Using self-determination theory to predict self-management and HRQoL in moderate-to-severe COPD

Gareth Norris,Rachel Rahman,Liam Knox,Keir Lewis

doi:10.1080/21642850.2021.1938073

Abstract

ABSTRACT Objective: Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition that detrimentally affects health-related quality of life (HRQoL), with self-management proposed as an effective treatment. Using self-determination theory (SDT), this research explored psychological need satisfaction, frustration, and behavioural regulation to explain indicators of self-management. Design and Main Outcome Measures: Cross-sectional, questionnaire-based methods in people on a pulmonary rehabilitation waiting-list. 72 participants completed SDT, HRQoL, and self-management knowledge questionnaires. Path analyses investigated the ability of SDT concepts to predict self-management knowledge and HRQoL. Results: Chi-square tests found no significant differences (χ2(13, N=72) = 16.7, p > 0.05) between the just – and over-identified models, and multiple measures suggested an acceptable fit to the data. Relatedness frustration positively predicted controlled regulation and autonomy and relatedness satisfaction positively predicted autonomous regulation. The associations between the other needs and the different regulation types were not statistically significant. Both regulation types strongly predicted HRQoL (35% variance explained) and self-management knowledge (22% variance explained). Conclusion: SDT concepts can predict more self-determined self-management regulation, self-management knowledge, and HRQoL and provide a framework for researchers and healthcare professionals to develop future health interventions for people with COPD. Greater research is needed to understand basic psychological need frustration in health contexts.

Highlights

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, irreversible condition which affects approximately 1.2 million people in the United Kingdom (UK; National Institute for Health and Clinical Excellence [NICE], 2018) and is the third most L
It is important to note that higher scores on the health-related quality of life (HRQoL) measure (CAT) are indicative of worse health states; HRQoL was found to be relatively poor in the people who participated in this study
Increasing self-management knowledge and HRQoL has been identified as crucial to support people with COPD (Kielmann et al, 2010) and, contrary to previous literature (Gillison et al, 2019; Ntoumanis et al, 2020), the path analysis suggests that controlled and autonomous regulation to self-manage could both be variables to consider in this endeavour

Summary

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, irreversible condition which affects approximately 1.2 million people in the United Kingdom (UK; National Institute for Health and Clinical Excellence [NICE], 2018) and is the third most L. Multiple studies have linked depression in people with COPD to a loss of functional mobility and ability to tend to daily tasks, alongside increased symptom burden and mortality (McCathie, Spence, & Tate, 2002; Ng et al, 2007). Due to the progressive nature of the disease, people with COPD are extensive healthcare users, representing the second most common cause of emergency hospital admission in the UK and directly costing the National Health Service (NHS) £1847 million in 2014 (Trueman, Woodcock, & Hancock, 2017)

Methods

Results

Conclusion