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The efficacy of Self Determination Theory-based interventions in increasing students' physical activity: A systematic review

May 2020
Physical Activity Review 8:82-94

DOI:10.16926/par.2020.08.09

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Széchenyi István University

Recent studies suggest that students fail to meet the international guidelines for physical activity. Therefore, an increased number of physical activity interventions attempt to change this trend. The current paper reviews the intervention studies which were based on the Self-Determination Theory (SDT). Three databases (PsycINFO, Medline, and SPORTDiscus) were scrutinized in the current review, which yielded 437 potential articles. Employing the recommended selection based on the population, intervention, comparators, and outcome (PICO), 14 articles could be included in the narrative analysis. The results showed that interventions based on the SDT were very heterogeneously operationalized in these studies. Despite different interventions, the results suggest that SDT-based interventions have the potential to increase students' physical activity through both, autonomy and supportive environment. Teachers' professional development in implementing SDT-based physical activity interventions for students is highly recommended. Cite this article as: Juwono I, Szabo A. The efficacy of Self Determination Theory-based interventions in increasing students' physical activity: A systematic review. Phys Activ Rev 2020; 8: 82-94.

Article selection process for the current review. Based on Liberati et al. (2009)

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Physical Activity Review, vol. 8(1), 2020

www.physactiv.eu

_____________________________________________________________________________________

Original Article

doi: 10.16926/par.2020.08.09

The efficacy of Self Determination Theory-based

interventions in increasing students’ physical activity:

A systematic review

Ignatius Darma Juwono12ABCD , Attila Szabo1AD

1ELTE Eötvös Loránd University, Budapest, Hungary

2Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia

Authors' Contribution: A – Study Design, B – Data Collection, C – Statistical Analysis, D – Manuscri pt Preparation, E – Funds Collection

____________ ______________________________________________ ________ _____________________________________________ ______________________________________________ ____

Abstract

Recent studies suggest that students fail to meet the international guidelines for physical activity.

Therefore, an increased number of physical activity interventions attempt to change this trend. The

current paper reviews the intervention studies which were based on the Self-Determination Theory

(SDT). Three databases (PsycINFO, Medline, and SPORTDiscus) were scrutinized in the current review,

which yielded 437 potential articles. Employing the recommended selection based on the population,

intervention, comparators, and outcome (PICO), 14 articles could be included in the narrative analysis.

The results showed that interventions based on the SDT were very heterogeneously operationalized in

these studies. Despite different interventions, the results suggest that SDT-based interventions have

the potential to increase students’ physical activity through both, autonomy and supportive

environment. Teachers’ professional development in implementing SDT-based physical activity

interventions for students is highly recommended.

Keywords: active living; exercise; health; learning; school

____________ ______________________________________________ ________ _____________________________________________ ______________________________________________ ____

Address for correspondence: Attila Szabo, Institute of Health Promotion and Sport Sciences, Faculty of

Education and Psychology, ELTE Eötvös Loránd University Budapest, Hungary, e-mail: szabo.attila@ppk.elte.hu

Recevied: 23.11.2019; Accepted: 16.12.2019; Published online: 6.05.2020

____________ ______________________________________________ ________ _____________________________________________ ______________________________________________ ____

Cite this article as: Juwono I, Szabo A. The efficacy of Self Determination Theory-based interventions in

increasing students’ physical activity: A systematic review. Phys Activ Rev 2020; 8(1): 74-86. doi:

10.16926/par.2020.08.09

Physical Activity Review, vol. 8(1), 2020

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INTRODUCTION

We live in an increasingly sedentary world [1-3]. The Statistical data from World Health

Organization (WHO

) revealed that nearly 30% of the adult population is physically inactive [3]. This

segment of the population could be at higher risk for mortality rates related to diabetes,

cardiovascular diseases, and other non-infectious diseases.

Education can play a role in increasing physical activity. Through physical education (PE)

courses, extracurricular activities, and sports events at primary, secondary, or tertiary level, schooling

can help students to regulate their physical activity so that they can be intrinsically motivated to also

exercise in adulthood. However, recent studies showed that students at different levels are also

showing signs of insufficient physical activity [1-3]. It is estimated that around 80% of the adolescents

(11-17 years old) are not meeting the WHO’s recommendation of 60 minutes of moderate-to-vigorous

physical activity (MVPA) per day [1-2].

With a growing concern on how to increase students’ physical activity several intervention

studies were carried out. Studies examining university students were summarised in two systematic

reviews [4-5], which concluded that not all intervention are effective in increasing physical activity

level. However, these reviews were limited to university students’ and none of them focused on a

theoretically driven intervention.

Physical activity interventions developed from theoretical frameworks are often considered to

be more effective in changing the behaviour [6-7]. One of theoretical frameworks that has been used to

explain exercise and other health behaviours is the Self-Determination Theory (SDT).

The SDT is a macro theory about motivation [8-10]. According to the theory, human behaviour

is either intrinsically or externally motivated. Intrinsic motivation is the impetus for doing a behaviour

for the internal reasons [11]. According to SDT the intrinsic motivation is related to three basic needs:

autonomy (the need to have the feeling of owning the behaviour), competence (the need to have a

sense of mastery in the behaviour), and relatedness (the need to be connected with those who have

similar interest). These needs can either be facilitated or thwarted by the environment. People can

move within the intrinsic-extrinsic motivation continuum, depending on the environment. Individuals

can show more intrinsic motivation in an autonomy supportive environment, whereas a more

controlling environment would result in a more extrinsic motivation. In this regard, SDT can be

described as a motivation theory having a dynamic organismic nature that integrates both

intrapersonal factors (i.e. personal goals, basic needs) and interpersonal and environmental factors

[11].

In the context of health behaviours, there were studies that used SDT approach to increase

physical activity and found that SDT-based interventions are effective in changing behaviour in health

settings [12]. Two systematic reviews by Ng and colleagues [9] Teixeira and colleagues [10] revealed

that SDT is a viable framework for interventions aimed at increasing physical activity. The SDT is said

to perform better in understanding why some individuals were responsive to interventions (and as a

result easier to change the negative behaviours) than others [9-10, 13]. However, to the authors’ best

knowledge, no systematic review exists on SDT-based intervention aimed at increasing students’

physical activity. Previous intervention studies were either not theory-driven or were based on other

theories (i.e. social-cognitive theory, transtheoretical theory), and/or were limited to university

student populations.

Physical Education (PE) in primary and secondary schools are mandatory for most schools

[11]. The PE course offers a unique chance where PE teachers can help students to internalize their

motivation for exercise. Hence once they reach university level (or graduate from university), where

physical education is no longer mandatory, they might be motivated to stay active. The PE teachers

who instructed their class in an autonomy supportive way could affect students’ basic needs

satisfaction which later affect their physical activity level [11]. Despite the fact that an increasing

number of studies implement SDT-based intervention to increase students physical activity, the

effectiveness of these interventions was not evaluated to date.

The aim of the current paper is to systematically review intervention studies based on the SDT

aimed at increasing students’ physical activity. The current work complements the earlier systematic

reviews which were limited to a university student population. Schools, through PE and

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extracurricular activities offer chance for researchers and practitioners to influence student’s

motivation for exercise. Therefore, studies performed in this milieu should also be evaluated with

special focus on the factors that promote intrinsic motivation.

METHODS

The current review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis

(PRISMA) guidelines [14-16]. The search is delimited to articles published in English.

Eligibility Criteria

Studies inclusion criteria were:

1. Original academic articles published in peer reviewed journals.

2. The studies employ SDT-based intervention(s).

3. Selection of the studies is based on Population Intervention, Comparison, and Outcome (PICO)

standard [14]:

a. P (population): students of any level education (primary, secondary, and university) of

any socioeconomic status.

b. I (intervention): the intervention aimed at promoting physical activity must be based

on the SDT.

c. C (comparison): the study must involve and intervention and a control group.

d. O (Output): the studies need to report physical activity level. The physical activity can

be objectively measured (e.g. accelerometer or pedometer data) or subjectively

measured or graded performance by assessors. If no physical activity reported, the

study will be excluded. Articles that report only protocols of intervention will be

excluded.

Since the aim of current systematic review is to summarize efficacy of SDT-based interventions

to increase students’ physical activity, only intervention studies that report physical activity level of

students are included here. Protocol report, reviews, or correlational studies will be excluded from the

result.

Search Strategy

The search was done by examining research articles from three electronic databases

(SPORTDiscus, PubMed/Medline, and PsycINFO). A combination of keywords related to the theory

(SDT), population of interest (student) and context (physical activity) were utilized under a Boolean

logic-commands. The results were sorted by relevance. Other than searching through the databases,

the authors also looked at the references in previous systematic reviews and articles from a website

(www.selfdeterminationtheory.org). The search strategy is outlined in the Table 1.

Table 1. Search strategies used in current review.

Search Strategy Items

Details

Used keywords

Combination of two from the following:

Self-determination theory OR related constructs (e.g.

autonomous motivation or intrinsic motivation)

Physical activit* OR exercise* OR Sport

- Student*

Searched databases

PubMed/MEDLINE, Sportdiscus, and PsycINFO

Time filter

none

Language filter

English only

Document type filter

Articles in peer-reviewed journals

Inclusion criteria

Original article complying to the established PICO

Exclusion criteria

Reviews, Dissertation, Technical papers

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Data Extraction and Analysis

The resulting selected studies are summarized and describe the authors, countries where the

study took place, study design, characteristics of participants (education level, sex, age), and PA

measure. Characteristics of the interventions employed is also summarized: duration of intervention,

type of intervention, and target of population.

Data from the articles is analysed by the type of interventions. Each type of intervention is

described in more detail. Potential impact of the intervention is reported on the analysis. Narrative

analysis and synthesis is used to summarize the findings.

Risk of Bias Assessment

The studies included here were evaluated with Risk of Bias (RoB) 2.0. The RoB 2.0 is a tool for

evaluating the bias from selected studies in a systematic review. The RoB 2.0 assesses five potential

domains of bias source: (1) bias due to randomization process, (2) bias due to deviations from

intended intervention, (3) missing outcome data, (4) bias in measurement of outcome, and (5) bias of

selective reporting in results [17-19]. It can be used for randomized parallel-group trials, cluster-

randomized parallel-group trials, and randomized cross-over trials and other matched designs. The

five domains used different signalling questions that can be answered “Yes”, “Probably Yes”, “Probably

No”, “No”, and “No Information.” Based on answers to the signalling questions, the bias will be rated

“low concern”, “some concern” or “high risk of bias”.

Since three studies included here are not randomized controlled trials, the authors used

different bias evaluation tool for the three studies. The Risk of Bias in Non-Randomized Studies of

Intervention (ROBINS-I) is similar to the RoB 2.0. However, the ROBINS-I is specifically used for non-

randomized intervention studies. ROBINS-I evaluates studies in 7 domains: (1) confounding variables,

(2) selection of participation bias, (3) classification of intervention bias, (4) deviations from intended

intervention bias, (5) missing data, (6) measurement outcome bias, and (7) selective reporting bias

[20]. These domains were evaluated by answering signalling questions. Depending on the answers to

the signalling questions, the overall risk of bias was categorized into “low risk”, “moderate risk”,

“serious risk”, “critical risk”, or “no information.”

RESULTS

Through the search of the three databases, 371 potential articles were identified for the current

systematic review. Additional search from Google Scholar, references of previous systematic review,

and self-determination theory website (www.selfdeterminationtheory.org) found 66 more articles as

potentially includable in the review, resulting in a total of 437 articles. Of this total, 88 duplicates were

removed.

The remaining 349 articles’ were screened by their titles and abstracts. Ensuing, 261 articles

were removed because they were not in accord to the inclusion criteria (i.e. not focusing on physical

activity, not intervention studies). The remaining 88 potential studies needed further assessment. Of

the 88 articles, 64 were removed because they were either not intervention studies (n = 20), or not

using the SDT as framework for the adopted intervention (n = 44), or no physical activity

measurement was reported (n = 10). Consequently, 14 articles could be included for the qualitative

synthesis in the current review. The search result is depicted in Figure 1.

Characteristics of the Included Studies

The included studies are presented in numerical order in Table 2 and cited according to their

number in the subsequent text. Of the 14 articles, two articles reported the same intervention study

from two different perspectives [21-22]. Therefore, these two articles are treated as one study.

Three of the studies were RCT studies (study 1, 7, 9), seven were cluster RCT studies (study 3,

4, 6, 10, 11, 12, 13), and three were quasi-experimental design (study 2, 5, 8). The studies had large

variation in terms o

f the sample size, ranging from 43 in one study to 1806 participants in another

study.

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Figure 1. Article selection process for the current review. Based on Liberati et al. (2009)

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Table 2. Summary of included articles.

Authors Country

Study

design Context

Number of

partici pants

(student s)

Total

Attrition

Sex of

Particip ants Groupings

Mean Age of

Particip ants

(SD)

Outcome

Measure

Vansteenkiste,

et al (2004)

Belgium

RCT

S-Sch

224

4 (EG1-

FC-B

Wilson, et al

(2005)

Quasi-

experiment

P-Sch

2 (EG-

CG)

EG = 11

(0.6)

CG = 11

(0.7)

Obj-PA

Chatzisarantis,

et al (2009)

Cluster

RCT

S-Sch

235

2 (EG-

CG)

TS = 14.84

(0.48)

SR-PA

Lonsdale, et al

(2013)

Australia

Cluster

RCT

P-Sch

288

4 (EG1-3,

CG)

TS =13.6

(SD not

reported)

Obj-PA

Pardo, et al

(2014)

Spain

Quasi

experiment

S-Sch

682

2 (EG,

CG)

Obj-PA

Smith, et al

(2014)

Australia

Cluster

RCT

S-Sch

361

2 (EG-

CG)

TS = 12.7

(0.5)

Obj-PA

7 Peng, et al

(2015) US RCT Uv 127 6 MF 4 (EG1-3,

CG)

EG1 =

20.32

(1.19)

EG2 =

20.26

(1.44)

EG3 =

20.00

(1.73)

CG = 20.13

(1.48)

Obj-PA

Wang, et al

(2015)

Singapore

Quasi

experiment

4 (EG1-3,

CG)

22.3 (1.51)

SR-PA

Sylvester, et al

(2016)

RCT

144

2 (EG-

CG)

F = 20.87

(3.09)

M = 21.88

(3.57)

SR-PA

Ha, et al (2017)

Hongkong

Cluster

RCT

S-Sch

767

2 (EG-

CG)

TS = 14.38

(1.07)

Obj-PA

Hankonen, et al

(2017)

Finland

Cluster

RCT

S-Sch

2 (EG-

CG)

Obj-PA

Lonsdale, et al

(2017)

Australia

Cluster

RCT

S-Sch

1806

385

2 (EG-

CG)

EG = 12.96

(0.56)

CG = 12.90

(0.52)

Obj-PA

Escriva-

Boulley, et al

(2018)

French

Cluster

RCT

P-Sch

293

2 (EG-

CG)

TS = 8.31

(1.13)

Obj-PA

RCT - randomized controlled trial; Cluster RCT - cluster randomized controlled trial; S-Sch - secondary school;

P-Sch - primary school; Uv - University; NR - not reported; MF - male & female; M - male; F - female;

EG - experimental group(s); CG - control group; TS - total sample; GP - graded performance; FC-B - free choice

behavior; Obj-PA - objectively measured physical activity; SR-PA - self-report physical activity

The studies also targeted students’ physical activity at different education levels. Three studies

targeted physical activity level in primary school (2, 4, 13), six studies focused on secondary school

students (1, 3, 5, 6, 10, 11, 12), and three studies focused on university students (7, 8, 9). The studies

also employed different physical activity measurements. Nine studies used objective measurement (i.e.

using accelerometer) (2, 4, 5, 6, 7, 10, 11, 12, 13). Another three studies collected self-reported data to

measure physical activity (3, 8, 9) and one study used physical education teachers’ grade of

performance in physical activity (1).

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Table 3. Summary of intervention used in the current review.

No.

Authors

Target Intervention

Intervention

Provider

Duration

Stu

Teac

Sch

Adm

Sch

Comm

Tra

Pra

Res

Teac

Pro

Vansteenkiste, et al (2004)

✓

1 wk

Wilson, et al (2005)

✓

4 wk

Chatzisarantis, et al (2009)

✓

10 wk

Lonsdale, et al (2013)

✓

8 wk

Pardo, et al (2014)

✓

3 yr

Smith, et al (2014)

✓

8 mo

Peng, et al (2015)

✓

4 wk

Wang, et al (2015)

✓

12 wk

Sylvester, et al (2016)

✓

6 wk

Ha, et al (2017)

✓

3 mo

Hankonen, et al (2017)

✓

6 mo

Lonsdale, et al (2017)

✓

15 mo

Escriva-Boulley, et al (2018)

✓

10 mo

St - students; Teac - teachers; Sch-Adm - school administrators; Sch comm - school community; Tra - training;

Pra - practice; EP - equipment provision; Res - researchers

The reviewed studies differ in the intervention targets, form of intervention, and duration of

the intervention. The duration of the interventions varied from one-week (1) to three years (5). All

studies examined students’ physical activity, but six studies also looked at teachers’, school

administrators’, and parents’ behaviour which encourage students’ physical activity (3, 4, 5, 6, 10, 11).

To increase students’ physical activity, three studies provided training for the students directly (1, 2,

3) while the other 10 studies arranged training and practice for the students or teachers (4, 5, 6, 7, 8, 9,

10, 11, 12, 13). One study also provided exercise equipment for the school to help increasing students’

activity level (6). Summary of the different intervention for the studies is presented in Table 3.

Risks of Bias

Assessment of bias from the randomized control trials included here showed that eight studies

showed low overall risk of bias. These studies appropriately randomized participants into different

treatments, ensured intervention fidelity, overcame potential bias from missing outcome data, used

unbiased measures toward a specific group, and reported the findings in a holistic manner. Two

studies had some concern of bias. These two studies had little information on how the randomization

was performed, resulting in some concern whether the randomization was appropriate. Summary of

the RoB 2.0 for the 10 randomized trials are presented in Table 4.

The remaining quasi experimental studies included in the review showed higher potential risk

of bias compared to the randomized trials. These studies might potentially suffer from bias related to

confounding variables. They do not consider the possible confound in data analysis. Unlike the

randomized trials, these studies do not try to estimate the participants’ missing data impact on the

overall outcome. In general, these quasi experimental studies seemed to have more potential biases.

Hence, the interpretation of their result should be cautious. The result of ROBINS-I of the quasi

experiment studies is summarized in Table 5.

Efficacy of Different SDT-based Interventions

While the included studies were based on the SDT, they adopted different intervention

techniques described in some detail below.

Effect of Written Text Material Bounded in Self-determination Framework

Vansteenkiste and colleagues conducted research that focused on whether PE class material

that is framed in accord with the self-determination approach would impact physical activity

behaviour of the students [23]. The researchers manipulated the written description of planned

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physical activity. In one condition they read the benefits which reflect intrinsic (autonomous) goals,

while in the other they read benefits associated with extrinsic (heteronomous) goals. The study also

manipulated teachers’ instruction to reflect autonomy in supportive or controlling manner.

Result of the study revealed that participants exposed to intrinsically motivating information

showed better physical exercise performance as graded by a blinded assessor [23]. Further analysis

revealed that the teachers’ instruction (autonomy supportive or controlling) had larger effect on the

graded performance and free choice behaviour compared to the written course material.

Effects of Student Training

Two studies used training for students as intervention [24-25]. Wilson and colleagues used an

afterschool program for inactive students [24]. The intervention focused on improving snacking

behaviour as well as increasing physical activity. Students were asked to come up with physical

activities they would like to do themselves. The study revealed that compared to control group (who

were given standard physical activity curriculum), participants in the experimental groups showed

greater increase in the moderate physical activity (MPA), moderate-to-vigorous physical activity

(MVPA), and Vigorous Physical Activity (VPA) levels. However, this pattern only occurred in program

days. On other days, there were no differences between the groups.

Similar to the above study, Sylvester and colleagues conducted a study where the participants

were allowed to make their own choices of the exercise they would like to do [25]. In this study,

university students were randomly assigned to a condition where they performed fitness training in a

variety situations (did similar exercises but with different techniques in different sessions) and low

variety situation (similar technique for each session). The analysis showed that there were differences

in exercise adherence and exercise behaviour between groups. The participants in the high variety

exercise condition reported significantly higher exercise behaviour and adherence to exercise

schedule.

Table 4. Risk of bias evaluation of randomized controlled trials in the current review.

Authors

Domain 1:

Randomization

Proc ess

Domain 2:

Deviation of

intended

intervention

Domain 3:

Missing

outcomes

Domain 4:

Measurement

of the outcome

Domain 5:

Selective

reporting

Overall

Bias

Vansteenkiste, et al

(2004)

High

Low

Some

concern

Peng, et al (2015)

Low

concern

Sylvester, et al (2016)

Low

concern

Chatzisarantis, et al

(2009)

Low

concern

Lonsdale, et al (2013)

Low

concern

Smith, et al (2014)

Low

concern

Ha, et al (2017)

Low

concern

Hankonen, et al (2017)

Low

concern

Lonsdale, et al (2017)

Some concern

Low

Some

concern

Escriva, et al (2018)

Low

concern

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Table 5. Risk of bias evaluation of quasi-experimental studies in the current review.

Authors Bias due to

confounding

Bias in

Selection of

Participants

Bias in

Classification

of Intervention

Bias due to

deviation of

intended

intervention

Bias due to

missing

data

Bias in

Measurement

outcome

Bias in the

selective

reporting

Overall

Bias

Wilson, et al

(2005)

Moderate

Low

Moderate

Low

Moderate

Pardo, et al

(2014)

Moderate

Low

Moderate

information

Information

Moderate

Low

Moderate

Wang, et al

(2015)

Serious

Information

No information

Low

Moderate

Low

Moderate

Effects of Teacher Training

Chatzisarantis and Hagger examined how teacher interpersonal behaviours impact students’

physical activity [26]. Ten teachers were randomly assigned to treatment and control conditions. In

the treatment condition the teachers were taught how to provide rationale for physical activity,

positive feedback, and how to acknowledge students’ difficulties in physical activity with the aim to

boost autonomy support in students. These behaviours were the SDT concepts’ application in real life

situation. In control condition, the teachers were simply asked to provide rationale for engaging in

physical activity. The results showed that students who were taught in an autonomy-supportive

manner reported more leisure time physical activity than those in the control group.

In another research, teachers were randomly assigned to four training conditions: 1) rationale

condition, 2) fixed choices condition, 3) free choices condition, and 4) practice as usual condition [27].

The first three groups reflected the SDT. In the rationale condition, the teachers were asked to explain

students the activity they are going to do in the beginning of physical education session. In the fixed

choice condition, the teachers were asked to provide students with options they can choose from. The

free choice condition required teachers to let the students decide on their own the exercise they want

to do. The results showed that only the free choice condition increased leisure time physical activity

and reduced sedentary behaviour. Providing a rationale and options from which students can choose

did not impact leisure time physical activity.

Similar results, to the previous study, were found in another research [28]. In this study 101

physical education (PE) teachers were randomly assigned to treatment condition or control condition.

In treatment condition, teachers were given a professional development program prior to an academic

year so that they can meet students’ basic psychological needs that later influence their exercise

behaviour. Analysis of difference between students in the experimental and control groups favoured

the former. At the end of the intervention, measures based on accelerometer data revealed that the

intervention group had 5% higher leisure time physical activity level than the control group. There

was a decrease in the difference between the groups in the follow up sessions, but the intervention

group still outperformed the control group.

Another study that focused on teacher training impact on students’ physical activity was

conducted by Escriva-Boulley and colleagues [29]. The researchers provided training for PE teachers

before and during an academic year. The teachers in the training group were given materials on how

to motivate students in their PE classes in an autonomy-supportive way. An evaluation at the end of

the academic year has revealed that students in the teachers in intervention condition improved their

MVPA level, whereas students in the control condition showed decreased MVPA compared to baseline.

Another study incorporated rope skipping for PE classes [30]. In this study, the researchers

provided PE teachers with training to integrate rope skipping for their PE classes to increase students’

physical activity. The training mimics the suggested practice for their PE classes. The results showed

that that the integration of rope skipping did not influence the physical activity level. Further analysis

indicated that the impact of rope skipping was moderated by the gender of the students. Rope skipping

did improve girls’ physical activity, but had no impact on boys’ physical activity level.

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The Effect of Whole School Approach

Two studies reported whole school approach that used multiple intervention strategies to

increase students’ physical activity [22, 31]. In a study conducted in Spain, an integrated intervention

that used curricular and extracurricular activities was evaluated [31]. The curricular activities include

training the PE teachers and a weekly tutorial on the implementation plans. The extracurricular

activities included information dissemination for the broader schools’ community (parents and other

teachers), as well as arranging events and programs to increase students’ physical activity. An

evaluation of the approach performed three years later, revealed that the schools in treatment

condition showed significantly higher MVPA level.

A similar study was conducted by Smith and colleagues [22]. The study used a wide array of

interventions: from teacher development program, dissemination of information to parents, seminars

for students, arranging sport sessions within the participating schools, mentoring, the utilization of

pedometer, and development of internet-based application to increase physical activity in obese boys

coming from lower socioeconomic status. The study reported mixed results. Analysis of the pedometer

data showed that the intervention had no impact on the overall level of physical activity. However, the

participants showed improved fitness skills (i.e. upper body muscular strength and resistance training

skills).

The Impact of Technology Assisted Intervention

With the growing use of internet and social media, two studies integrated the used of social

media or internet-based application in their intervention for physical activity [32-33]. A study

conducted by Peng and colleagues focused on the impact of features of gaming that has features

resembling application of SDT [32]. The game itself was an active video game (AVG) which required

players to move their controller to advance in the game. When comparing participants who played the

game with SDT-based features turned on and off, it was found that participants playing with the SDT-

based features had greater attendance at playing games and, subsequently, had greater MVPA because

of their higher frequency in moving while playing the AVG.

Another study tried to integrate the use of social media in the intervention [33]. This study

compared participants in: (a) 3 hours physical activity intervention group, (b) 3 hours physical activity

intervention group who were connected through a Facebook group, (c) 1-hour physical activity

intervention group who were connected through a Facebook group, and (d) a control group. The

results showed that the two 3-hours physical activity intervention groups, whether connected or not

on the Facebook, had higher physical activity compared to the other two groups. This finding suggests

that the 3-hours physical activity intervention was responsible for the increment of physical activity

level, and the connection through the Facebook group did not have any additional effect.

DISCUSSION

The objective of the current review was to synthesize the published articles SDT based

intervention to physical education for students. The current review found 14 articles reporting 13

intervention approaches delivered to primary, secondary, and university students. Of the 13 studies,

11 reported that the SDT-based interventions had a positive effect on physical activity. This finding

agrees with previous systematic review on SDT-based intervention [9-10] that were carried out on

mixed samples. It appears that the SDT-based interventions are effective in improving physical activity

level in students of different age.

Despite differences in the operationalization of the SDT intervention, the studies seemed to

indicate that perception of teachers’ interpersonal style impact subsequent students’ exercise

behaviour [23-24, 26, 29, 35-36]. Simply explaining the rationale and the importance of physical

activity is not enough in inducing changes in the level of physical activity [27, 30, 33]. Teachers’ who

provide rationale of the exercise as well as provide positive feedback, and acknowledge students’

difficulty to remain active will be perceived as more autonomy supportive and facilitate the basic need

satisfaction. The result of this perception can influence students’ activity level.

Such findings support the previous claims that autonomy support would influence students’

basic psychological needs satisfaction, which will lead to more autonomous motivation in doing

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exercise regularly [11, 37]. However, this issue should be investigated more thoroughly, because some

questions remain open. For example, how long the effects of teachers’ autonomy support could last? As

one study included here, indicated that after the intervention stopped, there were reduction in

students’ physical activity, though it was still significantly higher than at baseline. Longitudinal studies

that follow students’ exercise behaviour while transitioning into adulthood are necessary.

Another question begging for elucidation is how the teachers should interact with students

during the PE classes so that they could provide support for autonomy? It seems that merely

implementing one strategy (providing rationale only or choices only) is not enough to induce changes

in students’ physical activity. The SDT application should be used concurrently. It is recommended

that teachers provide rationale, give students opportunities to generate their own options, and

provide feedback as well as acknowledge students’ difficulty during the process [24-25]. These joint

actions could facilitate the internalization of physical activity.

Further, educating teachers on the concept of motivation in the SDT framework is important.

Providing teachers with trainings and workshops, as well as monitoring their progress while giving

feedback in an academic year should be endorsed. Such an intervention should not be limited to PE

teachers only, but also to teachers and administrators, which would lead to an overall better learning

climate in the school as a whole, not just in PE classes.

This review followed the suggestions of a previous review which proposed that theoretical

based intervention evaluation should concentrate on which interventions are effective, for whom are

they effective, and under what circumstances are they effective [34]. Specifically, this systematic

review revealed SDT-based interventions that are effective in increasing students’ physical activity

level.

Despite the reviews contribution to supporting the SDT-based interventions’ efficacy in

increasing physical activity in students, the work has some limitations too. One is related to the

inclusion of a few studies which used multi-interventions (e.g. providing physical activity equipment

for school at low socio-economic neighbourhood) [24, 29, 31, 35]. The integration of multifaceted

intervention creates difficulty in drawing specific conclusions concerning the SDT-based intervention’s

effectiveness. A second limitation (out of the authors’ control) is that the studies included here were

conducted in economically developed countries (i.e. US, UK, Australia, Singapore, Hongkong). These

countries may have more policies and infrastructures that facilitate physical activity. Hence, more

research are needed in this area, especially in developing countries.

CONCLUSION

There is strong support for SDT-based interventions’ positive impact of the physical activity

level of students at different levels of education. Providing teachers and administrators with training

on SDT and its implementation might be beneficial in increasing students’ physical activity as well as

overall learning climate.

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December 2019

Ignatius Darma Juwono · Attila Szabo

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NECESSIDADES PSICOLÓGICAS BÁSICAS E REGULAÇÕES MOTIVACIONAIS ENTRE UNIVERSITÁRIOS ATIVOS: COMPARAÇÃO ENTRE OBJETIVOS DE ESTÉTICA E SAÚDE

Chapter

Full-text available

Jan 2025

Objetivo: Comparar as necessidades psicológicas básicas (NPB) e as regulações motivacionais em universitários que praticam exercício físico pela estética e saúde. Materiais e Métodos: Participação 214 universitários de Santa Catarina, de ambos os sexos, acima de 18 anos. Foram aplicados um questionário sobre NPB e regulações motivacionais para a prática de exercício. As informações foram analisadas no Software R Studio para comparar os grupos (“saúde” e “estética”) pelo teste de Wilcoxon. Resultados: Há diferença significativa nas necessidades de autonomia (p=0,025; d=0,315) e competência (p=0,026; d=0,307) revelando valores de média maiores para os universitários que praticam exercício físico pela estética. Assim como, apresentaram, significativamente (p<0,00), valores de médias maiores para motivação autônoma (regulação identificada e integrada), porém ainda possuem comportamentos motivacionais mais externos, de acordo com os resultados da regulação introjetada (p=0,000) ao comparar com os universitários que praticam pela saúde. Conclusão: Os praticam pela estética apresentaram mais satisfação para as NPB e maior chance para motivação autônoma, o que levam terem mais autodeterminação quando comparado com quem pratica pela saúde.

Feasibility of Project Mentor: A Mentoring Program Based on Self-Determination Theory for Adolescents Classified as Overweight

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Apr 2023
RES Q EXERCISE SPORT

Purpose: This study examined the feasibility of Project Mentor, a mentoring program based on self-determination theory (SDT) for youth classified as overweight or obese. Methods: In Study 1, youth (N = 23) ranging from 12-18 years of age were randomly assigned to a mentoring intervention or wait-list control condition. Study 2 served as a replication sample and consisted of N = 38 youth who participated in the mentoring program. As part of a process evaluation, attendance and exercise heart rate were monitored to assess whether participants exercised at a moderate-to-vigorous level as intended. Mentees also rated whether mentors created a need-supportive environment. For outcome evaluation, basic need satisfaction, behavioral regulation, fitness, and body composition were assessed at pre, post, and follow-up. Results: Across both studies, participants attended over 80% of the exercise sessions and exercised at a moderate to vigorous intensity level. Mentees also perceived that mentors created a need-supportive environment. Post-test and follow-up basic need scores were higher than baseline values and autonomous motivation increased for mentoring program participants. Effect sizes were generally moderate to large in magnitude based on partial eta-squared and Cohen d. Aerobic fitness (i.e., Vo2peak) showed a moderate to large increase at post-test that was partially maintained at follow-up. Body composition changes were nonsignificant and small in magnitude. Participants in the wait-list control reported showed small changes or decreases across SDT related constructs, fitness, and body composition across both studies. Conclusions: Results across both studies support the feasibility of a mentoring program focused on CARE (competence, autonomy, relatedness, and enjoyment).

A tailored mobile phone app promoting daily physical activity: A randomized trial

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ABSTRACT Objectives: Although mobile App are a promising tool to promote changes in daily Physical Activity (PA), recent meta-analysis showed modest evidence for their effectiveness and noted the limited number of randomized controlled trials. Furthermore, research pointed that App users tend to give up prematurely program intervention. The aim of this randomized controlled trial was to evaluate the effects of a tailored App compared with a single pedometer feedback on PA (primary outcome), and on intervention adherence. Methods: The participants were 30 adults (40% men and 60% women), aged between 35 and 60 years (45.33 ± 7.6). They were randomly assigned to a control group (CG, N=15), or to an experimental group (EG, N=15). Participants from the EG received personalized information from a tailored mobile App. They benefited from daily walking step-count feedback, individually adapted goals per week, behavioral advices and health information. Participants from the CG only benefited of daily walking step-count from a native mobile App (a single pedometer). The number of walking steps per week assessed physical activity. Data were collected at baseline, week 6 and week 12. The number of weeks the participants connected their mobile App assessed intervention adherence. Results: Non-parametric statistics indicated significant effects: (i) the EG maintained their adherence to the program (11.46±1.18 weeks), more than the CG (4.40±3.41 weeks); (ii) the all EG (N=15) reached 52,373 steps in the 6 th week and 49,958 steps in the 12 th week, whereas only 47% of the CG (N=7) reached 24,256 steps in the 6 th week of the program. Conclusions: Healthy adults adhere better to daily physical activity when they benefit from a personalized program a tailored App delivered.

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Jan 2023

Elise Allard Latour

Face au constat de désintérêt des adolescentes pour l'Éducation Physique et Sportive (EPS), notamment au lycée professionnel, les enseignants paraissent manquer de solutions, même si une dense littérature scientifique sur la motivation pour l'activité physique fournit des recommandations. Cette thèse a pour ambition de mener une réflexion partagée, entre enseignants et chercheurs, sur les pratiques et les contenus susceptibles de faire évoluer l’intérêt du public féminin en EPS. À partir d’un travail d’analyse de la littérature scientifique, et d'une étude observationnelle sur la spécificité des sources de l'intérêt en situation chez les filles en EPS, ce projet s’est concrétisé par la co-conception d’une séquence d’EPS, fondée sur des jeux vidéo-actifs et sur la théorie de l’intérêt. Les effets de cette séquence ont ensuite été évalués sur l’évolution de quatre variables : l'intérêt en situation, l’intérêt personnel pour l’EPS, la compétence perçue en EPS, et la durée d’activité physique au cours des séances. L'étude principale de cette thèse montre que les stratégies d'intervention mobilisées sollicitent bien les différentes sources de l'intérêt en situation, avec une influence significative et positive sur le défi, l’intention d’exploration et l'intérêt personnel pour l'EPS des adolescentes. La durée de l’activité physique augmente au cours de la séquence.

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Physical education (PE) offers an optimal setting for promoting higher moderate-to-vigorous physical activity (MVPA) and reducing sedentary behaviour (SB). This study examines the MVPA and SB among elementary schoolchildren during an obstacle course-based PE lesson and compares it to a traditional PE lesson, with the same students participating in both conditions. Moreover, it explores how gender, age and intrinsic motivation for PE relate to time spent in MVPA and SB during PE. A sample of 251 children within 24 classes in grades 1, 3 and 5 participated in this study. ActiGraph GT3x accelerometers monitored their PA during PE, while the Behavioral Regulations in Physical Education Questionnaire assessed their motivation for PE. Multi-level regression analyses indicated that MVPA was significantly higher ( p < 0.001) and SB was significantly lower ( p < 0.001) during an obstacle course-based PE lesson compared to the traditional PE lesson. Boys exhibited higher MVPA ( p < 0.001) and lower SB ( p < 0.001) than girls, with no notable grade differences. Intrinsic motivation was positively associated with MVPA ( p = 0.04). These findings suggest that children displayed higher MVPA and lower SB during the obstacle course-based PE lesson when compared to their traditional PE lesson. It could be a practical and effective strategy for improving PA behaviours, though future interventions should explore long-term impact, sustainability, and how class factors such as classroom management and teacher behaviours relate to MVPA and SB.

Using self‐determination theory in research and evaluation in primary care

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Oct 2022
HEALTH EXPECT

Background Multimorbidity (the co‐existence of two or more long‐term conditions within an individual) is a complex management challenge, with a very limited evidence base. Theories can help in the design and operationalization of complex interventions. Objective This article proposes self‐determination theory (SDT) as a candidate theory for the development and evaluation of interventions in multimorbidity. Methods We provide an overview of SDT, its use in research to date, and its potential utility in complex interventions for patients with multimorbidity based on the new MRC framework. Results SDT‐based interventions have mainly focused on health behaviour change in the primary prevention of disease, with limited use in primary care and chronic conditions management. However, SDT may be a useful candidate theory in informing complex intervention development and evaluation, both in randomized controlled trials and in evaluations of ‘natural experiments’. We illustrate how it could be used multimorbidity interventions in primary care by drawing on the example of CARE Plus (a primary care‐based complex intervention for patients with multimorbidity in deprived areas of Scotland). Conclusions SDT may have utility in both the design and evaluation of complex interventions for multimorbidity. Further research is required to establish its usefulness, and limitations, compared with other candidate theories. Patient or Public Contribution Our funded research programme, of which this paper is an early output, has a newly embedded patient and public involvement group of four members with lived experience of long‐term conditions and/or of being informal carers. They read and commented on the draft manuscript and made useful suggestions on the text. They will be fully involved at all stages in the rest of the programme of research.

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Article

Jan 2022

This paper is based on a review of studies focusing on student autonomy in early childhood, primary, and secondary education in Spain published in the last 10 years. Autonomy is defined as the capacity of individuals to act in a self-determined way. Educational institutions play a key role in the development of autonomy through experience, and students demonstrate more autonomy in learning when they are older. The method used in this paper consists of an overview of empirical studies from different databases and the application of three pre-defined filters. A total of 41 studies is analysed and critically assessed in relation to (1) the area of knowledge and level of schooling, (2) the definition of autonomy, (3) the method used, and (4) the elements influencing student autonomy. Results indicate that (1) physical education in secondary education is the most researched area, (2) most studies have defined autonomy and used self-determination theory as a framework for measuring student autonomy, (3) the majority of studies have used quantitative methods and a student sample, and (4) autonomy support provided by teachers positively influences student autonomy. In addition, the results show that intrinsic elements, such as the development of stable individual identity and psychological resources, enhance student autonomy. The paper concludes that future research should be aimed at a more specific conceptualisation of student autonomy to be assessed, measured, and promoted in different international educational environments and areas of knowledge.

Tools for assessing risk of reporting biases in studies and syntheses of studies: A systematic review

Article

Full-text available

Mar 2018

Background Several scales, checklists and domain-based tools for assessing risk of reporting biases exist, but it is unclear how much they vary in content and guidance. We conducted a systematic review of the content and measurement properties of such tools. Methods We searched for potentially relevant articles in Ovid MEDLINE, Ovid Embase, Ovid PsycINFO and Google Scholar from inception to February 2017. One author screened all titles, abstracts and full text articles, and collected data on tool characteristics. Results We identified 18 tools that include an assessment of the risk of reporting bias. Tools varied in regard to the type of reporting bias assessed (eg, bias due to selective publication, bias due to selective non-reporting), and the level of assessment (eg, for the study as a whole, a particular result within a study or a particular synthesis of studies). Various criteria are used across tools to designate a synthesis as being at ‘high’ risk of bias due to selective publication (eg, evidence of funnel plot asymmetry, use of non-comprehensive searches). However, the relative weight assigned to each criterion in the overall judgement is unclear for most of these tools. Tools for assessing risk of bias due to selective non-reporting guide users to assess a study, or an outcome within a study, as ‘high’ risk of bias if no results are reported for an outcome. However, assessing the corresponding risk of bias in a synthesis that is missing the non-reported outcomes is outside the scope of most of these tools. Inter-rater agreement estimates were available for five tools. Conclusion There are several limitations of existing tools for assessing risk of reporting biases, in terms of their scope, guidance for reaching risk of bias judgements and measurement properties. Development and evaluation of a new, comprehensive tool could help overcome present limitations.

Promoting Physical Activity Among University Students: A Systematic Review of Controlled Trials

Article

Full-text available

Sep 2018
AM J HEALTH PROMOT

Objective University study is often accompanied by a decline in physical activity (PA) levels but can offer the opportunity to promote a lifelong active lifestyle. This review aims to summarize controlled trials of interventions promoting PA among university students, describing the quality of the evidence, effective strategies, and deficiencies in the interventions employed, to provide directions for future research and for practical implementations. Data Source PubMed, PsychINFO, Cochrane Library, Education Source, and SPORTDiscus. Study Inclusion Criteria Randomized or nonrandomized controlled trial, describing an intervention to promote PA in university students, where PA was one of the outcomes and results were published in English. Data Extraction Country, study design, participants’ inclusion criteria, participation rate and characteristics, randomization, blinding, theoretical framework, intervention characteristics, participant retention rate and withdrawal reasons, measures employed, data analysis, PA results, and findings regarding PA correlates. Data Synthesis Data were synthetized considering study characteristics, strategies used, and outcomes. Results Two thousand five hundred eighty-five articles were identified. Twenty-seven studies met the inclusion criteria. Sixteen studies reported an increase in PA levels. Conclusion Physical Activity promotion interventions should address a range of behavioral determinants. Personalized approaches and PA sessions should be considered in future studies. The high risk of bias of many studies (mainly due to attrition and poor reporting) and missing information about intervention components limit the strength of conclusions about the most effective strategies and the evidence of effectiveness, highlighting the need for further high-quality studies.

Need-Supportive Professional Development in Elementary School Physical Education: Effects of a Cluster-Randomized Control Trial on Teachers' Motivating Style and Student Physical Activity Title page with all author information

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Full-text available

Jan 2018

This cluster-randomized controlled trial investigated the efficacy of a teacher professional development (TPD) program, grounded on self-determination theory, to increase elementary school teachers’ need-supportive motivating style and consequently their students’ physical activity (PA) during PE lessons. Participants were 15 elementary school teachers and their 293 students. Teachers in the treatment condition received a sports-related notebook and attended four 3-hours workshops over one school year; teachers in the control condition received the notebook only. Students’ PA and teachers’ motivating style were assessed on four occasions via accelerometers and observations, respectively. Results showed that teachers in the treatment condition increased support of their students’ psychological needs for the majority of the school year, but there was a slight decrease in the fourth wave of measurement. Students in the treatment condition increased their time spent in moderate to vigorous PA (MVPA), independently of the sport taught, while their counterparts from the control condition decreased their MVPA. This is the first study to provide elementary school teachers with a PE TPD program grounded in SDT, and demonstrate the potential of such a program to improve teachers’ motivating style and student MVPA in PE.

An internet-supported school physical activity intervention in low socioeconomic status communities: Results from the Activity and Motivation in Physical Education (AMPED) cluster randomised controlled trial

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Full-text available

Oct 2017

Objective Quality physical education (PE) is the cornerstone of comprehensive school physical activity (PA) promotion programmes. We tested the efficacy of a teacher professional learning intervention, delivered partially via the internet, designed to maximise opportunities for students to be active during PE lessons and enhance adolescents’ motivation towards PE and PA. Methods A two-arm cluster randomised controlled trial with teachers and Grade 8 students from secondary schools in low socioeconomic areas of Western Sydney, Australia. The Activity and Motivation in Physical Education (AMPED) intervention for secondary school PE teachers included workshops, online learning, implementation tasks and mentoring sessions. The primary outcome was the proportion of PE lesson time that students spent in moderate-to-vigorous physical activity (MVPA), measured by accelerometers at baseline, postintervention (7–8 months after baseline) and maintenance (14–15 months). Secondary outcomes included observed PE teachers’ behaviour during lessons, students’ leisure-time PA and students’ motivation. Results Students (n=1421) from 14 schools completed baseline assessments and were included in linear mixed model analyses. The intervention had positive effects on students’ MVPA during lessons. At postintervention, the adjusted mean difference in the proportion of lesson time spent in MVPA was 5.58% (p<0.001, approximately 4 min/lesson). During the maintenance phase, this effect was 2.64% (p<0.001, approximately 2 min/lesson). The intervention had positive effects on teachers’ behaviour, but did not impact students’ motivation. Conclusions AMPED produced modest improvements in MVPA and compares favourably with previous interventions delivered exclusively face-to-face. Online teacher training could help facilitate widespread dissemination of professional learning interventions. Trial registration number ACTRN12614000184673.

Increasing students' physical activity during school physical education: Rationale and protocol for the SELF-FIT cluster randomized controlled trial

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Full-text available

Jul 2017
BMC PUBLIC HEALTH

Background: The Self-determined Exercise and Learning For FITness (SELF-FIT) is a multi-component school-based intervention based on tenets of self-determination theory. SELF-FIT aims to increase students’ moderate-to-vigorous physical activity (MVPA) during physical education lessons, and enhance their autonomous motivation towards fitness activities. Using a cluster randomized controlled trial, we aim to examine the effects of the intervention on students’ MVPA during school physical education. Methods: Secondary 2 students (approximately aged 14 years) from 26 classes in 26 different schools will be recruited. After baseline assessments, students will be randomized into either the experimental group or wait-list control group using a matched-pair randomization. Teachers allocated to the experimental group will attend two half-day workshops and deliver the SELF-FIT intervention for 8 weeks. The main intervention components include training teachers to teach in more need supportive ways, and conducting fitness exercises using a fitness dice with interchangeable faces. Other motivational components, such as playing music during classes, are also included. The primary outcome of the trial is students’ MVPA during PE lessons. Secondary outcomes include students’ leisure-time MVPA, perceived need support from teachers, need satisfaction, autonomous motivation towards physical education,intention to engage in physical activity, psychological well-being, and health-related fitness (cardiorespiratory and muscular fitness). Quantitative data will be analyzed using multilevel modeling approaches. Focus group interviews will also be conducted to assess students’ perceptions of the intervention. Discussion: The SELF-FIT intervention has been designed to improve students’ health and well-being by using high-intensity activities in classes delivered by teachers who have been trained to be autonomy needs supportive. If successful, scalable interventions based on SELF-FIT could be applied in physical education at large.Trial registration: The trial is registered at the Australia New Zealand Clinical Trial Registry (Trial ID:ACTRN12615000633583; date of registration: 18 June 2015).Keywords: Physical education, Moderate-to-vigorous physical activity, School-based intervention, Health-related fitness,Self-determination theory, Basic psychological needs, Fitness dice

Randomised controlled feasibility study of a school-based multi-level intervention to increase physical activity and decrease sedentary behaviour among vocational school students

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Full-text available

Mar 2017
INT J BEHAV NUTR PHY

Background No school-based physical activity (PA) interventions among older adolescents have demonstrated long-term effectiveness, and few of them so far have addressed sedentary behaviour (SB). Based on behavioural theories and evidence, we designed a multi-level intervention to increase PA and decrease SB among vocational school students. This study investigates feasibility and acceptability of two main intervention components and research procedures. We also examine uptake of behaviour change techniques (BCTs) by the participants. Methods Design was an outcome assessor blinded, cluster-randomised controlled trial. Four classes of students (matched pairs) were randomised into one intervention and one control arm. The intervention consisted of (1) a 6-h group-based intervention for students, (2) two 2-h training workshops to reduce their students’ sitting in class for teachers, and (3) provision of light PA equipment in classrooms. At baseline (T1), mid-intervention (T2) at 3 weeks, post-intervention (T3) and 6 months after baseline (T4) we measured hypothesised psychosocial mediators and self-reported PA and sitting. Objective assessment of PA and SB (7-day accelerometry) was conducted at T1, T3 and T4. Body composition (bioimpedance) was measured at T1 and T4. Students and teachers in the intervention arm filled in acceptability questionnaires at T3. Results Recruitment rate was 64% (students) and 88.9% (teachers), and at T3, all post-intervention measurements were completed by 33 students (retention 76.7%) and 15 teachers (retention 93.8%). Acceptability ratings of sessions were high (students M = 6.29, scale 1–7), and data collection procedures were feasible. Intervention arm students reported increased use of BCTs, but uptake of some key BCTs was suboptimal. BCT use correlated highly with objective measures of PA. Based on both self-report and student evaluation, teachers in the intervention arm increased the use of sitting reduction strategies at post-intervention and T4 follow-up (p < .05). Conclusions We detected willingness of the target groups to participate, good response rates to questionnaires, adequate retention, as well as acceptability of the trial protocol. Investigation of BCT use among students helped further enhance intervention procedures to promote BCT use. After making necessary modifications identified, intervention effectiveness can next be tested in a definitive trial.

ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions

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Full-text available

Oct 2016
Br Med J

Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I ("Risk Of Bias In Non-randomised Studies-of Interventions"), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.

Examining the theory-effectiveness hypothesis: A systematic review of systematic reviews

Article

Feb 2019

A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective

Article

Oct 2018

A systematic review and meta-analysis was conducted of the techniques used to promote psychological need satisfaction and motivation within health interventions based on self-determination theory (SDT; Ryan & Deci, 2017). Eight databases were searched from 1970-2017. Studies including a control group and reporting pre- and post-intervention ratings of SDT-related psychosocial mediators (namely perceived autonomy support, need satisfaction and motivation) with children or adults were included. Risk of bias was assessed using items from the Cochrane risk of bias tool. 2496 articles were identified of which 74 met inclusion criteria; 80% were RCTs or cluster RCTs. Techniques to promote need supportive environments were coded according to two established taxonomies (BCTv1 and MIT), and 21 SDT-specific techniques, and grouped into 18 SDT based strategies. Weighted mean effect sizes were computed using a random effects model; perceived autonomy support g = 0.84, autonomy g = 0.81, competence g = 0.63, relatedness g = 0.28, and motivation g = 0.41. One-to-one interventions resulted in greater competence satisfaction than group-based (g = 0.96 vs. 0.28), and competence satisfaction was greater for adults (g = 0.95) than children (g = 0.11). Meta-regression analysis showed that individual strategies had limited independent impact on outcomes, endorsing the suggestion that a need supportive environment requires the combination of multiple co-acting techniques.

Methods of systematic reviews and meta-analysis preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

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