Virtually everyone agrees that health care in America is in crisis.
As a country we spend significantly more per individual for health care than any other industrialized nation yet, despite our excess spending, a World Health Report ranks the U.S. health care system 37th in the world in terms of performance.
An often overlooked reason for why the numbers are so bad is the fact that Americans are not healthy. More than 80 percent of our health care expenditures can be traced to care for chronic health problems — such as obesity, Type 2 diabetes, and cardiovascular disease — so-called lifestyle diseases.
The best solution to our health care woes is to improve the nation’s health through lifestyle change. But knowing that we should make a lifestyle change to improve our health and actually making that lifestyle change are two very different things.
In a new article published in the July 2012 issue of Perspectives on Psychological Science, psychological scientist Johan Ng of the University of Birmingham and his colleagues investigated the factors that influence our motivation to engage in and adhere to behaviors that promote good health.
According to the researchers, self-determination theory, a general theory of human motivation, is especially useful for understanding why we behave the way we do, especially in the context of health.
Self-determination theory holds that there are three basic psychological needs that, when met, help us to initiate and maintain health behaviors over the long term.
We have a need for autonomy, or feeling like we originate and control our own behaviors; we have a need for competence, or feeling effective; and we have a need for relatedness, feeling understood and care for by others.
“Although the framework of self-determination theory is frequently used by researchers within the health domain, to date no effort has been made to combine and compare research findings across the many subdomains of this research,” says Ng.
Such a comparison could have important implications both for research and for health practitioners.
Using a technique called meta-analysis, the researchers were able to examine and analyze the entire body of research on self-determination theory in health contexts.
After searching the literature, they identified 184 different sets of data that examined the influence that various factors may have on health behaviors such as physical activity, diabetes care, abstinence from tobacco, and weight control.
The researchers explored factors that influence health behavioral change: a health care climate supportive of patient autonomy; satisfaction of participants’ psychological needs; and how participants think about the causes of their physical health status.
Researchers discovered that respect for patients’ autonomy in health care settings was positively related to patients’ feelings of autonomy, competence, and relatedness in relation to the target health behavior.
Furthermore, satisfaction of the three psychological needs was positively related to patient well-being, including both improved mental and physical health.
Researchers also discovered an individual’s confidence that they could change or improve their health behaviors is critical to their ability to actually make that change.
“Recently, patient autonomy has been identified as an important aspect of medical ethics. Our findings show that this focus on patient autonomy is, in fact, conducive to positive health changes,” says Ng.
“Our results showed that supporting patients’ psychological needs is essential to practitioners in helping patients attain their health goals and outcomes.”
The findings support the onging movement toward a “patient-centered” health care focus, a perspective in which individuals take control of their own health destiny.