Content uploaded by Marylène Gagné
Author content
All content in this area was uploaded by Marylène Gagné on Jul 10, 2014
Content may be subject to copyright.
Motivation for behavior change in patients with chest pain
Health Education
Abstract
Purpose
To assess the effect of diagnostic testing for coronary artery disease (CAD) on motivation for change, and on lifestyle change for patients with chest pain.
Design/methodology/approach
This observational study followed patients with chest pain suggestive of CAD for three years. Constructs of autonomous and controlled motivation for lifestyle change, autonomous orientation, and autonomy support from self‐determination theory were assessed. Self‐reported tobacco use, physical activity, and diet were assessed at baseline and three years later. Physician rating of pre‐ and post‐test probability of CAD were also assessed. CAD diagnosis was established after three years.
Findings
Physicians' autonomy‐supportive style and patients' autonomous orientations both predicted greater patient autonomous motivation, which in turn predicted improved diet, more exercise, and marginally less smoking. High probability of CAD also led patients to become more autonomously motivated for lifestyle change.
Research limitations/implications
The observational nature of the study and the self‐report measures of health behaviors preclude causal conclusions from this study. Findings from this study suggest that patient motivation and risk behavior are affected by results of cardiac testing, by physicians' support of autonomy, and by patients' personalities.
Practical implications
Physicians may be effective in motivating behavior change around time of testing for CAD.
Originality/value
The self‐determination theory model for health behavior change accounted for change in patient health risk behavior change around the time of testing for CAD. Physicians and researchers might use these results to design and test interventions for practitioners to effectively motivate behavior change around the time of medical tests.
... 10 To our knowledge, there are no examples of education provision to waiting cardiology patients. This population reports high motivation to make behaviour change, 11 demonstrates a strong interest in CPR education, 12 and may be more receptive to receiving CVD-focused education than unselected populations from primary care or the emergency department. Motivation is a key precursor to lifestyle change in educational interventions, 13 and selfreported confidence to perform CPR is commonly used to describe layperson attitudes towards CPR. ...
... A low attrition rate was assumed as outcomes were collected immediately post-clinic, and a control proportion of 40% was selected based on evidence that patients with chest pain report high motivation for lifestyle change (mean 6 on a 7-point Likert scale). 11 For the sub-study, a sample size of 220 (1:1 intervention:control ratio), with 5% attrition, had 80% power to detect a relative increase of 37% (RR 1.37). A control rate of 50% was based on data from a survey of CPR confidence administered to 100 visitors entering Westmead Hospital in September 2018. ...
Objective:
Waiting time is inevitable during cardiovascular (CV) care. This study examines whether waiting room-based CV education could complement CV care.
Methods:
A 2:1 randomised clinical trial of patients in waiting rooms of hospital cardiology clinics. Intervention participants received a series of tablet-delivered CV educational videos and were randomised 1:1 to receive another video on cardiopulmonary resuscitation (CPR) or no extra video. Control received usual care. The primary outcome was the proportion of participants reporting high motivation to improve CV risk-modifying behaviours (physical activity, diet and blood pressure monitoring) post-clinic.
Secondary outcomes:
clinic satisfaction, CV lifestyle risk factors (RFs) and confidence to perform CPR. Assessors were blinded to treatment allocation.
Results:
Among 514 screened, 330 were randomised (n=220 intervention, n=110 control) between December 2018 and March 2020, mean age 53.8 (SD 15.2), 55.2% male. Post-clinic, more intervention participants reported high motivation to improve CV risk-modifying behaviours: 29.6% (64/216) versus 18.7% (20/107), relative risk (RR) 1.63 (95% CI 1.04 to 2.55). Intervention participants reported higher clinic satisfaction RR: 2.19 (95% CI 1.45 to 3.33). Participants that received the CPR video (n=110) reported greater confidence to perform CPR, RR 1.61 (95% CI 1.20 to 2.16). Overall, the proportion of participants reporting optimal CV RFs increased between baseline and 30-day follow-up (16.1% vs 24.8%, OR=2.44 (95% CI 1.38 to 4.49)), but there was no significant between-group difference at 30 days.
Conclusion:
CV education delivery in the waiting room is a scalable concept and may be beneficial to CV care. Larger studies could explore its impact on clinical outcomes.
Trial registration number:
ANZCTR12618001725257.
... Deci and colleagues conducted research that applied SDT to patients undergoing diagnostic testing for coronary artery disease (CAD; Williams et al., 2005). They first assessed risk behaviors among patients and conducted non-invasive tests for CAD, then provided CAD test results along with assessments of motivation one week later, and finally assessed risk behaviors, autonomy support, and motivation three years later. ...
Despite considerable progress in recent years, research in cardiac psychology is not widely translated into routine practice by clinical cardiologists or clinical health psychologists. Self-determination theory (SDT), which addresses how basic psychological needs of autonomy, competence, and relatedness contribute to the internalization of motivation, may help bridge this research–practice gap through its application to shared decision-making (SDM). This narrative review discusses the following: (a) brief background information on SDT and SDM, (b) the application of SDT to health behavior change and cardiology interventions, and (c) how SDT and SDM may be merged using a dissemination and implementation (D&I) framework. We address barriers to implementing SDM in cardiology, how SDM and SDT address the need for respect of patient autonomy, and how SDT can enhance D&I of SDM interventions through its focus on autonomy, competence, and relatedness and its consideration of other constructs that facilitate the internalization of motivation.
... Over the years, numerous studies have pointed to the importance of autonomous motivation (as opposed to controlled motivation) to human functioning, linking it to a variety of outcome variables. For example, autonomous motivation has been connected to various positive work outcomes (Becker et al., 2018;Fernet et al., 2012;Otis & Pelletier, 2005), learning and academic achievement in children (Froiland & Worrell, 2016;Ryan et al., 1990;Taylor et al, 2014), and positive physical health (Brunet et al., 2015;McSpadden et al., 2016;Williams et al., 2005). Research has also demonstrated the importance of autonomous motivation in college students. ...
Electronic devices (e.g., cellphones) are a means of technology advancement, but research suggests that frequent use of them in the classroom impairs attention and learning (Lee et al., 2017; Mendoza et al., 2018; Lee et al., 2020). The present study (N = 393) establishes a pre-existing regression model examining the significance of mindfulness (MND) to emotional regulation and cognitive performance among college students. Results suggest that MND’s effect on obsessiveness across all four conditions were seen: Group A, cellphone allowed, Group B, cellphone on silent mode, Group C, control group, and Group D, no cellphones. The findings also indicate that highly nomophobic participants in Group B showed better test performance. We expect that students’ excessive use of cellphones may have a negative impact on MND, especially when there are no cellphone restrictions.
... Furthermore, individuals with high controlled-orientation tend to be more hostile, defensive, vulnerable to peer effect (Deci, & Ryan, 1985;Neighbors et al., 2008) and emotionally reactive (Koestner & Losier, 1996) compared with individuals with low controlledorientation. Autonomy-orientation has been found to correlate with characteristics such as flexibility, creative thinking (Deci & Ryan, 1987), an internal sense of right and wrong (Neighbors et al., 2008), prosocial behavior (Gagné, 2003), initiative-taking approach and psychological freedom (Knee & Zuckerman, 1996), and constructive lifestyle changes (Williams et al., 2005). ...
This study examined the factors that are likely to be associated with preferred behavioural and emotional responses to honour‐threatening situations and possible differences between a dignity culture (United Kingdom) and an honour culture (Turkey). We examined the role of cultural background, type of social setting, and participants’ causality orientation in preferred emotional and behavioural responses to honour‐threatening situations. We first found that Turkish participants reported significantly higher levels of negative emotional response compared to British participants in the false accusation (not humiliation) scenario and in the public (not private) setting. Second, we found that Turkish participants reported a higher preference for retaliatory responses than did British participants when they imagined themselves being humiliated by one of their peers. Third, autonomy‐oriented participants in the Turkish sample reported significantly higher levels of negative feeling (but not higher retaliatory intentions) compared with autonomy‐oriented participants in the British sample, whereas controlled‐oriented participants in the Turkish sample tended to report lower levels of negative feeling compared with controlled‐oriented participants in the British sample. This interaction effect suggests that controlled‐ and autonomy‐orientations may serve different functions in the Turkish and British settings.
... We have assumed that approximately 40% of control participants would report being highly motivated to change behaviour (equal or greater than 6 on a 7-point Likert Scale) based on data reported by Deci et al on patients undergoing chest pain by specialists having high levels of motivation for lifestyle change (mean self-reported autonomous motivation 6.07 on a 7-point positively skewed Likert Scale approximately 1 week post episode (n=252, SD=0.81)). 32 In addition, we estimated a sample size of 220 (1:1 intervention:control ratio), allowing for ~5% attrition, twosided tests and type 1 error of 5% will have 80% power to detect a relative increase of 37% (RR 1.37) in the intervention arm. That is, an absolute increase of 18.5%, from x x ...
Introduction:
Patients with cardiovascular disease (CVD) frequently attend outpatient clinics and spend a significant amount of time in waiting rooms. Currently, this time is poorly used. This study aims to investigate whether providing CVD and cardiopulmonary resuscitation (CPR) education to waiting patients in a cardiology clinic of a large referral hospital improves motivation to change health behaviours, CPR knowledge, behaviours and clinic satisfaction post clinic, and whether there is any impact on reported CVD lifestyle behaviours or relevant CPR outcomes at 30 days.
Methods and analysis:
Randomised controlled trial with parallel design to be conducted among 330 patients in the waiting room of a chest pain clinic in a tertiary referral hospital. Intervention (n=220) participants will receive a tablet-delivered series of educational videos catered to self-reported topics of interest (physical activity, blood pressure, diet, medications, smoking and general health) and level of health knowledge. Control (n=110) participants will receive usual care. In a substudy, intervention participants will be randomised 1:1 to receive an extra video on CPR or no extra video. The primary outcome will be the proportion of intervention and control participants who report high motivation to improve physical activity, diet and blood pressure monitoring at end of clinic. The primary outcome of the CPR study will be confidence to perform CPR post clinic. Secondary analysis will examine impact on clinic satisfaction, lifestyle behaviours, CPR knowledge and willingness to perform CPR post clinic and at 30-day follow-up.
Ethics and dissemination:
Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee. All patients will provide informed consent via a tablet-based eConsent framework. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.
Trial registration number:
ANZCTR12618001725257.
Background: Autonomous self-regulation is a proxy for adapting long-term healthy behaviors with major impact on prevention of chronic illnesses. The psychometric properties of the Treatment Self-Regulation Questionnaire- Persian version (TSRQ-P) was assessed in this study for use in examination of autonomous regulation among the Iranian type 2 diabetes patients.
Methods: The preliminary draft of the TSRQ-P was prepared based on a standard translation/back translation procedure and 15 allied health specialists assessed its face and content validities. The internal consistency measure of the Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) were estimated to verify the TSRQ-P’s content validity and reliability. The exploratory (EFA) and confirmatory factor (CFA) analyses were performed to check the scale’s structural components.
Results: The calculated Cronbach’s alpha= 0.893 and ICC= 0.982 deemed the scale as content valid and acceptable in terms of measurement invariance. The EFA and CFA outputs yielded two distinct factor structure for the TSRQ-P (RMSEA=0.078, NFI=0.849, RFI=0.806, IFI=0.913, TLI=0.886, CFI= 0.911).
Conclusion: The TSRQ-P indicated robust psychometric features for application among Persian-speaking type 2 diabetes patients. Due to cross-borders cultural diversity of the subgroups of Persian speaking populations, further psychometric scrutiny is recommended to prevent bias and sociolinguistic inconsistencies.
Physical activity can improve function in patients with chronic pain, however, adherence is low, in part due to inconsistent activity patterns. Smart wearable activity trackers, such as Fitbits, may help promote activity. In our program for chronic pain, we examined: (1) Fitbit activity patterns (i.e., step count, moderate-to-vigorous physical activity (MVPA), sedentary behavior), and (2) whether achievement of weekly, individualized Fitbit step goals was associated with functional outcomes. We conducted a secondary analysis of Fitbit data from our 10-week mind-body activity program for chronic pain (GetActive-Fitbit arm, N = 41). Participants self-reported emotional and physical function and completed performance-based and accelerometer-based assessments. From week 1 to week 10, 30% of participants increased >800 steps; 32.5% increased MVPA; and 30% decreased sedentary behavior. Only step count significantly changed across time with mean steps peaking at week 8 (M = +1897.60, SE = 467.67). Fitbit step goal achievement was associated with improvements in anxiety (ß = -.35, CI [-2.80, -0.43]), self-reported physical function (ß = -.34, CI [-5.17, 8.05]), and performance-based physical function (ß = .29, CI [-71.93, 28.38]), but not accelerometer-based physical function or depression. Adhering to individualized Fitbit step goals in the context of a mind-body activity program may improve anxiety and self-reported and performance-based physical function.
Perspective: We examine Fitbit activity patterns and the association between quota-based pacing and functional outcomes within a mind-body activity program for adults with chronic pain. Complementing quota-based pacing and coping skills with Fitbits may be a useful approach to promote activity engagement and behavior change among chronic pain populations.
Background. The aim of this study is to provide an overview of the research examining the relationships between
contextual factor – autonomy support – and motivational process to control diabetes using self-determination theory
as a guiding framework.
Methods. Overview of published literature of applying SDT examining motivation and behavior in patients with
diabetes was performed. Sage, Medline and Google Scholar data basis were searched using “autonomy support and
diabetes” and “self-determination and diabetes” words combinations. Literature review included cross-sectional,
longitudinal research and experimental studies.
Results. Research shows that autonomy support directly affects autonomous motivation, competence and patient
satisfaction. Through the mediators in the behavior motivation model - autonomy and competence – autonomy
support is associated with diabetes related behavior, physiological and psychological outcomes.
Conclusions. It may be concluded that interrelationship between contextual social (relationship with health care
specialists), inner psychological (motivation) and physiological (glycemic index) factors is crucial considering the
content of educational programs of diabetes care. So, minimization of long-term diabetes complications, enhanced
psychological health and quality of life could be expected if health professionals provide autonomy support for their diabetes patients.
Keywords: autonomous motivation, perceived competence, health-behavior.
The present study investigated associations between interpersonal relations and motivation for social activity among older Japanese adults, focusing on their peer relations, spousal support, support from their children, and relations with their grandchildren. The participants were 498 older adults living in a community, who were attending social activities. After inappropriate responses were excluded, the data were analyzed from 225 participants (age: M = 75.48, SD = 4.89, range = 60 to 90). The results of partial correlation analysis indicated that peer relations, spousal support, and support from children significantly and positively predicted autonomous motivation for social activity. These results suggest that interpersonal relations, in particular those with peers and family members, may plan an important role in promoting autonomous motivation of older Japanese adults who attend social activities.
Two studies tested self-determination theory with 2nd-year medical students in an interviewing course. Study 1 revealed that (a) individuals with a more autonomous orientation on the General Causality Orientations Scale had higher psychosocial beliefs at the beginning of the course and reported more autonomous reasons for participating in the course, and (b) students who perceived their instructors as more autonomy-supportive became more autonomous in their learning during the 6-month course. Study 2, a 30-month longitudinal study, revealed that students who perceived their instructors as more autonomy-supportive became more autonomous in their learning, which in turn accounted for a significant increase in both perceived competence and psychosocial beliefs over the 20-week period of the course, more autonomy support when interviewing a simulated patient 6 months later, and stronger psychosocial beliefs 2 years later.
Physical activity and fitness are believed to reduce premature mortality, but whether genetic factors modify this effect is not known.
To investigate leisure physical activity and mortality with respect to familial aggregation of health habits during childhood and factors that may enable some individuals to achieve higher levels of fitness.
Prospective twin cohort study.
Finland.
In 1975, at baseline, 7925 healthy men and 7977 healthy women of the Finnish Twin Cohort aged 25 to 64 years who responded to a questionnaire on physical activity habits and known predictors of mortality. Those who reported exercising at least 6 times per month with an intensity corresponding to at least vigorous walking for a mean duration of 30 minutes were classified as conditioning exercisers, those who reported no leisure physical activity were classified as sedentary, and other subjects were classified as occasional exercisers.
All-cause mortality and discordant deaths among same-sex twin pairs from 1977 through 1994.
Among the entire cohort, 1253 subjects died. The hazard ratio for death adjusted for age and sex was 0.71 (95% confidence interval [CI], 0.62-0.81) in occasional exercisers and 0.57 (95% CI, 0.45-0.74) in conditioning exercisers, compared with those who were sedentary (Pfor trend <.001). Among the twin pairs who were healthy at baseline and discordant for death (n=434), the odds ratio for death was 0.66 (95% CI, 0.46-0.94) in occasional exercisers and 0.44 (95% CI, 0.23-0.83) in conditioning exercisers compared with those who were sedentary (P for trend, .005). The beneficial effect of physical activity remained after controlling for other predictors of mortality.
Leisure-time physical activity is associated with reduced mortality, even after genetic and other familial factors are taken into account.
Self determination theory proposes that behavior change will occur and persist if it is autonomously motivated. Autonomous motivation for a behavior is theorized to be a function both of individual differences in the autonomy orientation from the General Causality Orientations Scale and of the degree of autonomy supportiveness of relevant social contexts. We tested the theory with 128 patients in a 6-month, very-low-calorie weight-loss program with a 23-month follow-up. Analyses confirmed the predictions that (a) participants whose motivation for weight loss was more autonomous would attend the program more regularly, lose more weight during the program, and evidence greater maintained weight loss at follow-up, and (b) participants' autonomous motivation for weight loss would be predicted both by their autonomy orientation and by the perceived autonomy supportiveness of the interpersonal climate created by the health-care staff. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Responding to the expansion of scientific knowledge about the roles of nutrients in human health, the Institute of Medicine has developed a new approach to establish Recommended Dietary Allowances (RDAs) and other nutrient reference values. The new title for these values Dietary Reference Intakes (DRIs), is the inclusive name being given to this new approach. These are quantitative estimates of nutrient intakes applicable to healthy individuals in the United States and Canada. This new book is part of a series of books presenting dietary reference values for the intakes of nutrients. It establishes recommendations for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. This book presents new approaches and findings which include the following: The establishment of Estimated Energy Requirements at four levels of energy expenditure Recommendations for levels of physical activity to decrease risk of chronic disease The establishment of RDAs for dietary carbohydrate and protein The development of the definitions of Dietary Fiber, Functional Fiber, and Total Fiber The establishment of Adequate Intakes (AI) for Total Fiber The establishment of AIs for linolenic and a-linolenic acids Acceptable Macronutrient Distribution Ranges as a percent of energy intake for fat, carbohydrate, linolenic and a-linolenic acids, and protein Research recommendations for information needed to advance understanding of macronutrient requirements and the adverse effects associated with intake of higher amounts Also detailed are recommendations for both physical activity and energy expenditure to maintain health and decrease the risk of disease. © 2002/2005 by the National Academy of Sciences. All rights reserved.
I: Background.- 1. An Introduction.- 2. Conceptualizations of Intrinsic Motivation and Self-Determination.- II: Self-Determination Theory.- 3. Cognitive Evaluation Theory: Perceived Causality and Perceived Competence.- 4. Cognitive Evaluation Theory: Interpersonal Communication and Intrapersonal Regulation.- 5. Toward an Organismic Integration Theory: Motivation and Development.- 6. Causality Orientations Theory: Personality Influences on Motivation.- III: Alternative Approaches.- 7. Operant and Attributional Theories.- 8. Information-Processing Theories.- IV: Applications and Implications.- 9. Education.- 10. Psychotherapy.- 11. Work.- 12. Sports.- References.- Author Index.
The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001. Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical end points have been published. These trials addressed issues that were not examined in previous clinical trials of cholesterol-lowering therapy. The present document reviews the results of these recent trials and assesses their implications for cholesterol management. Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management. The trials confirm the benefit of cholesterol-lowering therapy in high-risk patients and support the ATP III treatment goal of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL. They support the inclusion of patients with diabetes in the high-risk category and confirm the benefits of LDL-lowering therapy in these patients. They further confirm that older persons benefit from therapeutic lowering of LDL-C. The major recommendations for modifications to footnote the ATP III treatment algorithm are the following. In high-risk persons, the recommended LDL-C goal is <100 mg/dL, but when risk is very high, an LDL-C goal of <70 mg/dL is a therapeutic option, ie, a reasonable clinical strategy, on the basis of available clinical trial evidence. This therapeutic option extends also to patients at very high risk who have a baseline LDL-C <100 mg/dL. Moreover, when a high-risk patient has high triglycerides or low high-density lipoprotein cholesterol (HDL-C), consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug. For moderately high-risk persons (2+ risk factors and 10-year risk 10% to 20%), the recommended LDL-C goal is <130 mg/dL, but an LDL-C goal <100 mg/dL is a therapeutic option on the basis of recent trial evidence. The latter option extends also to moderately high-risk persons with a baseline LDL-C of 100 to 129 mg/dL. When LDL-lowering drug therapy is employed in high-risk or moderately high-risk persons, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels. Moreover, any person at high risk or moderately high risk who has lifestyle-related risk factors (eg, obesity, physical inactivity, elevated triglycerides, low HDL-C, or metabolic syndrome) is a candidate for TLC to modify these risk factors regardless of LDL-C level. Finally, for people in lower-risk categories, recent clinical trials do not modify the goals and cutpoints of therapy.
Objective.
—To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.Data Sources.
—Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained.Study Selection.
—Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.Data Extraction.
—Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.Data Synthesis.
—The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.Conclusions.
—Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.(JAMA. 1993;270:2207-2212)