Primary author: Suzanne Cash_
“Human beings can be proactive and engaged, or alternatively passive and alienated, largely as a function of the social conditions in which they develop and function” (Ryan, 2000).
Chapter 11 describes factors that have the potential to impact health outcomes; namely interpersonal communication, and that the communication that occurs between the individual (patient) and the health care facilitator (physician, nurse, care manager etc) is an important influence in motivating (or impeding), the process of changing health behavior (Glanz, 2008). Glanz et al go on to provide two very different examples of clinician-patient communication. In the first example, the clinician methodically explains the treatment regimen detailing how the medication can treat the condition and result in the desired outcome, improved health. However this example doesn’t consider an alternative outcome: the medication didn’t work. The second example Glanz provided was a communication style tailored to affect motivational and cognitive processes that may impact health-related behaviors. The desired end result of clinician-patient communications is the enhancement of a patient’s ability to make health related decisions and support problem-solving moving them toward the end goal of adopting healthier behaviors that could move them into better health.
The communication function of self-determination theory (SDT) is to enable patient self-management with the key theme that “human behavior is driven to meet three basic needs – competence, autonomy, and relatedness” (Glanz, 2008). The concept that motivation is in part affected by these three basic needs, and the extent to which they represent autonomy versus control sets SDT apart from other motivational theories (Moller, 2006).
Looking more closely at the 3 basic needs, competence within the SDT is an emotional response where the individual feels a sense of confidence and effectiveness in their actions, relatedness is that feeling of connection with other people where there is caring, and a sense of belongingness, while autonomy is self’s perception of understanding the origins of one’s behavior (Deci, 2004).
An assumption of SDT is that the individual is naturally aligned toward physical and psychological health and is” more likely to adopt healthy behaviors, or to change unhealthy ones, when their basic psychological needs for autonomy, competence, and relatedness are supported” (Williams, 2009). SDT has been found to be effective in a variety of domains: parenting, education, environmentally friendly behavior, health care, management of for-profit and not-for-profit organizations, excercise programs, mentally challenged inviduals, and injured athletes to name only a few domains (Deci, 2004). My specific area of interest with SDT is in relation to disease management programs that utilize health advocates engaging identified members to change health behaviors supported by evidence based guidelines.
Health outcomes matter. The three main goals of clinical medicine is 1) the restoration of health after disease or injury, 2) the prevention of future disease, progression of chronic disease, disability, or premature death, and 3) health-related quality of life with the ability to live and participate in life as long as they can until they reach a point when life become physically unbearable or life has lost its meaning (Zubialde, 2009). In circling back to chapter 11 and interpersonal communication between clinician and an individual; in thinking about our most recent assignment looking at a variety of communities and choosing a model to address specific needs, I am thinking about SDT and how the clinician can use the underlying needs of competence, relatedness, and autonomy to design programs that have a greater opportunity to result in the desired health behaviors and hence better health outcomes.

Deci, E. L., and Ryan, Richard M. (2004). Handbook of Self-Determination Research. Rochester: The University of Rochester Press.
Glanz, K., Rimer, Barbara K., and Viswanath, K. (2008). Health Behavior and Health Education Theory, Research, and Practice (4th ed.). San Francisco: Jossey-Bass.
Moller, A. C., Ryan, Richard M., and Deci, Edward L. (2006). Self-Determination Theory and Public Policy: Improving the Quality of Consumer Decisions Without Using Coercion. [Journal Article]. Journal of Public Policy & Marketing, 25(1), 13.
Ryan, R. M., and Deci, Edward L. (2000). Self Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well Being. American Psychologist, 55(1), 11.
Williams, G. C. M., PhD, Patrick, Heather, PhD, Niemiec, Christopher P. MA, Williams, L. Keoki MD, MPH, Divine, George PhD, Lafata, Jennifer Elston PhD,Heisler, Michele MD, Tunceli, Kaan PhD, and Pladevall, Manel MD, MS. (2009). Reducing the Health Risks of Diabetes. How Self-determination Theory May Help Improve Medication Adherence and Quality of Life. The Diabetes EDUCATOR, 35(3), 9.
Zubialde, J. P., Mold, James, and Eubank, Daniel. (2009). Outcomes that matter in chronic illness: A taxonomy informed by self-determination and adult-learning theory. [Journal; Peer Reviewed Journal]. Families, Systems, & Health, 27(3), 8.