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The Example of Self-Determination Theory-Based Interventions Marlene N Silva, Marques, & Teixeira STD, theory and practice original article Testing theory in practice: The example of self-determination theory-based interventions Marlene N. Silva Leonardo da Vinci once tested the application of the TCS, investigating i) the University of Lisbon said that, “He who loves extent and type of theory use in health behavior ULHT practice without theory is change interventions to increase physical activity and Marta M. Marques like the sailor who boards healthy eating, and ii) the associations between University of Lisbon ship without a rudder and theory use and intervention effectiveness. The Pedro J. Teixeira compass and never knows authors found poor reporting on the application of University of Lisbon where he may cast”. theory in intervention design and evaluation. For Similarly, advancing example, few interventions targeted and measured behavioral science requires a good understanding of changes in all theoretical constructs defined by the how interventions are informed by theory, how they theory or linked all the behavior change techniques can better test theory, and which behavior change to those constructs. Since this meta-analysis tested techniques should be selected as a function of theory the TCS framework with only two theories (Social (or theories). However, simply claiming that an Cognitive Theory [SCT] and the Transtheoretical intervention is theory-based does not necessarily Model), more research is needed to test the fidelity to make it so. Critical evaluation of applied theory is theory in health behavior change interventions based needed for a more integrated understanding of on other frameworks and its differential impact on behavior change interventions, their usefulness, and interventions effectiveness. One such framework is their effectiveness. Self-Determination Theory (SDT; Deci & Ryan, 2000), The Theory Coding Scheme (TCS; Michie & which is increasingly being used in the area of Prestwich, 2010) was recently developed with the aim behavioral nutrition and physical activity (Teixeira et of providing a reliable research tool to describe and al., personal communication, May 22, 2014). evaluate the theoretical basis of interventions. It In this paper we will focus on the development, includes a list of items assessing whether relevant implementation, and evaluation of theory-based constructs of a certain theory are targeted, how well interventions, using SDT as the example. This paper they are measured, which behavior change techniques follows on the first two articles of this issue by Peters are used to impact those constructs, and whether (2014) and Kok (2014), which highlight the study design allows for theory itself to be tested and importance of identifying and selecting theory-based refined. The TCS encourages a careful consideration of constructs and appropriated methods to develop what constitutes a theory-based intervention (i.e. effective complex behavior change interventions. provides means for a more rigorous and systematic examination of the use of theory within intervention research), and how these interventions can be most Self-Determination Theory-based usefully developed and evaluated serving as a interventions in health structure to inform the design of theory-based interventions. SDT has emerged as a popular theoretical A recent meta-analysis (Prestwich et al., 2014) framework to explain the motivational dynamics volume 1 6 issue 5 The European Health Psychologist 1 71 ehp ehps.net/ehp Silva, Marques, & Teixeira STD, theory and practice behind the regulation of health behaviors, focusing what results from it. The predominant feeling is what on the psychological antecedents, mechanisms, and is sometimes referred to as “willingness” (‘I truly basis for interventions in health contexts. Evidence chose and want to…’). By contrast, in controlled regarding its rationale and utility in facilitating and motivation, the predominant feeling is pressure, explaining health behavior change and maintenance which is often associated with ambivalence. The is rapidly increasing (Fortier, Duda, Guerin, & pressure (or “controls”) that regulates the behavior Teixeira, 2012; Ng et al., 2012; Ryan, Patrick, Deci, & can either stem from external (rewards or demands) Williams, 2008; Teixeira, Carraça, Markland, Silva, & or internal (guilt, shame, pride) pressures (Deci & Ryan, 2012). Readers are encouraged to consult Deci Ryan, 2000). Expressions such as ‘must’ and ‘should’ and Ryan (2000) and Vansteenkiste, Niemec and are typically associated with this form of motivation. Soenens (2010) for a summary of the fundamental Importantly, different types of motivation have theoretical premises of SDT. been associated with different outcomes and a Briefly, SDT postulates that human beings have growing body of research has demonstrated the three essential psychological needs - autonomy importance of autonomous motivation for a range of (feeling of being the origin of one’s own behaviors), health behaviors. To put it simply, the more competence (feeling effective), and relatedness autonomously motivated individuals are, the more (feeling understood and cared for by others). These adaptive their behavioral and health outcomes have needs represent “psychological nutriments” that are shown to be (e.g. Ng et al., 2012; Teixeira, Carraça, et essential for ongoing psychological growth, integrity, al., 2012). and well-being (Deci & Ryan, 2000). Support and subsequent satisfaction of these needs provides the basis for the psychological energy that is predicted SDT mechanisms of action and to, and has been empirically confirmed to, motivate intervention component techniques the initiation and long-term maintenance of health behaviors (Ryan et al., 2008; Silva et al., 2011). Social-environmental factors decisively influence The issue of the quality of motivation is central to cognitive, behavioral, and affective patterns SDT, which is less concerned with “how much” exhibited in health behavior change processes. motivation people have, and more about “which type” According to the SDT process model (Ryan et al., (or types) of motivation prevails in goal pursuit. 2008), the effect of the environment on motivation Unlike some perspectives that only posit the intrinsic and behavioral regulation is not direct, but occurs as vs. extrinsic distinction, viewing extrinsically a result of the support for, and consequent motivated behavior as invariantly non-autonomous, satisfaction of the three universal psychological SDT proposes that extrinsic motivation can vary needs. Thus, the most important social environmental greatly in the degree of internalization (i.e. self- factor within an SDT-based motivational climate congruence). In short, the fundamental distinction is concerns the degree of need-supportiveness or the between autonomous and controlled forms of extent to which others and the environment more motivation and behavioral regulation. Autonomous broadly support vs. thwart these needs, objectively motivation is based on deeply reflected endorsement and as perceived by the individual. Indeed, one of the of one’s behavior. When feeling autonomous, people strengths of SDT is that it proposes processes of perceive that their behavior emanates from the self behavior change that can be targeted in different and is self-authored, and they act because they find health behavior interventions. In these interventions, interest in or are challenged by the experience of techniques are developed and implemented to satisfy behavior, or because they find personal meaning in volume 1 6 issue 5 The European Health Psychologist 1 72 ehp ehps.net/ehp Silva, Marques, & Teixeira STD, theory and practice the three basic psychological needs, thus fostering quantitatively synthesized the relatively large volume the process of internalization (i.e. the active of empirical studies (k = 184) in health care and transformation of controlled regulation into more health promotion contexts addressing SDT-related autonomous forms of [self-] regulation), in turn constructs, and analyzed the relations among support leading to increased integration of this regulation for patients’ psychological need satisfaction, into a person’s personality, and positive behavior autonomous regulation, and physical and mental change (Fortier et al., 2012; Ryan et al., 2008; Su & health. Results from this meta-analysis showed that Reeve, 2011). the relations of personal and contextual SDT Key component techniques of need-support have constructs with each other, and with relevant positive been described in several papers and chapters and health/exercise outcomes, were in the directions some operational definitions for each interpersonal hypothesized by the theory. These findings were in condition have been advanced (see for example, accordance with those from a systematic review in Haerens et al., 2013; Reeve, 2009; Su & Reeve, 2011). the context of exercise behaviors (Teixeira, Carraça, et These are briefly summarized next: al., 2012), and are generally consistent across i) Autonomy support: Relevance, by providing a different study designs, health behaviors, and clear and meaningful rationale for activities, treatment settings. facilitating self-endorsement; Respect, by acknowledging the importance of clients’ perspective, feelings, and agenda; Choice, by encouraging clients Are SDT interventions theory-based? to follow their own interests and providing options Preliminary results of a systematic whenever possible; Avoidance of control, by not review using
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