Chantal Levesque

A New Tool to Assess Treatment Fidelity and Evaluation of Treatment Fidelity across 10 Years of Health Behavior Research.

A. Bellg, B. Borrelli, et al. (2004) previously developed a framework that consisted of strategies to enhance treatment fidelity of health behavior interventions. The present study used this framework to (a) develop a measure of treatment fidelity and (b) use the measure to evaluate treatment fidelity in articles published in 5 journals over 10 years. Three hundred forty-two articles met inclusion criteria; 22% reported strategies to maintain provider skills, 27% reported checking adherence to protocol, 35% reported using a treatment manual, 54% reported using none of these strategies, and 12% reported using all 3 strategies. The mean proportion adherence to treatment fidelity strategies was .55; 15.5% of articles achieved greater than or equal to .80. This tool may be useful for researchers, grant reviewers, and editors planning and evaluating trials.

Autonomy and Competence in German and American University Students: A Comparative Study Based on Self-Determination Theory

According to self-determination theory (R. M. Ryan & E. L. Deci, 2000), supports for autonomy and competence are essential for growth and well-being in any learning environment. Educational contexts differ in their relative support for these 2 needs. The authors examined the role of autonomy and competence in 2 German and 2 American university settings, as they were predicted to differ in terms of their relative emphasis on competence versus autonomy. Invariance analyses supported the construct comparability of the measures and demonstrated that German students felt significantly more autonomous and less competent than American students. Perceived pressures and positive informational feedback were modeled as antecedents of autonomy and competence, and well-being was examined as a consequence. The hypothesized model was generally supported across the 4 samples.

On the Investigation of Primed and Chronic Autonomous and Heteronomous Motivational Orientations

Four studies examined primed and chronic autonomous and heteronomous motivations. Study 1 showed that autonomy and heteronomy can be primed and influence perceptions and behavior in a way consistent with consciously regulated motives. In Study 2, a measure of chronic motivation was developed and its construct validity and reliability were assessed. In Study 3, the chronicity measure predicted behavior while consciously regulated motives predicted intention but not behavior. Results of Study 4 replicated results of the priming manipulation in Study 1. However, this effect was moderated by level of motivational chronicity. The priming effect was found to be stronger for non-chronics than for chronics. Overall, the findings suggest that autonomous and heteronomous motivations can be regulated automatically as well as consciously.

A Self-Determination Multiple Risk Intervention Trial to Improve Smokers' Health

AbstractBACKGROUND: Little is known about how interventions motivate individuals to change multiple health risk behaviors. Self-determination theory (SDT) proposes that patient autonomy is an essential factor for motivating change. OBJECTIVE: An SDT-based intervention to enhance autonomous motivation for tobacco abstinence and improving cholesterol was tested. DESIGN: The Smokers’ Health Study is a randomized multiple risk behavior change intervention trial. SETTING: Smokers were recruited to a tobacco treatment center. PATIENTS: A total of 1,006 adult smokers were recruited between 1999 and 2002 from physician offices and by newspaper advertisements. INTERVENTIONS: A 6-month clinical intervention (4 contacts) to facilitate internalization of autonomy and perceived competence for tobacco abstinence and reduced percent calories from fat was compared with community care. Clinicians elicited patient perspectives and life strivings, provided absolute coronary artery disease risk estimates, enumerated effective treatment options, supported patient initiatives, minimized clinician control, assessed motivation for change, and developed a plan for change. MAIN OUTCOME MEASURES: Twelve-month prolonged tobacco abstinence, and change in percent calories from fat and low-density lipoprotein-cholesterol (LDL-C) from baseline to 18 months. RESULTS: Intention to treat analyses revealed that the intervention significantly increased 12-month prolonged tobacco abstinence (6.2% vs 2.4%; odds ratio [OR]=2.7,P=.01, number needed to treat [NNT]=26), and reduced LDL-C (−8.9 vs −4.1 mg/dL;P=.05). There was no effect on percent calories from fat. CONCLUSIONS: An intervention focused on supporting smokers’ autonomy was effective in increasing prolonged tobacco abstinence and lowering LDL-C. Clinical interventions for behavior change may be improved by increasing patient autonomy and perceived competence.

Intrinsic and Extrinsic Motivation

Intrinsic motivation underlies behaviors performed purely for interest and enjoyment; extrinsic motivation underlies behaviors performed to obtain separable rewards or avoid negative outcomes. Different types of extrinsic motivations exist and can be placed on a self-determination continuum. Intrinsic motivation and self-determined forms of extrinsic motivation facilitate positive outcomes such as well-being. Non-self-determined forms of extrinsic motivation are associated with negative outcomes such as anxiety. Autonomy-supportive environments which provide choices and options foster the development of intrinsic motivation and self-determination. In education, autonomy-supportive environments provide the context for greater learning outcomes such as increased classroom involvement, performance, and satisfaction.