33. Let's Get Motivated!: Identifying What Facilitates Youth's Motivation for Learning About Health Self-Management

Abstract

In this study we focused on youth's perceptions of healthcare providers as potential motivational supports in learning how to self-manage their health and healthcare needs. As youth transition to adulthood, they need to know how to communicate with healthcare providers, who to call when sick, and when it is necessary to call a healthcare provider. In this study we tested the universality of basic psychological needs in facilitating motivation for learning about health management among youth with varying degrees of mobility limitations (ML). That is, we wanted to determine whether autonomy, relatedness, and or competence, would be more or less important for one group of youth, than for others. Data come from the MyPath project, a longitudinal study that investigates the transition from pediatric to adult centered healthcare for youth with and without ML. The community-based sample from the Midwest includes 352 young people with severe (n=67), moderate (n=84), and little to no (n=201) mobility limitations (ML) between the ages of 16 and 24. Participants completed an online survey at baseline and at 18 months following enrollment. Predictor variables were measured at baseline and include healthcare autonomy (4-items, α= .81), health competence (6-items, α= .85), and relatedness (4-items, α= .82). The dependent variable, motivation for learning about self-management (5-items, α= .87), was measured at 18 months. Covariates included age, sex, geographic location, maternal education level, and assistive equipment use. We employed a multigroup path analysis comparing three groups of youth: no ML, moderate ML and severe ML. Results from the multigroup path analysis revealed that the model was invariant between the three groups. The path coefficients from autonomy to motivation and relatedness to motivation were only significant for youth with severe ML. Results indicate the invariance constraints on autonomy to motivation were significant X2(2) = 17.750, p = .001, as were relatedness to motivation, X2(2) = 8.265, p=.016. Although path coefficients were different for competence, the path was not significantly different. Results from our study show that for youth with severe ML, autonomy matters, as does relatedness. For youth with severe ML, their sense of control in their interactions in the healthcare environment and sense of freedom of health-related choice facilitates their motivation to learn about health self-management. Additionally, relatedness had a surprisingly negative effect on motivation for youth with severe ML—it impeded youth's motivation for learning about health self-management. The more belonging or affiliated youth felt to healthcare providers, the less motivated they were in learning how to manage their healthcare. Motivation for learning about health self-management is critical as youth are expected to manage their health and healthcare needs in adulthood; and knowing what facilitates or impedes this motivation can help providers in developing effective interventions. As we develop programs that teach youth about the healthcare transition and engage them in transition related conversations we need also to be examining their motivation to learn such information.