Patient autonomy crucial to achieving health goals

By Sarah Guy

Supporting patient autonomy in healthcare leads to positive health outcomes, suggesting that self-determination theories (SDTs) should become the foundation for developing interventions in healthcare promotion, say UK researchers.

The team carried out a meta-analysis of studies that used SDT - a theory of motivation that propounds when autonomy is supported, more autonomous forms of behavioral regulation ensue ‑ in health-promotion contexts.

They found that the approach "positively predicted higher levels of patient/client autonomy, competence, and relatedness within the health behavior domain" - the three psychologic needs central to the SDT model.

"Despite the continuous growth in both governmental and private health care expenditures... the prevalence of chronic health problems in developed countries, such as the United States, is on the increase," say Johan Ng, from the University of Birmingham, and colleagues, who mention the examples of obesity and Type 2 diabetes.

"Thus, understanding the motivation to engage in and adhere to health-conducive behaviors is of vital importance for the maintenance and improvement of people's health," writes the team in Perspectives in Psychological Science.

The analysis included 184 data sets that each examined health behaviors such as physical activity, diabetes care, abstinence from tobacco, and weight control.

Ng and co-authors observed moderate but positive correlations between mental health and autonomy supportive healthcare (where patients are motivated to act due to inherent enjoyment derived from the health behavior itself), with effect sizes ranging from 0.22 to 0.37 (where 0.50 or above is considered to be large). They also report negative correlations with indicators of negative healthcare with autonomy supportive healthcare, at a range of -0.17 to -0.23.

Furthermore, the studies showed that patients' psychologic needs and autonomous forms of self-regulation were positively related to indices of positive mental health (effect size 0.22 to 0.62) and negatively related to indicators of negative mental health (range -0.05 to -0.50). The researchers observed similar results for physical health.

Conversely, controlled forms of health regulation that include introjected interventions such as patient motivation via guilt or shame, and amotivation - where patients lack any intention to act - were positively associated with indicators of poor mental health, with an effect size ranging from 0.13 to 0.46.

"Recently, patient autonomy has been identified as an important aspect of medical ethics," said Ng in an associated press release. "Our results showed that supporting patients' psychological needs is essential to practitioners in helping patients attain their health goals and outcomes," he added.

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