HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Sussman, A. L. PubMed Articles by Sussman, A. L.

Self Determination Theory and Preventive Care Delivery: A Research Involving Outpatient Settings Network (RIOS Net) Study

Department of Family and Community Medicine (ALS, RLW), University of New Mexico
Department of Medicine (RL), University of New Mexico
Albuquerque Service Unit, US Indian Health Service (PWG), Albuquerque
Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (BFC), Piscataway

Correspondence: Corresponding author: Andrew L. Sussman, PhD, MCRP, Family and Community Medicine, MSC 09-5040, 1 University of New Mexico, Albuquerque, NM 87131-0001 (E-mail: asussman{at}salud.unm.edu)

Purpose: Traditional approaches to improving preventive care have had limited success. In response, researchers have adopted new ways of examining the primary care environment and clinical encounters to better understand the factors that impact care delivery. We examined how clinicians make preventive counseling decisions to ascertain if self-determination theory (SDT) may further clarify influences on clinicians' decisions to take time for preventive counseling.

Methods: We studied clinical decision making through a mixed-method approach using obesity counseling as an example of preventive counseling. We conducted in-depth interviews and focus groups with 30 primary care clinicians in RIOS Net, a Southwestern US practice-based research network and distributed a survey, which was completed by 75% of 195 network members. We then used the components of SDT autonomy, competence, and relatedness to organize the factors that clinicians identified as most influential in their preventive counseling decisions.

Results: We found that SDT provides an organizing structure for understanding some of the psychology of clinicians' decisions to provide preventive counseling in the brief primary care encounter. In the specific case of obesity counseling clinicians expressed a high degree of autonomy, but barriers to competence and generally low levels of relatedness with professional colleagues seemed to limit their delivery of preventive counseling.

Conclusion: SDT provides a new perspective on factors that impact preventive counseling delivery, with a focus on the psychology of clinical decision making. Further research testing the predictive value of SDT may open new avenues for enhancing the delivery of preventive services.

This article has been cited by other articles:

				M. A. Bowman, A. V. Neale, and P. Lupo Third Journal of the American Board of Family Medicine Practice-based Research Theme Issue J Am Board Fam Med, July 1, 2008; 21(4): 255 - 257. [Full Text] [PDF]