d’Alzheimer, qui selon de nombreuses études, auraient des effets positifs sur le bien-être et le fonctionnement cognitif et social des patients. Dans le secteur de la santé, divers travaux ont montré l’importance des facteurs motivationnels dans l’efficacité de la prise en charge des personnes et pour leur bien-être. Dans la perspective de la théorie de l’autodétermination (DECI et RYAN, 2000), il apparaît que la présence d’une motivation autodéterminée pour la prise en charge, ainsi que les perceptions de compétence, d’autodétermination et d’appartenance sociale au cours de celle-ci, participent à sa réussite. En analysant l’effet possible des activités proposées aux personnes atteintes de la maladie d’Alzheimer sur leur bien-être, et le rôle de la motivation lors de celles-ci, l’objectif de notre recherche est d’améliorer la prise en charge et d’enrichir la réflexion sur les aides apportées à ces personnes.
... Relatedness means feeling bonded and connected with other individuals and the community. Satisfying these needs is fundamental to motivating an individual to act toward a desirable goal [17] and serves an important role in activating and maintaining motivated behavioral change [18]. Our first set of hypotheses connect psychological needs for motivation and post-discharge outpatient follow up. ...
Objective
Motivating older adults to follow up with an outpatient clinician after discharge from emergency departments (ED) is beneficial yet challenging. We aimed to answer whether psychological needs for motivation and discrete emotions observed by care transition coaches would predict this behavioral outcome.
Methods
Community-dwelling older adults following ED discharge were recruited from three EDs in two U.S. states. We examined home visit notes documented by coaches (N=725). Retrospective chart reviews of medical records tracked participants’ health care utilization for 30 days.
Results
Observed knowledge-based competence predicted higher likelihood of outpatient follow-up within 30 days, while observed sadness predicted a lower likelihood of follow-up within seven days following discharge. Moreover, participants who demonstrated happiness were marginally more likely to have an in-person follow-up within seven days, and those who demonstrated knowledge-based competence were more likely to have an electronic follow-up within 30 days.
Conclusions
Knowledge-based competence and emotions, as observed and documented in coach notes, can predict older adults’ subsequent outpatient follow-up following their ED-discharge.
Practice implications
Intervention programs might encourage coaches to check knowledge-based competence and to observe emotions in addition to delivering the content. Coaches could also customize strategies for patients with different recommended timeframes of follow-up.
... Self-determination theory is a psychological theory that focuses on the engagement, adherence and intrinsic motivation of individuals (Klag et al., 2010;Williams et al., 1998;Ryan & Deci, 2000). Such intrinsic motivation always stems from the individual's psychological needs for autonomy, competence and relatedness (Ryan & Deci, 2000). ...
Through addressing management educators in four public business schools in Egypt, the authors of this paper aim to uncover the impact of holding multiple academic jobs on the mental health of management educators. The paper asserts that management educators do not perceive the holding of multiple academic roles as a stimulant of any form of mental illness (e.g., anxiety, depression, stress) if it is accompanied by a sense of autonomy (proper teaching loads, rational time for supervising theses, reasonable requests for research production) a feeling of competence (relevant monthly salary, available training and learning opportunities) and a sense of relatedness (feeling of involvement, flexible work hours, option to work from home).
... Behavioral regulations for PA were assessed using the Exercise Treatment Self-Regulation Questionnaire. 42 It consists of four subscales reflecting controlled (i.e., external regulation, introjected regulation) and autonomous motivation (i.e., identified regulation, intrinsic motivation). The word "exercise" was replaced with "physical activity." ...
A single-arm feasibility trial was conducted to explore rural-living young adult cancer survivors’ physical activity, fruit and vegetable consumption, and motivational processes underlying any behavior changes during a telehealth behavior change intervention grounded in self-determination theory. Participants ( n = 7; 85.7% female; Mage = 33.9, range = 28–37) met with a health coach once a week for 60 min for 12 weeks. Participants completed pre- and post-intervention surveys that assessed their behaviors, basic psychological needs satisfaction, and behavioral regulations. Participants also completed a semi-structured interview post-intervention. Quantitative results indicate behavioral outcomes, basic psychological needs satisfaction, and behavioral regulations increased from pre- to post-intervention. Five themes provide context for the observed increases. Results provide preliminary evidence that motivation for physical activity and fruit and vegetable consumption may be facilitated by a one-on-one telehealth intervention among rural-living young adult cancer survivors. Large scale studies are needed to determine effectiveness of the intervention and identify mechanisms underpinning behavioral outcomes.
... For example, in the educational setting, students experience intrinsic enjoyment and enhanced academic performance when rewards and feedback are presented in supportive and encouraging ways (Koestner et al., 1984;Grolnick and Ryan, 1989;Williams and Deci, 1996;Black and Deci, 2000;Joussemet et al., 2004;Soenens et al., 2006). Informative feedback and rewards are also positively correlated with patients' treatment adherence in health sectors (Williams et al., 1998) and with athlete training in sports settings (Bartholomew et al., 2010(Bartholomew et al., , 2011. ...
In the present research, we validated a new scale developed from self-determination theory (SDT) to assess the functional meaning of cash rewards offered in the workplace. According to SDT, rewards can take on different meanings based on the way they are perceived by individuals. In a series of three studies in different socioeconomic contexts, we replicated the two-factorial structure of the scale measuring respectively workplace cash rewards’ informative and controlling meanings. In Study 1, we validated the English version of the scale by exploring and then confirming its two-factor structure with two English-speaking employee samples. We further replicated its two-factor structure in a French-speaking employee sample of employees in Study 2 and in a Greek-speaking employee sample in Study 3, allowing us to validate its French and Greek version. Results from our three studies show how distinct meanings attributed to cash rewards, i.e., informative or controlling, relate differently to autonomous and controlled forms of motivation based on SDT. These findings suggest that workplace cash rewards differently influence employees’ motivation depending on whether they are perceived as informative or controlling, thus providing empirical evidence for the theoretical and practical implications of SDT’s concept of functional meaning of cash rewards. Our research contributes to the assessment and understanding of employees’ experience of workplace cash rewards and provides empirical evidence that the concept of the functional meaning of cash rewards is a distinct concept from other money-related concepts such as subjective pay satisfaction, performance-contingent rewards, and financially contingent self-worth.
... For example, people engaged in parachuting aim to learn a new skill, and enjoy excitement and a sense of accomplishment. Peers, parents and organizational institution are environmental factors that can be influential in the type and strength of a person's motivation or the internalization process [46] [63]. This study will focus on the moderation effect of organizational institution on customers' self-determination motivation. ...
The aim of this study is to contribute to the understanding of organizational value creation by in depth investigating the creative processes of actors at the theatre using a theoretical framework from cultural economics. The empirical base for this study is qualitative interviews with professional actors from institutional theatres in Finland. From a micro perspective, the narratives generated from the actors focus on their upbringing, path to the profession, wellbeing and creative processes within their work at the theatre. An abductive and reflexive research methodology is being used for analyses and interpretations of the empirical material. The central theoretical framework for the study is based on existing research on cultural economy, creative processes and creative management.
The study shows that creativity is central part of the actors´ social reality live and work environment and that creative challenges within the theatres creative processes produce a creative anguish that works as an energy and value potential in searching for suitable practical solutions. The concept of creative anguish within the study is examined, understood and developed as a central ingredient in relation to how creative processes develop from given creative visions, strategies and frames. The study also shows the importance, for both the management and the staff, of understanding how to handle the recourse of the creative anguish to be able to maintain an adaptive and creative capacity in relation to the creative challenges within the processes. Furthermore, the research also argues that the actors´ creative work both individually and socially generates positive health and wellbeing.
From a micro perspective, the study shows that creative anguish managed under balanced conditions generate an energy producing innovative expressions with an economical value as result. This value is in this dissertation referred to as creaconomy. By regarding this creaconomical value from a macro perspective the study suggests that mainly four value creative elements can be identified. They are: I) that the creative anguish is a force and an energy source that both individually and socially works as fuel within development of organization value creation; II) that value is better developed in case both the creative and operative management allows enough space for “un-structure” within the creative processes; III) that both understanding and trust is necessary toward the operational workforce engaging in the creative challenges within the production processes, however without demanding results to early or showing indifference to need of support during the creative process; IV) that trust and understanding toward trial and error is of central importance within the creative process and that definitions like “to succeed” and “to fail” both are of importance and therefore should constitute equivalent units in relation to the aim of creating economical value within the creative processes.
By introducing the concept creaconomy, the dissertation presents a theoretical framework that defines that; value creation managed in a balanced manner individually, socially, collegially, organizationally can be generated in relation to any creative processes. To sum up, from a micro perspective the study defines that the creative anguish can add creaconomic value to the organization.
Keywords: cultural economy, theater and acting, creative processes, creative challenges, creative anguish, creaconomy.
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