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A Classification of Motivation and Behavior Change Techniques Used in Self- Determination Theory-Based Interventions in Health Contexts

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While evidence suggests that interventions based on self-determination theory have efficacy in motivating adoption and maintenance of health-related behaviors, and in promoting adaptive psychological outcomes, the motivational techniques that comprise the content of these interventions have not been comprehensively identified or described. The aim of the present study was to develop a classification system of the techniques that comprise self-determination theory interventions, with satisfaction of psychological needs as an organizing principle. Candidate techniques were identified through a comprehensive review of self-determination theory interventions and nomination by experts. The study team developed a preliminary list of candidate techniques accompanied by labels, definitions, and function descriptions of each. Each technique was aligned with the most closely-related psychological need satisfaction construct (autonomy, competence, or relatedness). Using an iterative expert consensus procedure, participating experts (N=18) judged each technique on the preliminary list for redundancy, essentiality, uniqueness, and the proposed link between the technique and basic psychological need. The procedure produced a final classification of 21 motivation and behavior change techniques (MBCTs). Redundancies between final MBCTs against techniques from existing behavior change technique taxonomies were also checked. The classification system is the first formal attempt to systematize self-determination theory intervention techniques. The classification is expected to enhance consistency in descriptions of self-determination theory-based interventions in health contexts, and assist in facilitating synthesis of evidence on interventions based on the theory. The classification is also expected to guide future efforts to identify, describe, and classify the techniques that comprise self-determination theory-based interventions in multiple domains.
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SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 1
A Classification of Motivation and Behavior Change Techniques Used in Self-
Determination Theory-Based Interventions in Health Contexts
Pedro J. Teixeira1, Marta M. Marques2, Marlene N. Silva1, Jennifer Brunet3, Joan Duda4, Leen
Haerens5, Jennifer La Guardia6, Magnus Lindwall7, Chris Lonsdale8, David Markland9, Susan
Michie10, Arlen C. Moller11, Nikos Ntoumanis12, Heather Patrick13, Johnmarshall Reeve8,
Richard M. Ryan8, Simon J. Sebire14, Martyn Standage15, Maarten Vansteenkiste5, Netta
Weinstein16, Karin Weman-Josefsson17, Geoffrey C. Williams18, Martin S. Hagger19,20
1University of Lisbon, 2Trinity College Dublin, 3University of Ottawa, 4University of
Birmingham, 5Ghent University, 6Omada Health, 7University of Gothenburg, 8Australian
Catholic University, 9Bangor University, 10University College London, 11Illinois Institute of
Technology, 12Curtin University, 13Carrot, Inc, 14University of Bristol, 15University of Bath,
16Cardiff University, 17Halmstad University, 18University of Rochester, 19University of
California, Merced, 20University of Jyväskylä
© 2020, American Psychological Association. This paper is not the copy of record and may not
exactly replicate the final, authoritative version of the article. Please do not copy or cite
without authors permission. The final article will be available, upon publication, via its DOI:
10.1037/mot0000172
Full citation: Teixeira, P. J., Marques, M. M., Silva, M. N., Brunet, J., Duda, J., Haerens, L., La
Guardia, J., Lindwall, M., Londsdale, C., Markland, D., Michie, S., Moller, A. C., Ntoumanis,
N., Patrick, H., Reeve, J., Ryan, R. M., Sebire, S., Standage, M., Vansteenkinste, M., . . .
Hagger, M. S. (2020). Classification of techniques used in self-determination theory-based
interventions in health contexts: An expert consensus study. Motivation Science.
https://doi.org/10.1037/mot0000172
Author Note
Martin S. Hagger’s contribution was supported by a Finnish Distinguished Professor
(FiDiPro) award from Business Finland (grant # 1801/31/2105). Marta Marques’ contribution
was funded by the Marie-Sklodowska-Curie (EDGE) Fellowship programme (grant agreement
No. 713567). We thank Eliana Carraça and Jorge Encantado for their contribution to the data
synthesis. We have no known conflict of interest to disclose. Correspondence regarding this
article should be addressed to Martin S. Hagger, SHARPP Lab, Psychological Sciences,
University of California, Merced, 5200 N. Lake Rd., Merced, CA 95343, email:
mhagger@ucmerced.edu
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 2
Abstract
While evidence suggests that interventions based on self-determination theory have efficacy in
motivating adoption and maintenance of health-related behaviors, and in promoting adaptive
psychological outcomes, the motivational techniques that comprise the content of these
interventions have not been comprehensively identified or described. The aim of the present
study was to develop a classification system of the techniques that comprise self-determination
theory interventions, with satisfaction of psychological needs as an organizing principle.
Candidate techniques were identified through a comprehensive review of self-determination
theory interventions and nomination by experts. The study team developed a preliminary list of
candidate techniques accompanied by labels, definitions, and function descriptions of each.
Each technique was aligned with the most closely-related psychological need satisfaction
construct (autonomy, competence, or relatedness). Using an iterative expert consensus
procedure, participating experts (N=18) judged each technique on the preliminary list for
redundancy, essentiality, uniqueness, and the proposed link between the technique and basic
psychological need. The procedure produced a final classification of 21 motivation and
behavior change techniques (MBCTs). Redundancies between final MBCTs against techniques
from existing behavior change technique taxonomies were also checked. The classification
system is the first formal attempt to systematize self-determination theory intervention
techniques. The classification is expected to enhance consistency in descriptions of self-
determination theory-based interventions in health contexts, and assist in facilitating synthesis
of evidence on interventions based on the theory. The classification is also expected to guide
future efforts to identify, describe, and classify the techniques that comprise self-determination
theory-based interventions in multiple domains.
Keywords: Self-determination theory interventions; Autonomous motivation; Autonomy
support; Need satisfaction; Motivational technique
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 3
A Classification of Motivation and Behavior Change Techniques Used in Self-Determination
Theory-Based Interventions in Health Contexts
Chronic non-communicable diseases and conditions such as cancer, cardiovascular
disease, obesity, and diabetes contribute to a large proportion of population morbidity and
mortality worldwide, and also account for a substantive proportion of healthcare costs (Li et
al., 2018; OSBBR, 2016; The US Burden of Disease Collaborators, 2018). In response,
national departments of health and healthcare organizations have advocated prevention through
interventions to promote participation in health-related behaviors, such as participation in
physical activity, healthy eating, avoiding tobacco, and treatment adherence (Dunton,
Cousineau, & Reynolds, 2010; Ueda et al., 2018; Wood et al., 2018). Given that current
population-level participation in these behaviors is insufficient to confer health benefits and
prevent chronic disease, developing behavioral interventions and testing their efficacy and
effectiveness in increasing health behavior participation rates is considered a public health
priority (Bartholomew & Mullen, 2011; Glanz & Bishop, 2010; Johnson & Acabchuk, 2018).
Psychologists and behavioral scientists have applied motivational theories to identify
the modifiable factors and mechanisms that relate to health behaviors, which can be used as a
basis for the development and evaluation of behavioral interventions (Hagger, Cameron,
Hamilton, Hankonen, & Lintunen, 2020; Rothman et al., 2015; Sheeran, Klein, & Rothman,
2017). Self-determination theory (Deci & Ryan, 1985, 2000; Ryan & Deci, 2017) is a
prominent theory of motivation that has demonstrated promise in identifying the psychological
factors and processes that determine motivated behavior in diverse health contexts. In addition,
interventions based on the theory have been shown to be efficacious in promoting motivation
toward, and actual participation in, health behavior across multiple populations, contexts, and
behaviors (e.g., Chatzisarantis & Hagger, 2009; Emm-Collison, Jago, Salway, Thompson, &
Sebire, 2019; Gillison, Rouse, Standage, Sebire, & Ryan, 2018; Ng et al., 2012; Teixeira,
Carraca, Markland, Silva, & Ryan, 2012; Williams, McGregor, Sharp, Kouides, et al., 2006;
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 4
Williams, McGregor, Sharp, Levesque, et al., 2006). While there has been some previous
research specifying and defining the content of self-determination theory-based interventions
in education contexts (e.g., Aelterman et al., 2019; Cheon & Reeve, 2013; Reeve & Jang,
2006; Su & Reeve, 2011; Tessier, Sarrazin, & Ntoumanis, 2008), there have been few attempts
to develop descriptions of the essential and distinct techniques that comprise interventions
based on the theory (Gillison et al., 2018; Ryan, Patrick, Deci, & Williams, 2008). Moreover,
considerable variability in how the theory is currently applied and tested in health behavior
settings has been noted (Silva, Marques, & Teixeira, 2014). For example, interventions based
on the theory have tended not to identify the theory-based constructs targeted by the
intervention content, or clearly specify links between the content with the targeted constructs,
or conduct appropriate analyses to test whether the intervention content leads to changes in
both the construct and the outcome of interest, often a behavioral measure.
There is, therefore, a need to systematically identify and describe the practices or
techniques that comprise self-determination theory-based interventions (Ryan et al., 2008).
Identifying these techniques will be valuable to stakeholders (e.g., researchers, administrators)
interested in developing behavioral interventions based on the theory and conducting research
to establish their efficacy and effectiveness since it will provide a common set of descriptions
of the techniques that make up the content of the interventions. It will also contribute to
research aimed at developing an evidence base of optimally efficacious and effective
intervention techniques based on the theory. The purpose of the present study was to develop
an organized description of the essential techniques implemented within interventions based on
self-determination theory in health contexts using an expert consensus approach.
Self-Determination Theory and Basic Psychological Needs
Self-determination theory is a theory of human motivation that has demonstrated
efficacy in predicting motivated behavior in multiple contexts and populations, and for a
variety of behaviors (Deci & Ryan, 1985, 2000; Ryan & Deci, 2017), including health
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 5
behaviors such as physical activity, healthy eating, and smoking cessation (Ng et al., 2012;
Patrick & Williams, 2012; Ryan & Deci, 2017). Self-determination theory is unique among
theories of motivation due to its focus on the quality of motivation rather than quantity alone.
Self-determination theory emphasizes the importance of the kind of motivation that drives
people’s behavior, alongside considerations of how much they are motivated. Central to the
theory is the distinction between self-determined or autonomous, and non-self-determined or
controlled forms of motivation (Deci & Ryan, 2000; Ryan & Deci, 2017). These motivational
subtypes reflect the degree to which actions are fully self-endorsed by the individual.
Autonomous motivation reflects self-endorsed reasons for engaging in a behavior or pursuing a
particular goal. Individuals acting for autonomous reasons experience their actions as freely
chosen and consistent with their genuine sense of self, values, and personal goals, and feel that
they are the origin of their actions (Ryan & Deci, 2006). In contrast, controlled motivation
reflects reasons for acting that are not self-endorsed. Individuals citing controlled reasons for
action view their behavior as originating outside their self and feel that their actions are
controlled by external contingencies (Sheldon & Elliot, 1998; Sheldon et al., 2004). A third
form of regulation is amotivation, a state which reflects a lack of any motivational force to act.
Individuals who feel their actions are amotivated offer no discernible reason, motive, or
intention for action (Deci & Ryan, 2000; Ntoumanis, Pensgaard, Martin, & Pipe, 2004). Across
numerous health contexts, a cogent body of research has consistently found that autonomous
forms of motivation are associated with behavioral persistence and healthier psychological
outcomes (Hagger & Chatzisarantis, 2015; Ng et al., 2012; Pihu, Hein, Koka, & Hagger, 2008;
Ryan & Deci, 2017; Teixeira et al., 2012).
A further key premise of the theory is that the quality of motivation experienced by
individuals when acting is determined by the extent to which they view their actions to be
consistent with, and in the service of, three basic psychological needs autonomy,
competence, and relatedness (Deci & Ryan, 2000; Ryan & Deci, 2017). The needs are
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 6
considered universal, and are implicated in the process that gives rise to the type of motivation
experienced in behavioral contexts (i.e., hallmarks) of each of the three psychological needs.
The need to experience autonomy reflects actions as freely chosen and self-endorsed, reflecting
the need for individuals to experience a sense of ownership and responsibility over their
actions. The need for competence refers to the experience of being effective in one’s
environment, mastering mentally or physically challenging tasks, and perceiving sufficient
capacity to perform actions. The need for relatedness reflects the need to feel accepted and
respected, and to gain a sense of connectedness and mutual concern with important others
(Deci & Ryan, 2000; Ryan & Deci, 2017). A summary of the three basic psychological needs
from the theory is provided in Table 1. Large-scale research has supported the primacy of the
needs for autonomy, competence, and relatedness above other candidate needs (Sheldon, Elliot,
Kim, & Kasser, 2001) and across different cultural contexts (Chen et al., 2015). In addition,
satisfaction of the needs have been shown to mediate the associations between autonomous
motivation and behavioral persistence in multiple contexts including health behavior change
(Ng et al., 2012). Analogously, the frustration of these basic psychological needs has been
shown to mediate the associations between controlled forms of motivation and behavioral
disengagement and lower wellbeing (Bartholomew, Ntoumanis, Ryan, Bosch, & Thogersen-
Ntoumani, 2011; Haerens, Aelterman, Vansteenkiste, Soenens, & Van Petegem, 2015; Silva et
al., 2014; Vansteenkiste & Ryan, 2013).
Whether a person’s psychological needs are satisfied or frustrated depends largely on
the extent to which the person’s surrounding environment and relationships support or thwart
those needs (Deci, Eghrari, Patrick, & Leone, 1994; Deci & Ryan, 1985; Ryan & Deci, 2017).
The behaviors displayed, or messages provided, by social agents (e.g., health practitioners,
teachers, coaches, parents, peers, family members and colleagues) operating in an individual’s
social environment, or the content of messages communicated by other means (e.g., leaflets,
websites, text messages, smartphone ‘apps’), can be more or less supportive or thwarting of the
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 7
psychological needs. If the agents’ behaviors or messages support the satisfaction of
individuals’ psychological needs, then these individuals are likely to experience their actions as
autonomously motivated, and may engage with and/or maintain health behaviors (Deci &
Ryan, 2000; Ntoumanis, Quested, Reeve, & Cheon, 2018; Ryan & Deci, 2017). In contrast,
behaviors and messages that do not support, or actively hinder, satisfaction of psychological
needs likely undermine autonomous motivation and promote controlled forms of motivation or
amotivation, which may lead to maladaptive outcomes and behavioral disengagement (Deci &
Ryan, 2000; Ntoumanis et al., 2018; Ryan & Deci, 2017). Providing guidance on the behaviors
displayed by social agents, and specifying the content of messages, are potentially effective
means to promote autonomous motivation and sustained behavior change. The process by
which these interventions affect the quality of motivation is through the satisfaction of the
three basic psychological needs. Satisfaction of the needs is considered a key mediator of self-
determination theory-based interventions on outcomes, particularly behavior change.
Ryan, Patrick, Deci, and Williams (2008) proposed an integrative process model that
draws together the key components of self-determination theory. The model specifies the
theory-based processes by which need supportive actions and messages, and other dispositional
factors, relate to health behavior participation and outcomes. An adapted form of this model is
presented in Figure 1. As specified in the model, social agents’ (e.g., health practitioners,
teachers, coaches, parents, peers, family members and colleagues) behaviors and messages that
support autonomy, competence, and relatedness determine whether actors’ basic psychological
needs are supported or frustrated (path 1, Figure 1). The extent to which needs are satisfied or
frustrated will determine the type of motivation experienced (path 2, Figure 1), and the extent
to which the individual engages in, and persists with, health-related behaviors (path 3, Figure
1). The experience of actions as autonomous, controlled, or amotivated will also determine
whether an individual experiences adaptive emotional outcomes and overall levels of
satisfaction (path 4, Figure 1). Finally, the type of motivation experienced will determine the
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 8
extent to which individuals report adaptive or maladaptive mental (path 5a, Figure 1) and
physical (path 5b, Figure 1) health-related outcomes, respectively. Research has supported the
proposed relations among the constructs of the process model, including relations between
need-supportive interventions and need satisfaction, and between these interventions and
behavioral and health-related outcomes (Ng et al., 2012; Su & Reeve, 2011). There is also
evidence demonstrating effects of interventions based on the theory on health behavior through
need satisfaction and autonomous motivation, but tests of these mediating effects are relatively
sparse (Chatzisarantis & Hagger, 2009; Duda et al., 2014; Ng et al., 2012).
Specifying the ‘Techniques of Self-Determination Theory Interventions
As outlined in the previous section, the specific behavioral and communicative
techniques can both signal and support basic psychological need satisfaction and, in turn,
promote autonomous motivation. Often, interventions based on self-determination theory
comprise a number of these techniques, and previous work has aimed to identify and catalogue
these techniques. For example, research in the field of education has developed autonomy
support training programs in which teachers are trained on the necessary skills and techniques
to foster students’ need satisfaction in classroom contexts (e.g., Aelterman et al., 2019; Cheon
& Reeve, 2013; Cheon, Reeve, & Moon, 2012; Cheon, Reeve, & Ntoumanis, 2018; Lonsdale
et al., 2019; Reeve & Jang, 2006; Reeve et al., 2014; Tessier, Sarrazin, & Ntoumanis, 2010).
Within the context of education, Reeve and Jang (2006) produced a list of instructional
behaviors and lesson content that classroom teachers were observed to use to support
autonomy. This list has been updated and organized according to whether the behaviors were
autonomy-supportive or controlling (Reeve et al., 2014). Behaviors and instructions classified
as autonomy-supportive were: taking the students’ perspective, creating opportunities for
student input and initiative, providing explanatory rationales for teacher requests,
acknowledging and accepting expressions of negative affect, and displaying patience.
Instructional behaviors considered to be controlling were: taking only the teacher’s
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 9
perspective, introducing extrinsic incentives, uttering directives without explanations, relying
on pressuring language to silence students’ complaints, and pushing students into immediate
compliance with the teacher’s agenda.
These descriptions have been incorporated into the training programs designed to
develop autonomy-supportive behaviors in teachers and help them avoid the use of controlling
behaviors. By intervening to change teachers’ autonomy-supportive techniques, the programs
are expected to promote students’ autonomous motivation in class and, over time, better
academic engagement and attainment. The techniques included in these programs have also
been used in observational checklists to assess teachers’ use of autonomy supportive strategies
in class, and to assess changes in the use of more autonomy supportive strategies after their
delivery. In addition, this approach has been used to describe autonomy supportive intervention
content in multiple contexts (e.g. healthcare, education, the workplace, sport and coaching,
parenting, and therapy) and guide development of future educational interventions based on
self-determination theory (e.g., Aelterman, Vansteenkiste, Van den Berghe, De Meyer, &
Haerens, 2014; Carpentier & Mageau, 2016; Froiland, 2015; Gagné & Deci, 2005; Halvari &
Halvari, 2006; Jungert et al., 2015; McLachlan & Hagger, 2010; Zuroff et al., 2007).
There is also research that has isolated techniques aimed at promoting motivation
through support for competence and relatedness needs. Techniques to support competence
focus on promoting a sense of satisfaction on tasks or toward goals, with a focus on making
progress toward self-referenced goals, attaining mastery, and developing greater skills. For
example, research has identified three essential techniques for competence support: stating
clear expectations; providing how-to guidance; and giving constructive/positive feedback.
Studies have demonstrated the efficacy of these techniques in promoting motivation and
adaptive outcomes (e.g., Carpentier & Mageau, 2016; Jang, Reeve, & Deci, 2010; Sierens,
Vansteenkiste, Goossens, Soenens, & Dochy, 2009; Tessier et al., 2010). A parallel line of
research has focused on techniques that support relatedness. Research identified several
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 10
essential techniques purported to support relatedness: fostering individualized conversation;
promoting cooperation and teamwork; demonstrating awareness and care; and engaging in
warm, friendly communication (Sparks, Dimmock, Lonsdale, & Jackson, 2016; Sparks,
Lonsdale, Dimmock, & Jackson, 2017). Taken together, these research findings indicate sets of
techniques that promote motivation and behavioral outcomes through support for autonomy,
competence, and relatedness needs.
While numerous approaches to specifying the content of self-determination theory
interventions exist, no formal system has been developed to identify and describe the
techniques that comprise self-determination theory interventions. By comparison, relatively
recent research has developed systems to identify, describe, and organize the essential
techniques used in behavioral interventions more broadly. The development of classification
systems for these techniques, referred to as behavior change techniques, is a prerequisite to be
able to consistently describe behavioral interventions. The classification of behavior change
techniques as taxonomies are typically developed through expert consensus methods. The
development of taxonomies of behavior change techniques using the expert consensus method
provides an opportunity to develop a formal organized description of techniques that comprise
self-determination theory interventions. Development of a formal classification of techniques
of self-determination theory interventions will provide the research community with a common
set of terms to describe the content of interventions based on the theory, and allow for future
empirical testing of which techniques or sets of techniques are most efficacious in promoting
motivation and associated outcomes.
The Present Study
The purpose of the present study was to identify, define, and classify the unique
techniques that comprise interventions based on self-determination theory, and develop the
first classification of techniques comprising self-determination theory interventions in health
behavior contexts. We used an iterative expert-consensus method to develop the classification,
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 11
consistent with methods used to develop taxonomies of behavior change techniques (Kok et al.,
2016; Michie, Ashford, et al., 2011; Michie, Hyder, Walia, & West, 2011; Michie et al., 2013;
Michie et al., 2015). Unlike existing behavior change technique taxonomies, we organized the
current classification system according to links between the techniques and the psychological
constructs stipulated in the process model based on self-determination theory (see Figure 1;
Ryan et al., 2008). Specifically, we hypothesized intervention techniques to exert their effects
on behavior and associated outcomes through changes in psychological need satisfaction, as
well as autonomous and controlled forms of motivation, and amotivation. As the focus of the
techniques was on change in motivation types defined by self-determination theory, rather than
behavior specifically, the identified techniques are referred to as motivation and behavior
change techniques (MBCTs). The development of the classification system
1
should be viewed
as a first step in an ongoing, iterative process, progressively informed by empirical
investigation of the effects of MBCTs on behavioral outcomes mediated by satisfaction of
psychological needs of autonomy, competence, and relatedness.
Method
The unique MBCTs based on self-determination theory were identified, labelled,
defined, and classified using an iterative expert consensus procedure, similar to procedures
used to develop taxonomies of behavior change techniques (e.g., Michie, Ashford, et al., 2011;
Michie, Hyder, et al., 2011; Michie et al., 2013; Michie et al., 2015). An MBCT was defined as
a distinct, observable and replicable component of an intervention, designed to influence a
person’s behavior directly or indirectly by impacting the person’s
2
perceptions of autonomy,
relatedness, and/or competence need satisfaction in relation to a particular behavior or group of
1
We refer to a classification system rather than taxonomy as our proposed list of MBCTs is not expressed as a
taxonomic structure, i.e., a hierarchical relationship in which lower level entities have only one type of
relationship with a higher-order entity. The current classification is not, therefore, considered a true taxonomy.
2
The person refers to the individual or group (e.g., a client, patient, intervention participant) that is the target of
the intervention.
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 12
related behaviors. The definition was based on previous definitions used in taxonomies of
behavior change techniques (Michie et al., 2013), and a recent classification of motivational
interviewing techniques (Hardcastle, Fortier, Blake, & Hagger, 2017). Descriptions of
motivational interviewing techniques were useful to inform the definition due to the expressed
conceptual links between motivational interviewing and self-determination theory-based
intervention techniques (Markland, Ryan, Tobin, & Rollnick, 2005; Vansteenkiste & Sheldon,
2006). For example, many of the techniques from motivational interviewing, such as
supporting autonomy and exploring change expectations, have good congruence with strategies
used in autonomy-support interventions focusing on choice and setting self-referenced goals
(Hardcastle et al., 2017; Vansteenkiste, Williams, & Resnicow, 2012).
Participants
Experts (N = 18, 11 men, 7 women) participating in the consensus procedure were
leading researchers with expertise in designing, conducting, and evaluating self-determination
theory-based interventions in the health domain. Participants were identified from the network
of self-determination theory researchers (www.selfdeterminationtheory.org) and recruited by
email. Fourteen were psychologists, three were physical activity specialists, and one was a
physician and health psychologist. Experts were based in the United Kingdom (n = 5), United
States (n = 4), Australia (n = 3), Belgium (n = 2), Sweden (n = 2), Canada (n = 1), and South
Korea (n = 1). The core study team (PJT, MM, MS, MSH) developed the first list of
techniques, and were responsible for the feedback, discussion, and refinement of the MBCTs.
Their collective expertise is in social psychology, behavioral science, medicine, preventive
medicine, and exercise and nutrition sciences, and all have specific expertise in self-
determination theory.
Procedure
A seven-step expert consensus procedure was adopted (Table 2). The procedure began
with the development of an exhaustive list of candidate techniques based on the pooled
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 13
knowledge of the lead author group and a content analysis of previous self-determination
theory interventions. This was followed by a series of expert consensus exercises aimed at
refining descriptions and content of the candidate items, removing redundancy, and
establishing links between the techniques and need-satisfaction constructs from self-
determination theory.
Step 1: Development of the first list of MBCTs. The study team members generated
an initial ‘long list of distinct MBCTs used in self-determination theory-based interventions,
derived from a content analysis of published interventions, manipulations, and autonomy
support training programs (e.g., Chatzisarantis & Hagger, 2009; Cheon & Reeve, 2013; Deci et
al., 1994; Haerens et al., 2013; McLachlan & Hagger, 2010; Patrick, Resnicow, Teixeira, &
Williams, 2013; Reeve & Jang, 2006; Su & Reeve, 2011; Tessier et al., 2008)
3
. For each
potential distinct MBCT, initial labels and definitions were formulated and discussed among
the core study team members (PJT, MM, MS, MSH) until majority agreement was achieved.
Specifically, as in taxonomies of behavior change techniques (e.g., Michie, Ashford, et al.,
2011; Michie, Hyder, et al., 2011; Michie et al., 2013; Michie et al., 2015), definitions of
MBCTs were formulated using active verbs (e.g., elicit, prompt, use).
Step 2: Consensus exercise Round 1. An initial group of experts (N = 8) was asked
to provide written feedback on the initial list of MBCTs from Step 1, regarding the clarity and
content of each label and definition, as well as critical details any MBCTs would insufficiently
capture
4
.
Step 3: Consensus exercise Round 2. Based on these experts’ comments from
Round 1 and on further discussion among the core team (PJT, MM, MS, MSH), the initial list
of MBCTs was refined. Comments from Round 1 led to the decision to conduct a second round
with an additional pool of experts. In addition, the core team added a function to each MBCTs.
3
References of all included studies are available as an online supplement: https://osf.io/ytfbq/
4
Guidelines provided to the experts are available as an online supplement: https://osf.io/f42pe/
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 14
The function description outlined the purpose of the MBCT thereby specifying how it targets
the proposed primary mechanism of action (i.e., the corresponding need from self-
determination theory). The label, definition, and function descriptions of each MBCT were
discussed among the core study team members until majority agreement was achieved.
In this round, a larger group of experts (N = 18), including the eight experts from
Round 1, was asked to respond to a maximum of eight questions about each of 24 MBCTs
from the refined list through an online questionnaire, using online surveys administered via the
QualtricsTM software. The task was divided in two parts. In the first part, experts rated the
need-sensitivity of each MBCT, that is, the extent to which each MBCT targeted each of the
three psychological needs autonomy, relatedness and competence, starting with the need
hypothesized to be most closely related to the MBCT (Questions 1, 2, and 3)
5
. Reponses were
provided on a 5-point scale (1 = definitely no and 5 = definitely yes). Experts also rated the
essentiality of each MBCT is to a self-determination theory-based health intervention
(Question 4; coded 1 = essential, 2 = important but not essential, 3 = not important, and 4 =
uncertain/don’t know). In the second part, experts assessed the specificity of each MBCT by
assessing its uniqueness in relation to any of the other MBCTs listed (Question 5; coded 1 =
sufficiently unique, 2 = overlapping considerably, and 3 = uncertain/dont know). If experts
responded overlapping considerably”, they were asked to indicate which of the other
technique(s) the MBCT overlapped with (Question 6), and what changes could be done to
reduce it (Question 7). Finally, all experts were asked if they wanted to make any other
comments on each MBCT, such as changing labels, definitions, or function descriptions
(Question 8). Responses to this question were optional, and it used an open-ended response
format.
5
The reference list of definitions of basic psychological needs and their focus used by the experts is available as an
online supplement: https://osf.io/msu97/
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 15
Prior to participating in this exercise, experts were informed about the expected task
completion time and they could interrupt at any point, preferably after a set of related questions
(i.e., an MBCT). They were also asked to familiarize themselves with the full list of MBCTs
label, definition, and function description before starting the task. Follow-up reminders were
sent to experts after 10 days, and all responses were submitted within 2 weeks.
To avoid confusion during the consensus exercise, experts were further informed that
(1) when rating the MBCT-need link, each link should be considered separately, irrespective of
whether other needs are targeted by the same MBCT; (2) each MBCT should be considered on
its own, even if the MBCT is rarely used in isolation in self-determination theory-based
interventions; (3) when rating the uniqueness of each MBCT, potential interactions between
these techniques should not be considered; and (4) presenting each need separately does not
imply that the effect of any MBCT on a given need is independent of other needs.
For the specificity, essentiality, and uniqueness questions, frequencies and mode
averages of responses were calculated for each MBCT. Each MBCT was marked as requiring
further consideration, if at least one-quarter (25%) of the experts considered: (1) the technique
did not target the need theoretically hypothesized to be more closely linked to the MBCT (by
responding ‘definitely no’, ‘probably no’ or ‘uncertain’ to Question 1); (2) at least one of the
other two needs to be strongly targeted by the MBCT (i.e. by responding ‘definitely yes’ to
Questions 2 or 3); (3) the technique to be unimportant in a self-determination theory-based
health intervention (Question 4); and (4) the technique yielded considerable overlap
considerably with other MBCTs (Question 5).
Step 4: Discussion and feedback from core team members. Based on the expert
feedback in step 3, the core team members refined the list of MBCTs, based on the results
Round 2 of the consensus exercise. For MBCTs rated (a) not important in the context of a self-
determination theory-based intervention (Question 4), or (b) overlapping considerably with
other MBCTs (Question 5), by the panel of experts, the team discussed their removal or
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 16
rewording until majority agreement was achieved. All labels, definitions and function
descriptions were revised for comprehensiveness based on the experts suggestions provided in
Question 8.
Step 5: Consensus exercise Round 3. The same group of experts (N = 18) was asked
an additional set of questions about the MBCTs that required further consideration from the
previous round; they were also asked to conduct a fine-grained review of the MBCT
descriptions for clarity. In addition, for any MBCTs added to the list in this round, experts
were asked the same set of questions as in Round 2.
For all MBCTs, where a consensus on their specificity was not reached, experts were
asked to rate how (Question 1). Experts could select one of five responses: 1 = Confident that it
is largely specific to the [basic psychological need], 2 = Uncertain/don’t know, 3 = Confident
that it is not specific, and 4 = Confident that it is not specific. It also targets [alternate basic
psychological need] to a large extent, 5 = Confident that it is not specific. It also targets
[alternate basic psychological need] and [alternate basic psychological need] to a large
extent. Experts selecting option 2 on Question 1 were asked to provide suggestions to rephrase
the function description to improve the specificity of the MBCT (Question 2; open-ended
question). Experts selecting options 3, 4, or 5 on Question 1 were asked to indicate how the
MBCT targeted each of the needs selected (i.e., the proposed function), (Question 3; open-
ended question).
For all MBCTs where a consensus on their uniqueness was not reached, experts were
asked how satisfied they were that the MBCT was sufficiently unique in relation to others
considered to be overlapping in Round 2, to justify being listed separately (Question 4; coded 1
= sufficiently unique, 2 = overlapping considerably, and 3 = uncertain/dont know). If
participants responded “overlapping considerably”, they were asked to describe why they
considered the MCBTs to overlap, and suggest changes to the label, definition and/or function
description, to reduce overlap (Question 5 open-ended question).
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 17
Finally, experts were presented with a group of four MBCTs (randomly selected), one
at a time, and asked to review the label, definition, and function description for clarity of
English language, and suggest minor changes where appropriate. This was an optional, open-
ended response format.
As in Round 3, frequencies and mean or mode averages of responses were calculated
for each MBCT. Each MBCT was marked as requiring further consideration, if at least one-
quarter (25%) of experts considered that it was not specific to the stipulated need, and/or
targeted an alternate need, by returning a 2, 3, 4, or 5 response to Question 1 (i.e. confidence
that each MBCT is specific to each of the three psychological needs autonomy, competence,
and relatedness), and that it overlapped considerably with one or both of the other MBCTs by
returning a 2 response to Question 4 (i.e., the MBCT is sufficiently unique in relation to other
MBCTs or considered to be overlapping).
In addition, intraclass correlation coefficients (ICC) were computed in Rounds 2 and 3
to assess inter-rater reliability of experts specificity, essentiality, and uniqueness ratings.
Step 6: Revision and finalization of the list of MBCTs. Based on the ratings provided
in Round 3, and suggestions for improvement, the core study team refined the list of MBCTs,
including amendments to the wording of definitions, labels, and function descriptions to make
them more distinct from each other, and exclude redundant MBCTs. No further rounds were
required.
Step 7: Comparison of MBCTs and Techniques from the Behavior Change
Techniques Taxonomy (BCTT) v1. The core study team members compared the final list of
MBCTs with the BCTTv1 (Michie et al, 2013). The aim was to identify MBCTs that could
overlap with the ones presented in the BCTTv1, and in these cases, clarify the uniqueness of
the MBCT.
Results
Initial Classification: Steps 1 and 2
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 18
The initial ‘long list’ of MBCTs identified by the core study team from the literature
review and expert nomination identified 39 candidate techniques organized under the three
psychological need satisfaction categories from self-determination theory autonomy,
competence and relatedness
6
. MBCTs considered to be vague, redundant, or overlapping by
participating experts in Round 1 of the consensus method were reformulated or removed. The
revised list comprised 24 MBCTs, eight for each need satisfaction category
7
. The label,
definition, and function description of each MBCT was revised for clarity. A definitions key
for each psychological need under which the MBCTs were classified was also developed to
accompany the list of MBCTs.
Refining the Techniques: Steps 3 and 4
In Round 2, experts provided responses to each of the three criteria for rating the
candidate MBCTs identified in Round 1: specificity, essentiality, and uniqueness
8
. With
respect to the specificity criterion, all MBCTs were rated as sufficient in targeting the primary
need, with responses ranging from “probably yes” to “definitely yes”. There were some
instances where MBCTs were identified as targeting needs other than the hypothesized need.
Specifically, the “facilitate autonomous goals or outcomes (autonomy) and “support clients
initiatives and explorations around behavior change (autonomy) MBCTs were rated as
definitely yes” as also targeting competence by 38.9% and 44.4% of experts, respectively. In
addition, the acknowledge and accept clients perspectives (relatedness) and “encourage
client to ask questions (relatedness) MBCTs were both rated “definitely yes” as also targeting
autonomy by half of the experts. The ask permission to provide information or give advice
(relatedness) MBCT was rated “definitely yes” as also targeting autonomy by 38.9% of
6
The list of MBCTs for all rounds are presented as an online supplement: https://osf.io/2vh8y
7
Changes are documented in an online supplement: https://osf.io/2vh8y
8
A summary table of experts’ ratings of the MBCTs in Round 2 of the consensus survey is provided as an online
supplement (https://osf.io/fu38t/), along with a table providing full results for each MBCT (https://osf.io/cf3n7/).
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 19
experts. In addition, a substantive proportion of experts (33.3%) considered the MBCT
“explore sources of support from others” (competence) to also target relatedness.
With respect to essentiality, all MBCTs were considered essential or important
techniques for self-determination theory-based interventions. A substantive minority (27.8%)
of experts expressed uncertainty over the importance of the explore means to manage and
cope with pressure (competence) MBCT.
In terms of uniqueness ratings, only six of the MBCTs were judged to be conceptually
unique and free of considerable overlap with other MBCTs
9
. From experts comments and
suggestions to reduce overlap, it became clear that, when answering this question, some
experts were considering the interactions that occur between MBCTs in a given intervention,
rather than their potential conceptual overlap (e.g., the “acknowledge and accept the client’s
perspectives and “acknowledge feelings MBCTs were rated as overlapping by 55.6% of
experts). In Round 3, instructions for this section were improved.
The ICC values showed good consensus on ratings of specificity (ICC = .929, 95% CI
[.873, .968]), essentiality (ICC = .784, 95% CI [.623, .902]), and uniqueness (ICC = .902, 95%
CI [.823, .957]).
Based on these ratings, one MBCT was removed (“Support client’s initiatives and
explorations around behavior change”), and two further MBCTs were added under the
autonomy need satisfaction category: “explore intrinsic rewards and “encourage the person to
be supportive towards others with a similar condition. Changes were also made to the wording
of the labels, definitions, and function descriptions of the MBCTs. The refined classification
comprised 25 MBCTs, classified under the autonomy (n = 9), relatedness (n = 8), and
competence (n = 8) need satisfaction categories, respectively
10
.
Finalizing the Classification: Steps 5 and 6
9
Full details of overlapping MBCTs are provided in an online supplement: https://osf.io/cf3n7/
10
A full description of changes made to the MBCTs is provided in an online supplement: https://osf.io/2vh8y/
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 20
In Round 3 of the expert consensus procedure, experts (n = 16) were asked to rate the
two additional MBCTs using the same procedure as in Round 2
11
. With respect to the
uniqueness criterion, the majority of the experts (68.8%) judged the “encourage the person to
be supportive towards others with a similar condition MBCT to be more relevant to
competence and relatedness needs rather than its original classification under the autonomy
need. Both new MBCTs were judged to be conceptually unique and not overlapping with all
the other MBCTs, except for the overlap between the explore intrinsic rewardsand
“facilitate autonomous goals or outcomes” MBCTs (43.8% of experts).
In terms of specificity judgements, the “acknowledge and respect perspectives
(relatedness), “ask permission to provide information or give advice” (relatedness), and
“explore sources of support from others” (competence) MBCTs, were again judged by a
substantive proportion of the experts (56.3%, 31.3%, and 43.7%, respectively) as targeting
autonomy and relatedness.
Focusing on the uniqueness ratings, most MBCTs from the previous round were still
judged by experts as overlapping with other MBCTs. However, the number of MBCTs with
which each MBCT was judged to overlap decreased. For example, the “explore life aspirations
and values” MBCT was considered to overlap with four other MBCTs in Round 2, while in the
current round it was judged by a majority (56.3%) of experts to overlap with the “facilitate
autonomous goals or outcomes” MBCT alone. In addition, the “show unconditional regard”
and “take interest the person” MBCTs were rated conceptually unique.
The ICC scores showed good consensus on ratings of specificity (ICC = .658, 95% CI
[.334, .859]), and uniqueness (ICC = .955, 95% CI [.917, .981]).
Based on the ratings and suggestions from experts on the wording of the MBCTs, the
core study team revised the list of MBCTs. For the autonomy need category, the new
11
Full results of the consensus procedure for Round 3 are provided in an online supplement: https://osf.io/amnr4/
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 21
“encourage the person to be supportive towards others with a similar condition MBCT and the
“facilitate autonomous goals or outcomes MBCT were consolidated into the “provide choice
MBCT. The “acknowledge and respect perspectives and “acknowledge feelings MBCTs
were consolidated, and the “ask permission to provide information or give advice MBCT was
removed and integrated with the “use empathic listening” MBCT. In addition, the “explore
sources of support from others MBCT was reclassified from the competence need category to
the relatedness category. In addition, the wording of labels, definitions, and function
descriptions of the MBCTs was also revised based on experts’ suggestions. The final
classification of MBCTs (N = 21) with formal agreed labels, definitions, function descriptions,
and categorization according to their primary psychological need is presented in Table 3
12
.
Commonalities with Other Taxonomies: Step 7
The core study team matched the final list of MBCTs produced after the Round 3
consensus procedure with key BCTs from BCTTv1
13
. Seven MBCTs were considered
overlapping with existing BCTs, five of which were techniques hypothesized to improve
competence13. However, it is important to note that the definitions and function descriptions of
the MBCTs set these techniques aside from the matched BCTTv1. This is because each MBCT
is aligned with a theoretical construct from self-determination theory integral to the mechanism
by which it is purported to change motivation and behavior. Specifically, each MBCT is
defined in terms of the psychological need expected to mediate its effect on behavior change.
Whilst BCTTv1 has been linked using consensus and literature reviewing methods to
theoretical constructs (Carey et al., 2019; Connell et al., 2018), there has been no taxonomy or
classification linking MBCTs to the key constructs of self-determination theory. In addition,
12
Illustrative examples of each MBCT for client-practitioner interactions are provided in an online supplement:
https://osf.io/mhw5x/
13
Full results of the matching exercise are provided in an online supplement: https://osf.io/8jtm3/
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 22
the MBCTs are proposed to evoke change in motivation as well as behavior as end-points,
while techniques from BCTTv1 are exclusively defined in terms of changing behavior.
Discussion
The current research aimed to identify, describe, and classify the techniques employed
in motivation and behavior change interventions based on self-determination theory in health
contexts. The research extends knowledge on behavioral interventions based on the theory in
the health domain by providing a common set of terms and definitions for the identified
techniques. This classification is organized by the links between techniques and the
psychological need satisfaction constructs implicated in the mechanism by which the
techniques change motivation and behavior in accordance with Ryan et al.’s (2008) process
model (Figure 1). Consistent with the focus of self-determination theory on motivation quality,
techniques aimed at the end-points of motivation and behavior were labelled motivation and
behavior change techniques (MBCTs). We used an iterative expert consensus procedure to
identify, define, and classify techniques used in self-determination theory-based interventions,
similar to the procedures used to develop taxonomies of behavior change techniques (Michie et
al., 2005; Michie et al., 2013; Michie et al., 2015). This procedure yielded 21 MBCTs with
accompanying labels, definitions, and function descriptions, and each MBCT was classified
into autonomy, competence, and relatedness need satisfaction categories.
Interrelatedness Among Techniques and Relations to ‘Motivating Styles’
While the expert panel and iterative procedure used in the current analysis led to
general consensus on the techniques that comprise self-determination theory-based
interventions, and that each technique principally targeted change in one of the three basic
psychological needs, the experts also suggested that many of the techniques targeted change in
other needs. This is consistent with the premises of self-determination theory. Although clear
conceptual distinctions are proposed among the basic needs, the theory also states that the
needs are complimentary. According to Ryan and Deci (2017), “the three basic needs are
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 23
interdependent” because “the satisfaction of one need supports the satisfaction of the other two
needs” (p. 249). In addition, at the empirical level, measures of the three needs routinely
intercorrelate and factor analyses reveal that measures of satisfaction of the three psychological
needs form a higher order need satisfaction factor (Hagger, Chatzisarantis, & Harris, 2006).
That the MBCTs identified in the current research had close affinity to one need, but were also
linked to satisfaction of one or both of the other needs, is consistent with this premise.
Furthermore, although there is evidence to suggest that individual techniques can alone be
efficacious in changing motivation and outcomes (e.g., provision of choice, Patall, Cooper, &
Robinson, 2008), many techniques are designed to be used interactively. For instance, an
intervention providing a rationale for engaging in a task or behavior (MBCT5) is not likely to
promote autonomy satisfaction by itself, but a rationale paired with perspective taking
(MBCT1) and acknowledgement of negative feelings (MBCT8) is more likely to promote
autonomy satisfaction, and engagement (e.g., Deci et al., 1994; Jang et al., 2010; Reeve, Jang,
Hardre, & Omura, 2002). Similar effects have been found in the setting of intrinsic goals
(Vansteenkiste, Simons, Lens, & Sheldon, 2004; Vansteenkiste, Simons, Soenens, & Lens,
2004). Taken together, these theoretical perspectives and research suggest considerable
interrelatedness among the MBCTs and the underlying constructs they are proposed to change.
MBCT interrelatedness is consistent to the notion that promoting motivation change
using self-determination theory interventions involves adoption of ‘motivating styles’ by social
agents. Such ‘agents’ operate in multiple contexts such as healthcare (Williams & Deci, 1996),
education (Reeve & Jang, 2006), the workplace (Gagné & Deci, 2005), sport and coaching
(Carpentier & Mageau, 2016), parenting (Joussemet, Landry, & Koestner, 2008), and therapy
(Zuroff et al., 2007), and are responsible for supporting and nurturing autonomy among their
supervisees including patients, students, employees, athletes, and clients. The motivating styles
adopted by social agents frequently involve the simultaneous display of multiple MBCTs that
act synergistically in promoting need support and motivation change. Research has sought to
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 24
identify and describe motivating styles of social agents (Aelterman et al., 2019; Aelterman et
al., 2014; Delrue et al., 2019). A recent approach has been to characterize motivating styles in a
circumplex structure, with identified motivating styles differing in terms of their need-
supportive vs. need-thwarting character and their level of directiveness, with either the
motivating agent taking more the lead in the interaction or the person to be motivated being
more in charge (Aelterman et al., 2019). Within this circumplex, four broader motivating styles
get partitioned into two distinct approaches, that is, participative and attuning (i.e., autonomy
support), guiding and clarifying (i.e., structure), demanding and domineering (i.e., control),
abandoning and awaiting (i.e., chaos). These eight subareas display an ordered pattern with
individuals’ motivation and need satisfaction (Aelterman et al., 2019; Delrue et al., 2019), with
the most pronounced positive correlates being observed for the most need-nurturing
approaches (i.e., guiding, attuning) and the most negative correlates being observed for the
most need-thwarting approaches (i.e., domineering, abandoning). Interestingly, the other
identified subareas fall in between these two extremes, suggesting that some motivating
techniques are more strongly conducive to need satisfaction than others. This pattern of
gradations may also surface for the identified techniques herein, with some techniques being
more strongly conducive to the psychological needs and others instead creating the optimal
conditions for need satisfying experiences for clients to emerge.
The interrelatedness among the MBCTs and the adoption of a motivating styles
approach seems, at first glance, to be at loggerheads with the notion of identifying separate,
unique MBCTs. A primary function of taxonomies of behavior change techniques is to develop
a common set of descriptions and definitions of the unique techniques that comprise behavioral
interventions. A further goal of taxonomies is to provide researchers with means to develop
studies that isolate the unique and interactive effects of individual intervention techniques on
behavior change using factorial designs. This is aimed at developing optimally effective and
efficient interventions that work in given contexts, populations, and behaviors. Applying this
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 25
approach to produce the current classification of MBCTs serves a similar function, and allows
researchers to develop tests to establish the unique and interactive effects of the different
techniques of self-determination theory interventions in evoking change in need satisfaction,
motivation, and behavior. However, such a ‘micro’ approach to self-determination theory-
based interventions does not need to be irreconcilable with the more ‘macro’ approach
epitomized by motivating styles. In fact, they may be complimentary by using the classification
to describe specific groups of behaviors expected to be displayed in each motivating style.
Potentially, each style could be characterized by groups of MBCTs derived from the current
classification in a ‘profile’ approach, and this may be a direction for future research.
Mechanisms of Effect
A unique feature of the current classification of MBCTs is that it specifies explicit links
between the MBCTs and the psychological need satisfaction constructs from self-
determination theory. Organizing behavior change techniques according to the theoretical
constructs they are purported to change provides important information on how interventions
are likely to ‘work’ in changing behavior (Carey et al., 2019; Connell et al., 2018). The current
organization of MBCTs may inform efforts to identify possible mediators of intervention
effects, and, therefore, the mechanisms by which self-determination theory interventions
promote motivation change and affect outcomes (Hagger et al., 2020; Sheeran et al., 2017).
Consistent with the process model presented in Figure 1 (Ryan et al., 2008), employing the
MCBTs from the current classification in behavior interventions is expected to affect change in
the satisfaction of their respective psychological need. Specifically, autonomy-supportive
MBCTs are proposed to support autonomy need satisfaction in that they facilitate individuals’
sense of self-endorsed satisfaction, volition, sense of choice, ownership, and personal
endorsement of the task or behavior. Competence-supportive MBCTs are expected to support
competence need satisfaction through facilitation of individuals’ sense of satisfaction in
making progress, improvement, attaining mastery, and greater skill development on mental and
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 26
physical tasks and behaviors. Relatedness-supportive MBCTs are predicted to foster
relatedness need satisfaction by engendering individuals’ sense of interpersonal connectedness,
closeness, acceptance, understanding, intimacy, and unconditional regard. The links between
the MBCTs and specific need satisfaction constructs highlight the imperative of including
measures of the relevant need satisfaction constructs in research evaluating effects of MBCT-
based interventions to test the proposed mechanisms.
Links with Other Classifications of Techniques
We also compared the set of MBCTs identified in current classification with those from
BCTTv1 (Michie et al., 2013), a procedure which has been conducted for other classifications
of behavior change techniques (Hardcastle et al., 2017). The goal of the comparison was to
identify commonalities and redundancies across techniques and illustrate the distinctiveness of
the self-determination theory-based techniques identified in the current classification. Results
of the comparison illustrated that many of the MBCTs (five out of seven) classified under
competence need satisfaction shared similar content to those of existing taxonomies,
particularly the BCTTv1 (Michie et al., 2013). The congruent techniques are likely those aimed
at promoting change through changes in constructs such as self-efficacy, confidence, and
control. However, comparisons across the techniques from existing taxonomies should also be
interpreted in light of the explicit alignment of the MBCTs with self-determination theory, and
the focus on both motivation and behavior change. While recent work has specified links
between 56 behavior change techniques and 26 mechanisms of action (Carey et al., 2019;
Connell et al., 2018; Michie et al., 2015), these were not theory-specific. Although there were
techniques identified as having close content across the taxonomies in our comparison, we
opted to retain the MBCTs in the current classification because they have explicitly been
linked to the need satisfaction constructs from self-determination theory, and have a different
focus to those specified in existing taxonomies.
Strengths and Directions for Future Research
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 27
The current research advances knowledge by identifying the sets of techniques that
comprise self-determination theory-based interventions, providing a common set of labels and
descriptions for the techniques, and producing a classification system of the techniques with
basic psychological needs as an organizing principle. A major strength of the research is the
adoption of a rigorous expert-consensus procedure in order to arrive at agreed definitions,
descriptions, and classifications of self-determination theory intervention content. The panel of
experts comprised career researchers with considerable experience in applying self-
determination theory interventions across multiple behaviors, populations, and contexts, and
had in-depth knowledge of the extant research literature on self-determination theory
interventions. The panel applied this pooled knowledge in their evaluation of the candidate set
of techniques during the consensus rounds. The panel did not flag any omissions from the set,
lending support for its comprehensiveness. The procedure provided strong quality control over
the finalized terminology and descriptions of the techniques. Therefore, we are confident our
strategy was sufficiently comprehensive in identifying relevant techniques from the extant
literature, and developing common terms and descriptions of MBCTs that can be adopted by
future researchers to describe the content of self-determination theory-based interventions.
The present research also represents a step forward in specifying the content of self-
determination theory-based intervention in health behavior contexts. A key feature of our
classification system is the development of standardized labels, definitions, and function
descriptions for each MBCT. We encourage future researchers and interventionists to apply the
common terminology developed in the current classification when describing the content of
interventions based on self-determination theory. This will minimize variability and increase
precision in future descriptions of intervention content, and facilitate comparisons in content
across interventions based on self-determination theory, a key goal of classification systems
(Michie, Ashford, et al., 2011; Michie, Hyder, et al., 2011; Michie et al., 2013; Michie et al.,
2015).
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 28
In addition, we expect the increased capacity to directly compare intervention content
afforded by the classification will improve syntheses of evidence across self-determination
theory-based interventions, which have been somewhat hindered by a lack of consensus in
means to describe and characterize essential techniques that comprise these interventions
(Michie & Abraham, 2008; Ryan et al., 2008). The lack of consensus in descriptions creates
considerable problems for researchers attempting to synthesize findings across studies because
it makes it difficult to establish equivalence of intervention content across studies and,
therefore, evaluate intervention efficacy. The current classification is an essential pre-requisite
to the future development of coding systems that enable researchers to effectively link the
descriptions of self-determination theory interventions extracted from studies with the MBCTs
from the current classification (see Cane, Richardson, Johnston, Ladha, & Michie, 2015 for
examples; Michie et al., 2015). Together, such work will permit evaluation of the efficacy of
MBCTs in changing behavior through meta-analytic syntheses of intervention studies based on
self-determination theory. Such syntheses can assist in establishing whether the presence or
absence of specific MBCTs from the classification are efficacious in changing behavior. That,
in itself, is challenging given that few studies adopt factorial designs testing effects of
individual techniques, so such analyses are always going to be hampered by the presence of
other potentially confounding, co-occurring, or interacting techniques (Peters, de Bruin, &
Crutzen, 2015). Nevertheless, the current analysis is expected to pave the way for future
syntheses evaluating effects of individual, isolated intervention techniques based on self-
determination theory on behavior change, or the effects of particular combinations of
techniques. These syntheses contribute to the development of a database of information that
researchers can draw from when developing behavior change intervention based on self-
determination theory.
Related to the previous point, we expect the classification will help researchers develop
interventions testing the efficacy of particular techniques or groups of techniques in changing
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 29
motivation and behavior. We expect it will inform the development of studies using factorial
designs to test the unique and, importantly, interactive effects of groups of techniques on
motivational and behavioral outcomes. Such research may, ultimately, facilitate research
syntheses on the efficacy of individual technique in changing motivation and behavior of the
kind alluded to earlier. It will also inform the development of more efficient interventions
through the selection of techniques shown to be effective, and the elimination of those shown
to be ineffective, in changing motivation and behavior.
Our current research was developed in the domain of health behavior, a decision based
on the extensive research applying self-determination theory in this domain, and the
importance of behavior change and its maintenance to the prevention of chronic disease.
However, the classification system could be applied to behavior change interventions in
different domains, such as education and the workplace. Further research is needed to examine
the cross-domain generalizability of the MBCTs identified in the current classification. Further,
the expert consensus procedures adopted in the current research may also have implications for
the development of similar classifications of techniques for other theories in the motivation and
social psychological literature, and our approach based on theory, evidence, and expert
consensus may provide a template for doing so.
Limitations
Some limitations of the current research should be acknowledged. Although experts
were generally supportive of the use of psychological needs as a general organizing principle,
and that each MBCTs is classified under its primary’ or most closely matched psychological
need but may also be related to other needs, no hierarchy is offered. In fact, for some MBCTs
there was debate among experts as to which of the need satisfaction constructs was the closest
match. While we report the ancillary need satisfaction constructs linked to the techniques in the
course of the consensus procedure, the current classification does not provide an elaborated
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 30
‘map’ of relations between the techniques and the needs they are likely to satisfy, and this
should be a goal of future research.
A further caveat is that although the links between psychological needs and the MBCTs
were derived through a rigorous expert-consensus procedure, they are not based on empirical
evidence from health behavior change interventions. So, the classification does not reflect the
quality or strength of evidence for the links that have been tested. Instead, the links specified in
the current classification should be viewed as guidance on the potential mediators of the effects
of MBCTs on motivation and behavior. The classification should, therefore, inform future
research that synthesizes evidence on the mechanisms by which self-determination theory-
based interventions change behavior, as well inform the design of studies to test proposed
relations for which no previous evidence exists or is lacking. In such cases, the links expressed
in the current classification should be treated as theoretical predictions subject to confirmation
or rejection through empirical tests (Hagger, Gucciardi, & Chatzisarantis, 2017). Such research
will move knowledge and understanding of which techniques work in changing motivation and
behavior in health contexts forward, and assist in identifying the mechanisms responsible. To
speculate, it may be that some individual or groups of MBCTs have larger effects on
motivational and behavioral outcomes than others, and over time cumulative empirical
evidence may assist in identifying a ‘core’ set of self-determination theory techniques that are
most reliably efficacious in changing motivation and behavior.
A related issue of note is that our classification of MBCTs is silent on the effects of the
techniques themselves on outcomes including motivation and behavior. In fact, this is a feature
of all taxonomies of behavior change techniques (e.g., Michie, Ashford, et al., 2011; Michie et
al., 2013). This is because the goal was to develop a means to describe and classify the content
of behavior change interventions based on self-determination theory, rather than providing an
evaluation of whether each technique is efficacious in determining change. In fact, such an
endeavor is difficult for the very reason the current classification was developed in the first
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 31
place it is difficult to evaluate effects of techniques across studies because studies have
tended not to intervention content with sufficient precision, vary in the terms and language
used, and also differ in the number and combination of techniques used. As the field moves
toward more elaborated ontologies of behavior change (Larsen et al., 2016; Michie &
Johnston, 2017), the content of the current classification may be merged with syntheses of
research demonstrating MBCT efficacy and further links between MBCTs and constructs
representing mechanisms of effect. Such ontologies will provide intervention designers with
the comprehensive theory- and evidence-based knowledge necessary to develop interventions
that have optimal efficacy, and the current classification is an important step forward in their
development.
In addition, research is needed to determine whether specific MBCTs identified in the
current classification interact with conditions that moderate their efficacy in change and
maintenance of motivation, health behaviors, well-being, and disease burden. Such conditions
may include, but are not limited to, contact time between the practitioner or social agent and
the client or patient, frequency of contact, duration of intervention, type and training of social
agents (e.g., peer, family member, co-worker, teacher, clinician, or public health scientist), and
intervention cost. Once efficacy of interventions adopting individual or groups of MBCTs has
been established, they need to be tested for efficacy and effectiveness, cost-effectiveness,
implementation, and dissemination. In addition, the experts that contributed to the current
classification comprise largely of psychologists and behavioral scientists. Input is needed from
other stakeholders and practitioners (e.g., health professionals, teachers, public health
scientists, medical ethicists, peers, family members) who may assist in refining the content of
the current techniques, or may identify additional techniques that may satisfy psychological
needs and promote health behaviors that are currently not included in this classification.
Finally, recent research on self-determination theory has made the distinction between
need-supporting and need-thwarting strategies in evoking change in different types of
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 32
motivation and behavioral engagement (e.g., Bartholomew et al., 2011; Haerens et al., 2015;
Hein, Koka, & Hagger, 2015; Vansteenkiste & Ryan, 2013). While the lack of satisfaction of
psychological needs has been linked with reduced propensity to engage in behaviors for
autonomous reasons and reduced likelihood of attaining adaptive outcomes, including
behavioral persistence (Deci & Ryan, 2000; Deci, Spiegel, Ryan, Koestner, & Kauffman,
1982; Koestner, Ryan, Bernieri, & Holt, 1984), recent research has identified the deleterious
effects of thwarting or frustration of psychological needs on outcomes including behavioral
avoidance or disengagement (Bartholomew et al., 2011; Ryan & Deci, 2017; Vansteenkiste &
Ryan, 2013). In fact, recent theory has proposed a ‘dual process’ framework, proposing that
motivation is a function of need supportive and need thwarting processes that act in parallel
(Jang, Kim, & Reeve, 2016). Just as the need-supportive techniques identified in the current
classification enhance autonomous motivation, need thwarting strategies, such as controlling
interpersonal styles (e.g., use of contingent rewards), undermine autonomous motivation and
engender controlled motivation. Although avoidance of controlling techniques is referred to
within the current classification (e.g., “Use non-controlling, informational language”, MBCT
3), there has been no formal inclusion of techniques that thwart psychological needs. Future
research should seek to augment the current classification to encompass need-thwarting
techniques so that their effect can be also further explored and tested.
Conclusion
The present study developed an organized classification of the unique motivation and
behavior-change techniques (MBCTs) used in self-determination theory interventions to
change motivation toward, and participation in, health behavior. Our theory-based, expert
consensus procedure found support for 21 MBCTs organized according to the primary
psychological need (autonomy, competence, or relatedness) they are purported to change. A
key goal of the current classification is to provide researchers and interventionists with a
common set of terms and definitions to describe the content of self-determination theory-based
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 33
interventions in health contexts, and we expect it to facilitate the precision of descriptions of
future self-determination interventions. As with taxonomies of behavior change techniques, the
current classification is designed to be a first step in specifying the content of self-
determination theory-based interventions in health behavior contexts. The classification should
therefore be viewed as one that is flexible and open to modification as new evidence is made
available. Future research should aim to use the classification to inform the development of
self-determination theory-based interventions that test the efficacy of specific techniques in
changing health behavior. The classification system may also inform future coding of research
aimed at synthesizing evidence for self-determination theory-based interventions. Finally,
although the current classification is focused on health contexts, it may have broader
implications in other contexts. For example, the classification may form the basis of research
aimed at classifying and describing techniques used in self-determination theory-based
interventions in educational, organizational, and environmental contexts.
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 34
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SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 48
Table 1
Conceptual Definitions of the Three Psychological Needs from Self-Determination Theory
Psychological need
Conceptual definition
Autonomy
The psychological need to experience self-direction and personal
endorsement in the initiation and regulation of one’s behavior. The
hallmarks of autonomy need satisfaction are volitional action and
wholehearted self-endorsement (i.e., personal ownership) of that action.
Competence
The psychological need to be effective in one’s interactions with the
environment, and it reflects the desire to extend one’s capacities and skills
and, in doing so, to seek out optimal challenges, take them on, and exert
effort and strategic thinking until personal growth is experienced.
Relatedness
The psychological need to establish close emotional bonds and attachments
with other people, and it reflects the desire to be emotionally connected to
and interpersonally involved in warm relationships. The hallmarks of
relatedness need satisfaction are feeling socially connected and being
actively engaged in both the giving and receiving of care and benevolence
to the significant people in one’s life.
Note. Conceptual definitions are based on Ryan and Deci (2017).
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 49
Table 2
Steps in the Development of the Classification of Motivation and Behavior Change Techniques
(MBCTs)
Steps
Methods
1. Development of the first
list of MBCTs
Content analysis from published SDT interventions; Group
discussions within core research team
2. Consensus exercise
Round 1
Feedback from 8 experts on clarity and content of the
MBCTs; Group discussions within core research team
3. Consensus exercise
Round 2
Online expert feedback consensus (N = 18) on the need-
sensitivity, essentiality and uniqueness of each MBCT
4. Discussion and refinement
of the MBCTs
Core research team members discussed and refined the
MBCTs, based on the results from step 3
5. Consensus exercise
Round 3
Online expert feedback consensus with same poof of
experts, for 1) MBCTs which didn’t reach a sufficient
inter-rater agreement; 2) new MBCTs
6. Revision and finalization of
the MBCTs
Core research team members discussed and finalized the
MBCTs, based on the results from step 5
7. Mapping MBCTs to the
Taxonomy of Behavior
Change Techniques v1
The core study team members compared the final list of
MBCTs with the Taxonomy of Behavior Change
Techniques v1
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 50
Table 3
Classification of Motivation and Behavior Change Techniques
Label
Definition
Function description
Autonomy-Support Techniques
MBCT1. Elicit
perspectives on
condition or
behavior
Encourage exploration and sharing of
perspectives on current behavior (e.g.,
causes, perpetuating factors etc.).
Allows exploration of
behavior in more depth
(self-knowledge), which
can inform the program
and personal choices.
MBCT2. Prompt
identification of
sources of pressure
for behavior change
Prompt identification of possible sources of
external (or partially internalized) pressures
and expectations, and explore how they may
relate to client’s desired goals and outcomes.
Explores locus of
causality and potential
sources of
external/introjected
regulation and its
consequences.
MBCT 3. Use non-
controlling,
informational
language
Use informational, non-judgmental language
that conveys freedom of choice,
collaboration, and possibility when
communicating (avoiding constraining,
pressuring, or guilt-inducing language). For
example, use "might" or “could” instead of
"should” and “must”.
Avoids being a source of
pressure or creating
internal pressure,
countering external locus
of causality for actions.
MBCT 4. Explore
life aspirations and
values
Prompt identification and listing of
important life aspirations, values, and/or
long-term interests and explore how changes
in behavior (or maintaining the status quo)
could be linked to them.
Explores integrity and
internal coherence
between aspirations,
values, and
goals/behaviors, which
can sustain autonomous
regulation.
MBCT 5. Provide a
meaningful rationale
Prompt client to identify rationale for
behavior change and its maintenance that is
tailored, explanatory, and personally
meaningful or valuable.
Highlights and reinforces
motives/reasons that
could form the basis of
autonomous motivation.
MBCT 6. Provide
choice
Provide opportunities to make choices from
a collaboratively-devised menu of
behavioral options and autonomous goals. It
includes the decision not to change, delay
change, select focus/intensity of change,
personally endorsed intrinsic goals and
standards for success, including the timing
or pace for certain outcomes.
Promotes personal input
and ownership over
behavior change and
responsibility through
choice.
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 51
MBCT 7. Encourage
the person to
experiment and self-
initiate the behavior
Prompt the person to experiment and self-
initiate (new) target behavior that could be
fun and enjoyable, is experienced as positive
challenge, opportunity for learning or
personal expression, and/or are associated
with skill development, all of which provide
experiential / immediate positive
reinforcement.
Supports autonomous
action via intrinsic
motivation.
Relatedness-support techniques
MBCT 8.
Acknowledge and
respect perspectives
and feelings
Provide statements of empathy and
acknowledgment of the person’s
perspective, conflicts/ambivalence, distress
and negative affect (fear, confusion, etc.)
and also expression of positive feelings
when communicating with client
(concerning the target behavior, treatment,
or other related matters).
Indicates attention and
respect for the person’s
attitudes, thoughts
perceptions, and feelings,
which creates an
accepting and warm
social environment.
MBCT 9. Encourage
asking of questions
Prompt the client to pose questions
regarding their goals/behavioral progress.
Creates an open and
collaborative relation that
promotes trust.
MBCT 10. Show
unconditional regard
Express positive support regardless of
success or failure.
Demonstrates
unconditional respect,
care and support and
promotes warm social
environment.
MBCT 11.
Demonstrate/show
interest in the person
Provide statements of interest and curiosity
about the person’s thoughts and perceptions,
personal history and background, social
context, life events, etc. when
communicating.
Displays involvement,
indicates to the person
that their experiences and
input are valued.
MBCT 12. Use
empathic listening
Demonstrate attentiveness to the client’s
responses (e.g., stay silent to allow the
person to complete sentences), and provide
reflective and summary statements when
appropriate (directed at affect or content)
when communicating. Prompt permission to
provide new information, guidance or
advice.
Creates open,
collaborative relation;
promotes trust; Displays
respect for the person.
MBCT 13. Providing
opportunities for
ongoing support
Offer the person an appropriate venue and
means to contact you in the event of
difficulties or questions during the behavior
change process.
Shows care and personal
involvement.
MBCT 14. Prompt
identification and
Prompt identification of sources of support
for behavior change (if relevant),
Includes strategies that
will help in feeling
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 52
Note. Reference to “the person” in technique descriptions refers to the individual or group
whose behavior is to be changed (e.g., a client, patient or participant). MBCT = Motivation
and behavior change technique.
seek available social
support
acknowledge challenges in recruiting
adequate support (autonomous vs
controlled), and promote effective ways of
seeking positive support.
confident to overcome
potential challenges and
meet behavioral goal
(e.g., information about
available programs,
active involvement of
others such as family
members).
Competence-support techniques
MBCT 15. Address
obstacles for change
Prompt identification of likely barriers to
behavior change, based on previous
attempts, and explore how to overcome
them (e.g., what may have worked in the
past).
Increases confidence and
reinforces existing skills.
MBCT 16. Clarify
expectations
Prompt statements of client’s own
expectations in terms of behavior change
(e.g., identify a clear goal or learning
objective), both its experiential elements
(process) as well as outcomes.
Provides structure and
minimizes future failure
(and perceived
incompetence).
MBCT 17. Assist in
setting optimal
challenge
Assist in identification of goals that are
realistic, meaningful challenging, and
achievable.
Provides structure and
minimizes future failure
(and perceived
incompetence)
MBCT 18. Offer
constructive, clear,
and relevant
feedback
Provide relevant, tailored, non-evaluative
feedback on goal/behavioral progress. This
can include specific, process-focused
feedback.
Provides encouragement
and information to guide
future behavior.
MBCT 19. Help
develop a clear and
concrete plan of
action
Develop and provide summary of action
plan to work toward a behavioral goal.
Provides structure,
increases confidence, and
minimizes future failure
(and perceived
incompetence).
MBCT 20. Promote
self-monitoring
Prompt monitoring of progress, skill level,
or performance such as suggesting options
for monitoring tools/means and metrics for
success, including steps in the direction of
behavior change.
Provides structuring
information that
reinforces success and
self-awareness.
MBCT 21. Explore
ways of dealing with
pressure
Provide information to manage and limit
effects of pressuring contingencies that
would undermine competence such as
extrinsic rewards, criticism, negative
feedback.
Increase confidence to
deal with sources of
controlling pressure from
others and themselves.
SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 53
Figure 1. A basic process model of self-determination theory in health contexts.
1
Support for, or
Thwarting of,
Autonomy,
Competence, &
Relatedness
Autonomy, Controlled,
and Impersonal
Causality Orientations
Intrinsic and Extrinsic
Life Aspirations and
Goals
Satisfaction or
Frustration of
Psychological Needs for:
Autonomy
Competence
Relateness
Quality of
Motivation
Toward
Behavior:
Autonomous
Motivation;
Controlled
Motivation;
Amotivation
Mental Health
Outcomes, e.g.:
Affect
Vitality
Somatization
Quality of Life
Life Satisfaction
Degree of
Participation in
Health Behaviors:
Tobacco Exposure
Physical Activity
Alcohol Use
Healthy Eating
Use of Prescribed
Medication
Oral Hygiene
Practices
Physical Health
Outcomes, e.g.:
Body Weight
Glycaemic Control
Blood Pressure
Cholesterol Levels
Cancer Risk
Heart Attack and
Stroke Risk
Illness Progression
Oral Health
2a
3a
5a
5b
4
2b
... These psychological needs can be satisfied by creating a context in which, for example, individuals' perspectives are acknowledged, rationales are provided that are personally meaningful to them, choices are offered, and support is provided to strengthen their existing skills, all while minimizing pressure and control (Deci and Ryan, 2000;Vansteenkiste et al., 2004). Several studies have shown that applying these types of motivational techniques contributes to promoting intrinsic motivation and desired behavioral outcomes over time [for a review, see Gillison et al. (2019), Teixeira et al. (2020)]. Therefore, to enhance the intrinsic motivation of social influencers in health interventions, techniques from self-determination theory can be applied in the training to satisfy their needs for autonomy, competence, and relatedness. ...
... Through face-to-face interactions, social influencers experience that there is personal involvement and care from the intervention developers and that time is taken for them which contributes to their sense of relatedness (Gillison et al., 2019). Providing opportunities for ongoing support during the delivery of the health intervention to social influencers is also a technique that corresponds to their need for relatedness (Deci and Ryan, 2000;Gillison et al., 2019;Teixeira et al., 2020). ...
... The way in which the training or briefing on health behaviors is communicated to social influencers is important to ensure that they feel connected to and internalize the information conveyed (Pope et al., 2018). When non-controlling and informational language is applied, individuals are more likely to perceive choice and collaboration, which responds to their need for autonomy (Deci and Ryan, 2000;Gillison et al., 2019;Teixeira et al., 2020). In contrast, a controlling approach has been found to be experienced as external pressure for individuals, which could result in social influencers feeling that performing the behavior is not their own choice (Weinstein et al., 2020). ...
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... Habit formation). Furthermore, the recently developed classification for motivation and BCTs used in self-determination theory-based interventions [31] was added if applicable. In total, LiFE contains 21 BCTs and gLiFE contains 22 BCTs, the added BCT being "mental rehearsal of successful performance" (15.2.). ...
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Background Understanding the mechanisms through which behavior change techniques (BCTs) can modify behavior is important for the development and evaluation of effective behavioral interventions. To advance the field, we require a shared knowledge of the mechanisms of action (MoAs) through which BCTs may operate when influencing behavior. Purpose To elicit expert consensus on links between BCTs and MoAs. Methods In a modified Nominal Group Technique study, 105 international behavior change experts rated, discussed, and rerated links between 61 frequently used BCTs and 26 MoAs. The criterion for consensus was that at least 80 per cent of experts reached agreement about a link. Heat maps were used to present the data relating to all possible links. Results Of 1,586 possible links (61 BCTs × 26 MoAs), 51 of 61 (83.6 per cent) BCTs had a definite link to one or more MoAs (mean [SD] = 1.44 [0.96], range = 1–4), and 20 of 26 (76.9 per cent) MoAs had a definite link to one or more BCTs (mean [SD] = 3.27 [2.91], range = 9). Ninety (5.7 per cent) were identified as “definite” links, 464 (29.2 per cent) as “definitely not” links, and 1,032 (65.1 per cent) as “possible” or “unsure” links. No “definite” links were identified for 10 BCTs (e.g., “Action Planning” and “Behavioural Substitution”) and for six MoAs (e.g., “Needs” and “Optimism”). Conclusions The matrix of links between BCTs and MoAs provides a basis for those developing and synthesizing behavioral interventions. These links also provide a framework for specifying empirical tests in future studies.
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Background Despite advances in behavioral science, there is no widely shared understanding of the “mechanisms of action” (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change. Purpose This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature. Methods Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link. Results Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT–MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were “Beliefs about Capabilities” and “Intention.” Binomial test results identified up to five MoAs linked to each of the BCTs (M = 1.71, range: 1–5) and up to eight BCTs for each of the MoAs (M = 3.63, range: 1–8). Conclusions The BCT–MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation.
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Based on Self-Determination Theory, the present study adopts a helicopter-perspective towards motivating (i.e., autonomy support, structure) and demotivating coaching (i.e., control, chaos). Among five independent samples, consisting of individual and team sport coaches (N = 893; Mage = 37.83 years) and athletes (N = 377; Mage = 17.46 years), Multidimensional Scaling (MDS) analyses were used to examine how a variety of coaching practices reflective of four different coaching styles (i.e., autonomy support, control, structure, and chaos), assessed with a new vignette-based instrument, related to one another. Findings revealed that the (de)motivating practices could be graphically presented within a two-dimensional circumplex, with the horizontal axis representing the level of need-supportive coaching behavior and the vertical axis representing the level of coach directiveness. Moreover, the four coaching styles could be segmented in eight more specific approaches (i.e. clarifying, guiding, attuning, participative, awaiting, abandoning, domineering, and demanding), which formed an ordered sinusoid pattern of correlations, both among each other and in relation to a variety of critical outcomes (e.g. coach need satisfaction, athletes’ motivation). It is discussed how a circumplex approach produces both a more integrative and more fine-grained insight regarding (de)motivating coaching behavior, with resulting implications for practice.
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Many problems observed in today’s society can be linked, directly or indirectly, to human behavior. Problems with roots in, or links with, behavior include debilitating illnesses and chronic conditions (e.g., cardiovascular disease, cancers, obesity, sexually transmitted infections), global pandemics of communicable diseases (e.g., SARS, H1N1, COVID-19), mental health problems (e.g., depression, anxiety), addictions (e.g., substance abuse), social and interpersonal problems (e.g., bullying, abuse and violence in relationships), financial difficulties (e.g., personal debt, problem gambling), criminal behavior (e.g., social disorder, vandalism), educational challenges (e.g., truancy, attentional difficulties), and environmental concerns (e.g., overuse of nonrenewable resources, failures to recycle or save energy). Analogously, regular participation in relevant behaviors is associated with adaptive outcomes such as better health and wellbeing, positive mental health, better functioning in the workplace, in interpersonal relationships, and at school, and more environmentally conscious choices and consumer behavior. Vast databases of archival statistics demonstrating how behavior is linked to social problems are at the disposal of organizations responsible for developing policy to tackle them. Such data signal the need for behavioral solutions and have catalyzed fervent interest in the determinants of behavior and in methods and strategies to change behavior. Governments, organizations (private and public corporations, schools, community organizations), and professionals (government officials, health care workers, managers. teachers) recognize the value of developing strategies to change the behavior of targeted population groups in order to promote adaptive outcomes. To date, legislation (e.g., seat belt use) and regulation (e.g., banning smoking in public places) stand as some of the most successful means to change population behavior. However, in many cases, such initiatives are not possible, feasible, or acceptable. As a consequence, alternative approaches to behavior change are needed. Scientific inquiry into behavior change has entered into the mainstream. Recognition of the importance of behavior change to solving social problems has led governments to engage scientists from various disciplines within the social and behavioral sciences to inform policy and develop effective behavior change strategies targeting high priority, behavior-related problems. For example, governments and organizations have invested in funding initiatives to develop research evidence (e.g., National Cancer Institute, 2019; National Institutes of Health, 2019; Nielsen et al., 2018; OBSSR, 2016), commissioned reports and evidence syntheses (e.g., Behavioral Insights Team, 2019b; Cabinet Office, 2011; NICE, 2007, 2012, 2014), and set up working groups, expert panels, and conferences with an advisory purview on behavior change (e.g., Behavioral Insights Team, 2019a; Brandt & Proulx, 2015; House of Lords, 2011; Ogilvie Consulting, 2019; Spring et al., 2013). Researchers in the fields of psychology, sociology, behavioral economics, philosophy, implementation science, education, communication science, and political science have been at the forefront of research on behavior change (e.g., Little & Akin-Little, 2019; Nielsen et al., 2018; Sheeran, Klein, & Rothman, 2017; Young et al., 2015). Scientists in these disciplines have been primarily responsible for creating and disseminating evidence on behavior change at all levels on the “continuum of evidence,” from basic theoretical research on determinants and mechanisms to translational research on the application of strategies to change behavior in specific contexts. The proliferation of behavior change research is predicated on the recognized importance of evidence-based practice that began in fields like medicine (Guyatt et al., 1992) and allied health (NICE, 2019) and has since been adopted in other domains such as education (EEF, 2019) and crime reduction and policing (College of Policing, 2019). Such evidence is critical to the application of scientific principles to inform the development of effective behavioral solutions to social problems – a science of behavior change (Michie, Rothman, & Sheeran, 2007; Nielsen et al., 2018).
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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.
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Guided by Self-Determination Theory, we offer an integrative and fine-grained analysis of teachers’ classroom motivating style (i.e., autonomy support, structure, control, and chaos) to resolve existing controversies in the literature, such as how these dimensions relate to each other and to educationally important student and teacher outcomes. Six independent samples of secondary school teachers ( N = 1332; M <sub>age</sub> = 40.9 years) and their students ( N = 1735, M <sub>age</sub> = 14.6 years) read 12 ecologically valid vignettes to rate four dimensions of teachers’ motivating styles, using the Situations-in-School (SIS) questionnaire. Multidimensional scaling analyses of both the teacher and the student data indicated that motivating and demotivating teaching could best be graphically represented by a two-dimensional configuration that differed in terms of need support and directiveness. In addition, eight subareas (two subareas per motivating style) were identified along a circumplex model: participative and attuning, guiding and clarifying, demanding and domineering, and abandoning and awaiting. Correlations between these eight subareas and a variety of construct validation and outcome variables (e.g., student motivation, teacher burnout) followed an ordered sinusoid pattern. The discussion focuses on the conceptual implications and practical advantages of adopting a circumplex approach and sketches a number of important future research directions.
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Background -Americans have a shorter life expectancy compared with residents of almost all other high-income countries. We aim to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population. Methods -Using data from the Nurses' Health Study (1980-2014; n=78 865) and the Health Professionals Follow-up Study (1986-2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m2, ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0-5 scale) with mortality. We used data from the NHANES (National Health and Nutrition Examination Surveys; 2013-2014) to estimate the distribution of the lifestyle score and the US Centers for Disease Control and Prevention WONDER database to derive the agespecific death rates of Americans. We applied the life table method to estimate life expectancy by levels of the lifestyle score. Results -During up to 34 years of follow-up, we documented 42 167 deaths. The multivariable-adjusted hazard ratios for mortality in adults with 5 compared with zero low-risk factors were 0.26 (95% confidence interval [CI], 0.22-0.31) for all-cause mortality, 0.35 (95% CI, 0.27-0.45) for cancer mortality, and 0.18 (95% CI, 0.12-0.26) for cardiovascular disease mortality. The population-attributable risk of nonadherence to 5 low-risk factors was 60.7% (95% CI, 53.6-66.7) for all-cause mortality, 51.7% (95% CI, 37.1-62.9) for cancer mortality, and 71.7% (95% CI, 58.1-81.0) for cardiovascular disease mortality. We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3-29.8) for women and 25.5 years (95% CI, 24.7-26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3-44.9) for women and 37.6 years (95% CI, 35.8-39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8-16.2) longer among female Americans with 5 lowrisk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1-14.2). Conclusions -Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.
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Introduction Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. Objective To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. Design and Setting A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year. Main Outcomes and Measures Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. Results Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). Conclusions and Relevance There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.