The psychological theory of self-determination

Two researchers, Edward L. Deci and Richard M. Ryan, developed a Self-Determination Theory in which they propose that the three basic needs people have are: competence, relatedness, and autonomy. Sheldon, Williams, and Joiner (2003) wrote that self-determination theory is important in understanding how people maintain or improve physical health. They said that for patients, competence is a need to know how they can reach their health goals and a need to feel they can do the activities corresponding with reaching their goals. Autonomy is a need to make choices related to patients’ health goals. And relatedness is a need for “respect and care” from health care professionals and significant others.

Why is self-determination important?

If you have ever been hospitalized, you know firsthand what it feels like to feel the encroachment of the institution on your freedoms. Autonomy is hard to come by in a hospital, and even sometimes, on routine doctors visits. And yet, we have all have a need for it. We need a certain degree of bodily autonomy, and that can be hard in a place in which one is poked, prodded, attached to an IV, woken at 5:30am for bloodwork, told when and what to eat and drink, and given “orders.” In short, it is easy to feel as if one has little say in one’s own healthcare in a hospital. Autonomy is a basic human need, and yet, in conventional medicine, it is often denied by well-meaning medical providers who are working within a system that has little flexibility for patient choices.

One would think that respect and care for patients would be cornerstones of medical care. Sadly, I know I am not alone when I say that my needs for respect and care have sometimes not been met in medical settings. My child’s needs for respect and care are also sometimes not met, even in pediatric medical settings. Respect and care for patients are the building blocks of good medical care, and yet, it is all too common for patients’ pain and concerns to be dismissed, and for them to be treated as cases to fix rather than as people with feelings and needs.

Competence is related to mastery and efficacy, the sense that “yes, we can do this.” It is also related to health literacy. Far too often, medical providers provide medical information that is either too basic or too complex, not matching the health literacy levels of their patients. Medical providers can improve their ability to “match” patients, by encouraging patients to ask questions (which reveal a lot about health literacy levels), and by asking patients to “teach back” medical information that was provided to them. Medical providers can encourage patients to feel a sense of competence by being encouraging and supportive, and helping patients feel empowered to meet their own goals.



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