Overview: Self-Determination in Health

Motivation plays a central role for health behavior change and associated health outcomes (both physical and mental). For example, leading causes of death such as cardiovascular disease and many forms of cancer, are determined at least in part by people’s behaviors and lifestyles. Yet, diminishing health-compromising behaviors like smoking, abusing alcohol, overeating, or being sedentary can be hard. So can engaging in health-promoting behaviors such as exercise, controlling glucose levels, or following a medication regimen. SDT research demonstrates that to make meaningful behavior changes, individuals need to feel autonomous in their motivation and to have their basic psychological needs satisfied. Such outcomes are more likely to be achieved in health promotion and health care settings that are need supportive.

For instance, health-care providers play an especially important role in supporting patients’ psychological needs. By listening to patients’ perspectives, providing opportunities for choice in how treatment plans are enacted, acknowledging negative feelings, being empathetic, and providing clear explanations and rationales, practitioners increase the likelihood that patients will be successful in their behavior change attempts-and for the long term! Importantly, we now have a new classification system (by Teixeira et al., 2021) of need supportive behaviors that exemplifies how health promotion and health care professionals can be trained to be need supportive. SDT intervention studies indicate that training in providing need support can help physicians provide greater support and better care to their patients.

SDT health research and clinical trials have examined both patient motivation and provider need support in a wide variety of health areas, including weight loss, glucose control, tobacco cessation, medication adherence, increasing activity/exercise, healthy eating, dental hygiene, and others. This work supports the SDT health-care process model  showing that individuals experience better mental and physical health outcomes when they are in need supportive health care and health promotion environments; such effects are mediated by psychological need satisfaction and autonomous motivation. See associated readings for reviews of SDT-informed interventions in the health domain.

The types of wellness goals individuals set also determine wellness outcomes. For example, healthy eating that is motivated by the aspiration to increase one’s physical attractiveness (extrinsic aspiration) is likely to be less successful than when this same behavior is undertaken with the goal of improving health and increasing vitality (intrinsic aspiration). Lastly, autonomous causality orientations (pre-dispositions toward autonomy) are more likely to facilitate positive health behavior change.

A different strand of research within this field has also examined motivational processes and wellness among practitioners. Articles here include studies of the role of basic need supports in both professional training and practice, as well as studies of factors affecting practitioner-patient relations.

Suggested Readings & Research

(2022) The Oxford handbook of self-determination theory

Facilitating health behavior change: A self-determination theory perspective

Ntoumanis, N. Moller, A. C.

(2021) Health Psychology Review

A meta-analysis of self-determination theory-informed intervention studies in the health domain: Effects on motivation, health behavior, physical, and psychological health

Ntoumanis, N. Ng, J. Y. Y. Prestwich, A. Quested, E. Hancox, J. E. Thogersen-Ntoumani, C. Deci, E. L. Ryan, R. M. Lonsdale, C. Williams, G. C.

(2019) Health Psychology Review

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

Gillison, F. Rouse, P. Standage, M. Sebire, S. Ryan, R. M.

(2012) Perspectives on Psychological Science

Self-determination theory applied to health contexts: A meta-analysis

Ng, J. Y. Y. Ntoumanis, N. Thogersen-Ntoumani, C. Deci, E. L. Ryan, R. M. Duda, J. L. Williams, G. C.

(2021) Circulation

Strategies for Promotion of a Healthy Lifestyle in Clinical Settings: Pillars of Ideal Cardiovascular Health: A Science Advisory From the American Heart Association

Kris-Etherton, P. M. Petersen, K. S. Després, J-P., Anderson, C. A. M., Deedwania, P., Furie, K. L., Lear, S., Lichtenstein, A. H., Lobelo, F., Morris, P. B., Sacks, F. M., Ma, J.

(2021) Health Psychology

Does increasing autonomous motivation or perceived competence lead to health behavior change? A meta-analysis.

Sheeran, P. Wright, C. E. Avishai, A. Villegas, M. E. Rothman, A. J. Klein, W. M. P.

(2020) Journal of Consulting and Clinical Psychology

Self-determination theory interventions for health behavior change: Meta-analysis and meta-analytic structural equation modeling of randomized controlled trials

Sheeran, P. Wright, C. E. Avishai, A. Villegas, M. E. Lindemans, J. W. Klein, W. M. P. Rothman, A. J. Miles, E. Ntoumanis, N.

(2021) Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity

Development and cross-cultural validation of the Goal Content for Weight Maintenance Scale (GCWMS)

Encantado, J. Marques, M. M. Palmeira, A. L. Sebire, S. J. Teixeira, P. J. Stubbs, R. J. Heitmann, B. L. Gouveia, M. J.

(2020) Motivation Science

A classification of motivation and behavior change techniques used in self-determination theory-based interventions in health contexts

Teixeira, P. J. Marques, M. M. Silva, M. N. Brunet, J. Duda, J. L. Haerens, L. La Guardia, J. G. Lindwall, M. Lonsdale, C. Markland, D., Michie, S., Moller, A. C., Ntoumanis, N., Patrick, H., Reeve, J., Ryan, R. M., Sebire, S. J., Standage, M., Vansteenkiste, M., . . . Hagger, M. S.

(2020) PLoS Medicine

A gender-sensitised weight-loss and healthy living program for men with overweight and obesity in Australian Football League settings (Aussie-FIT): A pilot randomised controlled trial

Kwasnicka, D. Ntoumanis, N. Hunt, K. Gray, C. M. Newton, R. U. Gucciardi, D. F. Thogersen-Ntoumani, C. Olsen, J. L., McVeigh, J., Kerr, D. A., Wyke, S., Morgan, P. J., Robinson, S. Makate, M. Quested, E.

(2022) Motivation and Emotion

The relationship between autonomous and controlled motivation and eating behaviors: Examining the roles of self‐regulating eating quality and quantity

Guertin, C. Pelletier, L. G.

(2021) Medical Care Research and Review

Motivational mechanisms underlying physicians’ occupational health: A self-determination theory perspective

Moller, A. C. Olafsen, A. H. Jager, A. J. Kao, A. C. Williams, G. C.

(2021) Psychology & Health

How can older peer leaders best support motivation for walking in physically inactive older adults? A self-determination theory perspective

Kritz, M. Thogersen-Ntoumani, C. Mullan, B. Stathi, A. Ntoumanis, N.

(2018) Qualitative Research in Sport, Exercise and Health

Putting self-determination theory into practice: application of adaptive motivational principles in the exercise domain

Hancox, J. E. Quested, E. Ntoumanis, N. Thogersen-Ntoumani, C.

(2023) Nursing Inquiry

Person‐specific evidence has the ability to mobilize relational capacity: A four‐step grounded theory developed in people with long‐term health conditions

Zoffmann, V. Jorgensen, R. Graue, M. Biener, S. N. Brorsson, A. L. Christianse, C. H. Due-Christensen, M. Enggaard, H. Finderup, J. Haas, J., Husted, G. R., Johansen, M. T., Kanne, K. L., Kolltveit, B-C. H., Krogslund, K. W., Lie, S. S., Lindholm, A. O., Marqvorsen, E. H. S., Mathiesen, A. S., Olesen, M. L., Rasmussen, B., Rothmann, M. J., Simonsen, S. M., Tackie, S. H. S., Thisted, L. B., Tran, T. M., Weis, J., Kirkevold, M.

(2023) Scandinavian Journal of Caring Sciences

Impact of the person-centred intervention guided self-determination across healthcare settings—An integrated review

Olesen, M. L. Jorgensen, R.