Treatment Self-Regulation Questionnaire Research Articles

Associations of stigma, loneliness, and treatment self-regulation with HIV medication adherence among individuals with substance use disorder using a mobile health application

IntroductionMedication adherence contributes to poor HIV outcomes, especially among people with HIV and Substance use disorder (SUD). Mobile health applications have been leveraged to improve behavioral health outcomes among this population. Our cross-sectional study examined the relationship between medication adherence with factors such as treatment self-regulation, isolation, and internalized stigma, among people with HIV and SUD using the Addiction Comprehensive Health Enhancement Support System (A-CHESS) mobile app.MethodsA sample of 208 participants using A-CHESS to improve treatment adherence completed a survey. Adherence was measured using the Four-item Morisky Medication Adherence Scale and dichotomized (maximum score of 20 points considered as adherent). Positive and negative affect was measured separately using Positive Affect Negative Affect Schedule and loneliness was measured using UCLA three-item Loneliness Scale. Internalized stigma was measured using Internalized AIDS-Related Stigma Scale. Competence/Treatment self-regulation was measured using Treatment Self-regulation Questionnaire. Multivariable logistic regression was used to assess the associations of affect, treatment self-regulation, isolation, and internalized stigma, with adherence to antiretroviral therapy adjusting for age, education, and gender.ResultsAmong 208 participants in this study, most were Black (n = 137; 66%), male (n = 156; 75%) and had a mean age of 46 (standard deviation = 11.3). The most reported substances associated with missing HIV medication were alcohol (27%) and cocaine/crack (20%). Logistic regression analysis revealed that internalized stigma was significantly associated with HIV medication adherence (OR = 0.82; 95% CI: 0.70–0.99; p = 0.034).ConclusionInternalized stigma was significantly associated with HIV medication adherence. Further research is needed to better understand this relationship and develop interventions addressing stigma in people with HIV and SUD.

The Determinants of Mental Illness Self-Management for Patients With Schizophrenia and Type 2 Diabetes: A Self-Determination Theory Approach.

This study based on self-determination theory aimed to assess the relationship between motivation, competence in diabetes management and perceived autonomy support respectively and mental illness self-management; furthermore, the authors intended to explore the determinants of mental illness self-management for patients with schizophrenia and diabetes. This was a cross-sectional study. One hundred ten participants were recruited at the psychiatric hospital and assessed with the Illness Management and Recovery Scale, the Treatment Self-Regulation Questionnaire, the Perceived Competence Scale for Diabetes and the Health-Care Climate Questionnaire. Patients with lower educational levels, who were admitted to the chronic ward, were unemployed, had lower motivation in illness management, lower competence in diabetes management and perceived lower autonomy support all had lower mental illness self-management. Competence in diabetes management, employment status, autonomy support, educational levels and living alone were the determinants of mental illness self-management. Recovery from schizophrenia and comorbid diabetes is an enduring and complicated process requiring support from healthcare providers. Health professionals should assess the levels of illness self-management and provide integrated care interventions for patients with schizophrenia and diabetes, helping them manage both conditions. The illness management programme could apply to patients with schizophrenia and diabetes and address patients' characteristics such as low levels of education, living alone and being unemployed while additionally promoting motivation and competence, and providing supporting autonomy. The STROBE checklist was followed. Patients with schizophrenia and diabetes were recruited for this study and voluntarily completed the questionnaire.

The relationships between emerging adults self-efficacy and motivation levels and physical activity: a cross-sectional study based on the self-determination theory.

The study aims to examine the associations between exercise self-efficacy, motivation, physical activity, and body composition among emerging adults. Cross-sectional. A convenience sample of 147 emerging adults participated in the Releasing Weight (RELEW) project. The InBody720 analyzer was used to measure body composition, and the International Physical Activity Questionnaire-Short, the Shortened Physical Activity Self-Efficacy Scale, and the Treatment Self-Regulation Questionnaire were used to measure self-reported physical activity, self-efficacy, and motivation. Structural Equation Modeling was used to exam the complex relationships among multiple variables. in this study. The Partial least squares structural equation modeling analysis with bootstrapping in Smart PLS 3 was employed to explore the path coefficients and t-values for the relationships that were thought to exist. Significance was determined using a threshold of p < 0.05. The mean age of 147 participants was 18.5 ± 1.87, of whom 51.7% were female, recruited for this study. Exercise self-efficacy has a significant positive correlation with exercise motivation (r = 0.220, p = 0.008) and physical activity (r = 0.279, p < 0.001). Exercise motivation does not demonstrate significant associations with physical activity (r = 0.094, p = 0.298). Utilizing SEM, the model explained 9.2% of exercise self-efficacy, 11.8% of physical activity, and 68.3% of body composition variance. Mediation analysis revealed that exercise self-efficacy partially mediated the relationship between exercise motivation and physical activity (β = 0.106, t = 2.538, p < 0.05), and physical activity partially mediated the relationship between exercise self-efficacy and body composition (β = -0.296, t = 4.280, p < 0.001). This study sheds light on the complex relationships among motivation, self-efficacy, physical activity and body composition during emerging adulthood. Our results highlight the mediating role of self-efficacy and its impact on physical activity behaviors, offering valuable insights for targeted interventions and policy development to improve health outcomes in this demographic.

Measurement of the self-determination continuum of motivation for engaging in alcohol-related harm reduction behaviors: Improved content coverage of the Treatment Self-Regulation Questionnaire.

Self-determination theory (SDT) proposes that people are more likely to engage in behaviors that reduce the harms associated with alcohol use if they do so for more self-determined reasons. There is growing support for this proposal, but the Treatment Self-Regulation Questionnaire (TSRQ), which assesses the self-determination continuum of motivation for engaging in alcohol-related harm reduction behaviors, lacks content coverage. We generated additional items to improve the content coverage of the TSRQ and evaluated its psychometric properties. We also compared two randomly assigned instruction sets that referenced "responsible drinking" or "protective behavioral strategies" (PBS). Participants (n = 2,236) were college students from psychology departments at 10 universities in eight U.S. states who reported past-month alcohol use and completed the revised TSRQ; the online survey was completed for partial course credit. Exploratory factor analysis supported a three-factor structure representing autonomous motivation, controlled motivation, and amotivation for the PBS version. This factor structure was confirmed using exploratory structural equation modeling for both the PBS and responsible drinking versions. Scalar invariance was achieved across instruction sets. Latent mean differences showed that those who received the PBS version had lower autonomous and controlled motivation scores, but higher amotivation scores. Associations of the three TSRQ factors with alcohol-related outcomes were consistent with SDT, and the magnitude of these associations did not differ across instruction sets. More accurate assessment of the self-determination continuum of motivation for alcohol-related harm reduction behaviors will improve research on this topic which has promising implications for alcohol interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Measurement of the Self-Determination Continuum of Motivation for Engaging in Alcohol-Related Harm Reduction Behaviors: Improved Content Coverage of the Treatment Self-Regulation Questionnaire

Supplemental Material for Measurement of the Self-Determination Continuum of Motivation for Engaging in Alcohol-Related Harm Reduction Behaviors: Improved Content Coverage of the Treatment Self-Regulation Questionnaire

Assessing the role of biomarker feedback in a 12-week community weight management programme among overweight men: A pilot study.

The primary objective of this study was to examine the feasibility of recruitment, retention, and delivery of biomarker feedback among men partaking in Shape Up, a physical activity for health programme. Secondarily, it explored the potential effects of biomarker feedback on participants' adherence and motivation levels. In this two-arm non-randomised pilot study, 46 men (mean±SD age 46.0±8.6 years) participating in the 12-week Shape Up programme were assigned to a control group or biomarker feedback group. Biomarker feedback consisted of 3 blood test panels: at baseline, 12 weeks, and 24 weeks (follow-up), each with a doctor's report. Both groups completed questionnaires (Short Active Lives Survey [SALS], Treatment Self-Regulation Questionnaire [TSRQ], and EQ-5D-5L) to gauge levels of motivation and engagement. The mean difference was calculated between baseline and programme end. Recruitment, retention, and attendance rates were determined. Mean recruitment (approach-to-consent), retention, and attendance rates were 96.3%, 92.3%, and 83.7% in the control group, and 85.2%, 86.2%, and 81.5% in the biomarker feedback group, respectively. Of biomarker feedback group participants, 86.4% attended their 12-week blood test and 45.5% attended their follow-up blood test. The mean 12-week differences (95% CI) for the control group and biomarker feedback group were 138.1 (2.7, 273.5) and 467.3 (249.4, 685.2) for active minutes per week, 0.2 (-0.8, 1.2) and 0.4 (0.0, 0.8) for autonomous TSRQ domains, 0.2 (-0.3, 0.8) and 0.8 (0.1, 1.4) for controlled TSRQ domains, and 19 (12.7, 26.5) and 27.2 (19.8, 34.6) for EQ-5D-5L scores, respectively. Biomarker feedback was well-received by participants and deemed feasible, with high recruitment and retention rates for the duration of the 12-week programme. Biomarker feedback may affect aspects of motivation but did not appear to influence adherence to the programme. Biomarker data may provide additional evidence of programme efficacy. Important design considerations are provided for definitive larger-scale trials.

Development and evaluation of measures to assess self-determination in peripartum contraceptive decision-making

ObjectivesWe aimed to adapt and validate person-centered measures to evaluate various contributors to self-determination in perinatal contraceptive decision-making. Study designWe developed and administered four scales adapted from existing measures in the context of Self-Determination Theory: the Treatment Self-Regulation Questionnaire (TSRQ), Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire. The TSRQ consists of three subscales: autonomous motivation, controlled motivation, and amotivation. We recruited a nonprobability convenience sample of 300 hospitalized postpartum patients in Baltimore, MD, between 2015 and 2016 and administered surveys in English and Spanish. We validated the scales with Cronbach's alpha coefficients, confirmatory factor analysis, and invariance analysis. We examined construct validity by testing correlations between the scales and other person-centered measures, such as satisfaction with counseling. ResultsCronbach's alpha was >0.8 except for the amotivation subscale. Confirmatory factor analysis was adequate for all scales. Autonomous motivation correlated positively and significantly with perceived competence, health care provider autonomy support, important other autonomy support, and other measures of patient satisfaction. ConclusionsWe found the four scales to be internally consistent and valid except for the amotivation subscale. We recommend using the autonomous motivation subscale in place of the full TSRQ. The autonomous motivation subscale, Perceived Competence Scale, modified Health Care Climate Questionnaire, and Important Other Climate Questionnaire showed adequate internal consistency, construct validity, and adherence to the expected conceptual structure of the scales. ImplicationsAutonomous decision-making is central to ethics and quality of care, especially for contraceptive methods that require a provider for initiation or discontinuation and at more vulnerable times, such as postpartum and postabortion. These scales may help tailor person-centered and autonomy-supportive interventions and programs to improve contraceptive counseling and care delivery.

Motivational Influences on Health, Well-Being, and Lifestyle: Validation of the Spanish Version of the Treatment Self-Regulation Questionnaire in Four Health Domains.

Motivation is a central concept in self-determination theory (SDT). The Treatment Self-Regulation Questionnaire (TSRQ), which assesses motivation (autonomous, controlled, etc.), has been widely used. However, less is known about its applicability to samples such as college students, who may be at risk of having unhealthy behavior in many areas (including smoking, poor dietary habits, alcohol, or tobacco consumption). As this population is transitioning to adulthood, research is needed to understand motivation and changing health patterns. In addition, the lack of instruments for this population in Spain has made the measurement validation process a priority. The purpose of this psychometric study was to adapt the TSRQ to Spanish college students and to examine its structural and validity across four health domains. Two samples of Spanish college students (n = 347 and n = 244) agreed to participate in the study. Participants completed a booklet containing measures of motivation, well-being, general health, anxiety, depression, and lifestyle. CFA supported a five-dimensional structure in each domain. Reliability values were also adequate for each questionnaire. Regarding other sources of validity, statistically significant relationships between self-determination, health, and well-being were clearly confirmed, and autonomy was a significant predictor of lifestyle. The Spanish version of the TSRQ showed adequate psychometric properties (dimensionality and internal structure, reliability, and validity evidence regarding its relationships with other constructs) in college students. The Spanish TSRQ will provide future research aimed to understand the motivational role in college students' health behavior and well-being.

Changing trajectory of daily physical activity levels among at-risk adolescents: influences of motivational mechanisms

BackgroundGuided by Self-Determination Theory (SDT), the purpose of this study was to determine changes in the 16-week moderate-to-vigorous physical activity (MVPA) trajectory of underserved adolescents who participated in the Connect through PLAY afterschool program intervention and the effects of changes in participating adolescents’ intrinsic and autonomous extrinsic motivations on their MVPA trajectory over the 16-week intervention.MethodsA subsample of 113 adolescents (56.64% female; 61.06% African American; average age = 11.29) provided complete data throughout the 16-week intervention were examined. Adolescents’ objective daily MVPA was measured using 7- day accelerometer data. Changes in adolescents’ intrinsic motivation and autonomous extrinsic motivation were assessed using subscales from the Intrinsic Motivation Inventory [1] and the Treatment Self-Regulation Questionnaire [2] respectively. A hierarchical linear model was built and tested to address the research aims.ResultsThe results of hierarchical linear models showed that, on average, youth daily MVPA increased 6.36 minutes in each 8-week period. Intrinsic motivation change, but not autonomous extrinsic motivation, was a positive and significant level-2 predictor of daily MVPA changes.ConclusionThe findings provide significant evidence suggesting a benefit of integrating SDT-based approaches and further suggest that nurturing intrinsic motivation can be an effective approach to supporting youth daily MVPA in under-resourced afterschool programs.Trial registrationConnect Through PLAY: A Staff-based Physical Activity Intervention for Middle School Youth (Connect). https://clinicaltrials.gov/ct2/show/NCT03732144. Registered November 6th, 2018.

Physical activity and health-related fitness among Chinese older women: A test of self-determination theory

Regular physical activity (PA) contributes to maintaining health and improving the quality of life among older people. This cross-sectional study investigates the associations between motivations derived from self-determination theory (SDT) and physical activity levels, as well as health-related fitness indices, in older Chinese women. We recruited 92 retired older women (range: 60–85 years; mean age ± SD: 71.74 ± 5.39 years) from Hong Kong, China. We assessed participants' motivations (autonomous motivation, controlled motivation, and amotivation) using the Treatment Self-Regulation Questionnaire, and measured their moderate-to-vigorous intensity physical activity (MVPA) and weekly walking using the International Physical Activity Questionnaire. We also evaluated body fat (fat mass, fat percentage, and visceral fat) using the Tanita SC240MA, flexibility with the Back Scratch Test and Chair Sit-and-Reach Test, and muscle strength using the Five-Times Sit-to-Stand Test and "Timed Up and Go" Test. We analyzed the data using partial-least squares structural equation modeling with Warp PLS 8.0 software. The results showed that autonomous motivation was significantly and positively related to walking (β = .24, p < .01) and MVPA (β = .23, p < .01); controlled motivation was negatively associated with walking (β = -.26, p < .01) and positively associated with MVPA (β = .21, p < .05); and amotivation was significantly and negatively associated with walking and MVPA (β = -.17, p <.05; β = -.16, p < .05). The results also generally suggest that a higher PA level is linked to better health-related fitness. However, the expected indirect effects of motivation on health-related fitness outcomes were not statistically significant. Our results support SDT in explaining older women's participation in physical activity. Although physically active older women were more likely to be physically fitter, motivation in physical activity did not exert significant indirect effects on all health-related fitness outcomes.

Feasibility of a Virtual-Reality-Enabled At-Home Telerehabilitation Program for Stroke Survivors: A Case Study.

Stroke rehabilitation is a lengthy procedure that is necessary for stroke recovery. However, stroke rehabilitation may not be readily available for patients who live rurally due to barriers such as transportation and expenses. This shortage in wearable technology, in turn, causes health disparity among the rural population, which was exacerbated by the COVID-19 pandemic restrictions. Telerehabilitation (TR) is a potential solution for stroke rehabilitation in rural areas. This one-case study aimed to examine the feasibility and safety of a technology-enabled at-home TR program for stroke survivors living in a rural area in Canada. A VR setup was installed successfully in the home of our participant. A tablet was also supplied for the TR program. Each program consisted of 24 sessions to be completed over a 12-week period. Our participant was assessed on day one using the Fugl-Meyer assessment, the Modified Ashworth Scale, the 10 m walk test, and the Mini-Mental State Exam. Three questionnaires were also completed, including the Motor Activity Log (MAL), the Stroke Index Scale (SIS), and the Treatment Self-Regulation Questionnaire. These assessments were completed thrice, on day 1, at week 6, and at week 12. The participant found the tablet and its accompanying exercises easy to use, with a few limitations. The participant found the VR system more challenging to manage independently as a lack of comfortability, the visual contrast during the first trials, and certain technical aspects of the technology created several functional barriers. Although some limitations with the technology were noted, this case study indicates that telerehabilitation is feasible under certain circumstances when used in conjunction with traditional rehabilitation services.

The nutritional literacy of breast cancer patients receiving chemotherapy and its association with treatment self-regulation and perceived social support.

Chemotherapy can lead to malnutrition and post-menopausal recurrence among breast cancer (BC) patients, who need to achieve nutritional literacy (NL) to cope. The objective of this study was to explore the NL level in Chinese BC patients receiving chemotherapy and its predictors including both internal motivation and the external environment. A total of 326 BC female patients from three hospitals were enrolled. Participants completed the Nutrition Literacy Measurement Scale for Chinese Adult (NLMS-CA), Chinese version from the Treatment Self-Regulation Questionnaire (TSRQ-C), and the Perceived Social Support Scale (PSSS) to assess NL, treatment self-regulation, and social support. Stepwise multivariate linear regression was used to identify the main factors of NL. The total NL score was 151.31 ± 16.85, the "knowledge understanding" dimension had the lowest score. In the final regression model, patients with higher scores for "autonomous motivation" and "introjected regulation" on the TSRQ-C and "family support" and "other support" on the PSSS, higher educational levels and average monthly household incomes and endocrine therapy had higher NL levels (adjusted R2 = 66.7%, p < 0.05). The overall NL score among Chinese BC patients receiving chemotherapy was satisfactory, but the knowledge understanding score was low. Higher autonomous motivation, introjected regulation, family support and other support scores, higher educational and household income levels, and endocrine therapy were predictors of NL in female patients. Interventions should be designed according to the specific performances and predictors of NL in female patients.

Patient-Centered Outcomes After a Medication Adherence Intervention: a Pilot Study.

Self-determination theory (SDT) guided behavioral interventions are effective in improving several patient-centered metrics, including glaucoma-related distress. However, whether improvement in patient-centered metrics can drive an improvement in medication-taking behavior remains to be seen. The 7-month Support, Educate, Empower (SEE) personalized glaucoma coaching program was previously shown to improve glaucoma medication adherence by 21 percent points. This study's goal was to assess the impact of the SEE program on self-determination theory (SDT) metrics and other patient-centered outcome measures. Glaucoma patients (≥40y old, taking ≥1 medication) self-reporting poor medication adherence were recruited at the University of Michigan. Eight surveys (with 10 subscales) were completed before and after the 7-month SEE program. Three surveys assessed changes in SDT (Treatment Self-regulation Questionnaire, Healthcare-Climate Questionnaire, Perceived Competence) while the others assessed participants' Glaucoma Knowledge, Glaucoma Medication Self-efficacy, Glaucoma-related distress, Perceived benefits, confidence asking and getting questions answered. Thirty-nine participants completed the SEE program. Significant improvements were in 7 subscales, including all three SDT tenets of competence (mean change =0.9, SD =±1.2, adjusted P =0.0002), autonomy (0.5, ±0.9, 0.044), and relatedness ( P =0.002). Glaucoma-related distress (-2.0, ±3.2, 0.004), confidence in asking questions (1.1, ±2.0, 0.008), and confidence in getting questions answered (1.0, ±2.0, 0.009) also improved. Glaucoma-related distress was correlated with perceived competence ( r =-0.56, adjusted P =0.005), and an increase in perceived competence was associated with a decrease in glaucoma-related distress (β=-0.43, 95% CI -0.67 - -0.20, adjusted P =0.007). The SEE program improved participants' autonomous motivation, perceived support, perceived competence, glaucoma-related distress, and competence. These results point to the promising potential of SDT-guided behavioral interventions in improving patient-centered metrics.

Predicting role of illness perception in treatment self-regulation among patients with type 2 diabetes.

Impaired self-regulation negatively impacts self-efficacy, self-management, blood sugar control, and quality of life among patients with diabetes. Hence, identifying the predictors of self-regulation is a necessity for healthcare providers. The current study aimed to determine the predictive role of illness perception in treatment self-regulation in patients with type 2 diabetes. The current study is a descriptive cross-sectional study. A total of 200 patients with type 2 diabetes, who were referred to the only specialized clinic for endocrinology and diabetes affiliated with Qazvin University of Medical Sciences in 2019-2020, were recruited through a convenience sampling method. For data collection, the brief Illness Perception Questionnaire and the Treatment Self-Regulation Questionnaire were used. Collected data were analyzed by SPSS v21 using a multivariable regression model. Mean and standard deviation scores of self-regulation and illness perception were 69.11 ± 17.61 and 36.21 ± 7.05, respectively. Results of the multivariate regression model revealed the significant correlations of self-regulation with illness perception, age, cardiovascular complications, diabetic retinopathy, and diabetic foot ulcers. In this study, participants presented a moderate level of self-regulation. The results also revealed that illness perception could be a predictor of improving patients' self-regulation. Therefore, providing infrastructure programs such as continuous education and appropriate care programs for diabetic patients to improve their illness perception can effectively improve their self-regulation behaviors.

Reliability and validity of the Japanese treatment self-regulation questionnaire for Japanese workers

BackgroundMotivational interventions are used as preventive measures in occupational health. However, existing studies primarily focus on motivation methods and not the stage of motivation—the process from extrinsic to intrinsic motivation. The treatment self-regulation questionnaire (TSRQ) can predict workers’ health at each motivational stage. Accordingly, this study examined the reliability and validity of the Japanese version of the TSRQ (Diet and Exercise) in occupational health settings.MethodsResponses of 912 workers were analyzed. In this study, the Cronbach’s alphas were 0.85 for Diet and 0.84 for Exercise after excluding items with low Item-Total correlations. Regarding convergent validity, there was a weak correlation between behavior modification stages and the TSRQ. Regarding structural validity, confirmatory factor analysis was performed assuming a four-factor structure.ResultsThe goodness-of-fit indices were: Comparative Fit Index (CFI) = 0.94, Tucker Lewis Index (TLI) = 0.92, and Root Mean Square Error of Approximation (RMSEA) = 0.07 for Diet and CFI = 0.92, TLI = 0.91, and RMSEA = 0.08 for Exercise.ConclusionThe Japanese version of the TSRQ has a certain degree of reliability and validity. It can measure motivation for Diet and health-related behaviors in occupational health settings. The findings of this study may serve as a basis for promoting primary and secondary prevention.

S1534 Longitudinal Analysis of Gluten-Free Dietary Adherence and Psychosocial Health in Gluten-Associated Disorders: The UCLA Celiac Collective

Introduction: Gluten-free diet (GFD), the mainstay of gluten-associated disorder (GAD) treatment, relies on patient adherence to optimize its therapeutic value. Psychological distress and decreased quality of life are associated with GFD non-adherence, but longitudinal assessments of psychosocial health’s impact on dietary adherence are lacking. Our study is the first to explore mental health status and motivational factors (eg, motivation type, perceived competence), and their connection with longitudinal changes in GFD adherence. Methods: In our prospective study, we invited patients with self-reported GAD from the UCLA Celiac Collective to complete baseline (2016-2020) and follow-up (2022) surveys. Surveys captured demographics, medical history, and responses to the Celiac Dietary Adherence Test; Celiac Symptom Index; PRO Measurement Information System’s depression, anxiety, sleep disturbance, fatigue, pain, and social satisfaction domains; Celiac Disease Quality of Life; Treatment Self-Regulation Questionnaire for motivation; Perceived Competence Scale; and Health Care Climate Questionnaire for relationship with healthcare provider. Cross-sectional analyses of GFD adherence, the primary outcome, used McNemar’s and Wilcoxon rank-sum tests; the longitudinal analysis assessed changes in GFD adherence from baseline to follow-up with T-tests. Results: We identified 449 patients with GAD at baseline (87.9% female, mean age 48). Of those patients, 123 completed follow-up. Factors consistently associated with higher GFD adherence at baseline and follow-up were lower scores for disease activity, anxiety, depression, fatigue, pain; and higher competence, autonomous motivation, and social satisfaction. Forty-4 patients whose GFD adherence declined over time also saw an increase in disease activity, depression, fatigue; and a decrease in social satisfaction. Conclusion: This is the first longitudinal study to show that intrinsic (or autonomously) motivated GAD patients who perceived themselves to be competent in complying with a GFD achieved better adherence, which in turn was linked to less distress and disease activity. This pattern emerged at both assessment periods and suggests that specific motivational behaviors may drive GFD adherence and its therapeutic value. Providers, whose influence is demonstrated by the positive association seen between patient-provider relationships and adherence, should treat GAD by considering these intrinsic behavioral qualities while addressing mental health disorders. Table 1. - Measures associated with GFD adherence Non-Adherence (CDAT ≥ 13) Adherence (CDAT < 13) P-value Worsened Adherence Improved Adherence P-value Celiac Disease Activity (CSI) Baseline 45.0 (37.0-51.0) 29.0 (23.0-36.0) < 0.001 +4.2 (8.3) -2.8 (8.2) 0.002 Follow-up 38.5 (36.0-45.5) 32.0 (25.5-36.5) < 0.001 Anxiety (PROMIS-29) Baseline 9.0 (6.0-12.0) 6.0 (4.0-8.0) < 0.001 +1.2 (2.7) 0.0 (3.9) 0.154 Follow-up 9.0 (6.0-11.0) 7.0 (4.0-9.8) 0.018 Depression (PROMIS-29) Baseline 7.0 (4.2-10.0) 4.0 (4.0-6.0) < 0.001 +1.1 (2.1) -0.6 (3.3) 0.014 Follow-up 7.0 (5.0-9.0) 4.0 (4.0-5.0) < 0.001 Sleep (PROMIS-29) Baseline 10.0 (8.0-12.0) 7.0 (5.0-9.0) < 0.001 +0.4 (2.6) +0.3 (3.3) 0.842 Follow-up 9.0 (7.0-11.0) 8.0 (6.0-10.0) 0.185 Fatigue (PROMIS-29) Baseline 13.0 (9.5-16.0) 8.0 (6.0-10.0) < 0.001 +1.5 (2.8) -1.1 (3.2) < 0.001 Follow-up 12.0 (10.0-15.0) 8.0 (6.5-10.5) < 0.001 Satisfaction with Social Interaction (PROMIS-29) Baseline 10.0 (7.0-12.0) 14.0 (12.0-16.0) < 0.001 -1.0 (3.5) +1.0 (3.2) 0.019 Follow-up 10.0 (8.0-12.0) 15.0 (12.0-16.0) < 0.001 Pain (PROMIS-29) Baseline 9.0 (5.5-14.0) 4.0 (4.0-8.0) < 0.001 +0.6 (4.0) -0.8 (4.0) 0.15 Follow-up 8.0 (6.8-12.0) 5.0 (4.0-7.2) < 0.001 Relationship with Healthcare Provider (HCCQ) Baseline 21.0 (12.0-33.5) 25.0 (15.0-36.0) 0.05 -0.4 (11.2) +4.7 (8.6) 0.051 Follow-up 23.5 (14.2-29.8) 27.5 (19.5-38.2) 0.044 Competence (PCQ) Baseline 26.0 (22.8-28.0) 28.0 (27.0-28.0) < 0.001 +0.2 (2.2) +1.7 (4.2) 0.068 Follow-up 28.0 (25.0-28.0) 28.0 (28.0-28.0) 0.002 Autonomous Motivation (TSRQ) Baseline 40.0 (36.0-42.0) 42.0 (38.5-42.0) < 0.001 -1.1 (6.4) +1.1 (6.8) 0.172 Follow-up 40.0 (35.0-42.0) 42.0 (41.8-42.0) 0.003 Controlled Motivation (TSRQ) Baseline 16.5 (8.2-23.0) 13.0 (7.2-23.0) 0.444 -3.2 (7.9) -0.8 (6.4) 0.187 Follow-up 12.5 (6.0-22.0) 12.0 (6.8-20.0) 0.912 Amotivation (TSRQ) Baseline 4.0 (3.0-8.0) 4.5 (3.0-9.0) 0.988 -0.4 (3.9) -0.1 (4.4) 0.759 Follow-up 5.0 (3.0-8.0) 4.0 (3.0-7.8) 0.628 Quality of Life (CDQoL) Baseline 62.0 (49.0-77.0) 50.0 (37.0-59.5) < 0.001 -1.1 (12.6) -2.5 (12.4) 0.786 Follow-up 50.0 (43.2-63.5) 45.5 (40.0-52.5) 0.252 Data on the right ("Worsened Adherence" & "Improved Adherence") represent change of score means (SD) from baseline to follow-up. CDAT: Celiac Dietary Adherence Test; CSI: Celiac Symptom Index; PROMIS: PRO Measurement Information System; CD-QOL: Celiac Disease Quality of Life; TSRQ: Treatment Self-Regulation Questionnaire; PCS: Perceived Competence Scale; HCCQ: Health Care Climate QuestionnaireData from the left half of the Table (under "Non-Adherence" & "Adherence") represent score medians (Q1-Q3) at baseline and follow-up.

Subjective expectations from radiotherapy and chemotherapy in patients with oncological illnesses

IntroductionExpectations and fears about chemotherapy and radiotherapy in patients with oncological illness may not only affect their subjective well-being (Shaverdian et al., 2018) but also treatment satisfaction and complaints of side effects (Guidolin et al., 2018, Dong et al., 2014, Colagiuri et al., 2013).ObjectivesThe aim was to compare beliefs about treatment in patients referred to radiation therapy and chemotherapy, and to reveal their relationship to health anxiety and subjective well-being.Methods53 patients referred to radiation therapy and 63 patients referred to chemotherapy completed the Treatment Perception in Oncological Illnesses Scale (Kovyazina et al., 2021), Illness and Treatment Self-Regulation Questionnaire (Kovyazina et al., 2019), Satisfaction with Life Scale (Diener et al., 1985) and Scale of Positive and Negative Experiences (Diener et al., 2009).ResultsCompared to radiation therapy, with chemotherapy, patients tend to be more doubtful about the effectiveness of treatment and more anxious about the need for it (p&lt;.05). Moderated mediation analysis demonstrated that lack of understanding, doubts about the effectiveness and anxiety about radiation and chemotherapy are associated with subjective ill-being indirectly - through a higher level of health anxiety (β=-.79--.35, SE=.17-.26, 95% CI [-1.42 - -.75 – -.37 - -0,08]). Feelings of helplessness regarding treatment mediated the relationship between doubts and confidence about treatment effectiveness and well-being in both groups.ConclusionsResults demonstrated that some fears and expectations about chemo- and radiotherapy could provoke health anxiety and helplessness regarding treatment that is related to poorer well-being.DisclosureNo significant relationships.

Treatment self-regulation questionnaire across three self-care behaviours: An instrument validation study in Iranian patients with type 2 diabetes mellitus.

AimThe study aimed at testing the validity and reliability of the Persian version of the treatment self‐regulation questionnaire (TSRQ‐15) across healthy diet, exercise and medication‐use/glucose‐monitoring among Iranian people with type‐2 diabetes.DesignCross‐sectional design.MethodsContent validity was investigated by 16 experts. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed. Construct validity, convergent/discriminant validity and internal consistency were examined. Concurrent validity was assessed using Spearman's rho correlation across different behaviours.ResultsContent validity was confirmed for Persian TSRQ‐15. A three‐factor structure was revealed, in which external regulation and introjected regulations were validated, while amotivation and autonomous failed to show discriminant validity. Internal consistency was sound, and concurrent validity was approved. The Persian version of TSRQ‐15 was shown to be a valid and reliable tool for assessing motivation behind the practice of healthy diet, exercise and medication‐use/glucose‐monitoring in people with type 2 diabetes.

Examining long-term motivational and behavioral outcomes of two physical activity interventions

Objective To examine possible impacts of two theory-based interventions – “Enhancing quality of life through exercise: A tele-rehabilitation approach (TEQ) and Active Living Lifestyles for individuals with SCI who use Wheelchair (ALLWheel)” – 12–18 months post-intervention on the satisfaction of psychological needs and motivation for leisure-time physical activity (LTPA), LTPA participation, and participation experience. Design A mixed-methods follow-up study. Setting Community. Participants Sixteen TEQ and six ALLWheel participants completed questionnaires and a semi-structured interview, 12–18 months after completing the interventions. Intervention TEQ intervention participants received a weekly LTPA counseling session with a trained kinesiologist through videoconferencing for 8 weeks. ALLWheel participants interacted with a peer mentor who provided LTPA counseling using smartphones for 10 weeks. Outcome Measures The Psychological Need Satisfaction in Exercise, and the Treatment Self-Regulation Questionnaire were used as primary outcome measures. The LTPA barrier self-efficacy scale, the Measure of Experiential Aspects of Participation, and the 7-day LTPA Questionnaire for Adults with SCI were used as secondary outcome measures. A coding framework was created and deductive thematic analyses were used to analyze the qualitative data. Results Medium to large effects were found for autonomous motivation (TEQ), competence (TEQ and ALLWheel), and barrier self-efficacy (TEQ and ALLWheel). LTPA remained higher for the TEQ intervention group compared to the control group at follow-up, while an increase in moderate-to-vigorous LTPA was found in ALLWheel participants. Conclusion Community-based tele-rehabilitation and virtual rehabilitation approaches, informed by theory, may assist adults with SCI in implementing LTPA over the long term.

Clustering of motivational constructs based on self-determination theory for diet and physical activity and their associations with behaviour: a cross-sectional study.

The present study explored whether motivational constructs for diet and physical activity (PA) cluster and how these motivational constructs relate to dietary and PA behaviour. Data of 1142 participants were used from a randomised controlled trial examining the effects of a web-based diet and PA promotion intervention based on self-determination theory and motivational interviewing. Motivation was assessed using the Treatment Self-Regulation Questionnaire and Behavioural Regulation in Exercise Questionnaire. The dietary outcomes were measured using an adapted Food Frequency Questionnaire. PA was assessed using the Short QUestionnaire to ASsess Health. Spearman rank-order correlations showed large correlation coefficients (rs ≥ 0⋅63) between similar motivational constructs between the two lifestyle domains, except for intrinsic motivation where a medium correlation coefficient was found (rs = 0⋅41). Furthermore, the exploratory factor analysis illustrated that more self-determined forms of motivation seem to be more domain-specific. In contrast, non-self-determined forms of motivation seem to be domain-independent. Last, regression analyses demonstrated that intrinsic motivation towards PA was the only motivational construct significantly positively associated with all PA sub-behaviours (standardised regression coefficients ranging from 0⋅17 to 0⋅28, all P < 0⋅0125). Intrinsic motivation to eat healthily was significantly positively associated with fruits, vegetables and fish intake (standardised regression coefficients ranging from 0⋅11 to 0⋅16, all P < 0⋅0125), but not with unhealthy snacks. Insight of this exploratory study is useful for understanding the interrelationships of motivational induced behaviours, the development of interventions targeting multiple behaviours, and the construction of questionnaires.