A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health

Understanding the impact of COPD and self-management interventions: a self-determination theory perspective

People with COPD (pwCOPD) experience a range of daily living limitations caused by breathlessness, which can affect their quality of life and physical and mental health. There are approximately 1.2 million pwCOPD in the UK. Two common behavioural interventions are self-management support and pulmonary rehabilitation, which support pwCOPD to exercise and adopt techniques to decrease their symptoms; however, adherence to these can be poor. This study aimed to understand whether these two different interventions can affect motivational concepts and explore how pwCOPD experience their condition and these interventions. This study used a mixed-method design. Participants were allocated to receive either: pulmonary rehabilitation and PocketMedic (a self-management intervention), only PocketMedic, or only pulmonary rehabilitation. Questionnaires measuring self-determination theory motivational concepts were completed at baseline and seven weeks. Semi-structured interviews were conducted and analysed using Reflexive Thematic Analysis. 53 participants were recruited to the three conditions. An ANOVA found no statistically significant differences between the groups for any of the questionnaires, which may be related to the low sample size. However, when the research condition was held constant, significant improvements were identified for competence satisfaction (p < 0.001) and relatedness satisfaction (p < 0.05) and autonomy frustration (p < 0.001) and competence frustration (p < 0.05). Seven participants from the PocketMedic conditions were interviewed. Overarching themes described the participants' experiences and adaptations to psychological need frustration, and how the interventions facilitated basic psychological need satisfaction. This study suggests that pulmonary rehabilitation and PocketMedic can improve basic psychological need satisfaction and frustration; however, there were no cumulative affects when the interventions were combined. Need frustration is important to consider in research on long-term conditions. The qualitative analysis provides greater knowledge on mechanisms by which healthcare interventions have been shown to be effective. Further research is needed including larger and more diverse samples to enable complete generalisability.

An internet-delivered psychoeducational intervention (Fex-Can 2.0) targeting fertility-related distress and sexual dysfunction in young adults diagnosed with cancer: Study protocol of a randomized controlled trial with an internal pilot phase

BACKGROUND

While previous literature has continuously demonstrated the negative effects of cancer and its treatment on fertility and sexuality, evidence-based interventions to alleviate fertility-related distress and sexual dysfunction are lacking. This study protocol describes the internal pilot study and randomized controlled trial of an internet-delivered psychoeducational intervention: Fex-Can 2.0. The primary objective is to determine efficacy of Fex-Can 2.0 in terms of reduction of fertility-related distress and sexual dysfunction at end of the 12-week intervention. The internal pilot study will assess feasibility of the study, determined according to pre-specified progression criteria and individual interviews.

METHODS

The study has a randomized controlled design, with an internal pilot phase. The intervention group will receive Fex-Can 2.0, consisting of psychoeducational- and behavior change content. The control group will be allocated to standard care. Primary outcomes are fertility-related distress (RCAC) and sexual function and satisfaction (PROMIS SexFS Brief Sexual Profile). Secondary outcomes include body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), need satisfaction and frustration scale (NSFS), fertility- and sex-related knowledge, and self-efficacy related to fertility and sex life. Outcomes will be assessed at baseline, directly after the intervention, and 12 weeks later. During the internal pilot, data on trial recruitment, data collection, drop out, and adherence will be collected to assess feasibility. Semi-structured interviews will be conducted to further assess acceptability of Fex-Can 2.0.

CONCLUSIONS

This randomized controlled trial aims to evaluate whether Fex-Can 2.0 is superior to standard care, in terms of reducing fertility-related distress and sexual dysfunction in young adults diagnosed with cancer. If proven efficacious, the Fex-Can 2.0 intervention may be a valuable resource in health care, with the potential to significantly improve the care of young adults experiencing fertility-related distress and/or sexual dysfunction following cancer.

TRIAL REGISTRATION

ClinicalTrials.gov ISRCTN18040643.

A self-determination theory perspective of motivations for cannabis-related harm reduction behaviours: evaluation of an expanded and adapted Treatment Self-Regulation Questionnaire

OBJECTIVE

We sought to evaluate an expanded and adapted version of the Treatment Self-Regulation Questionnaire (TSRQ) to assess the internalization continuum of motivation per self-determination theory (SDT) for responsible cannabis use and cannabis protective behavioural strategies (PBS).

METHODS AND MEASURES

We recruited 1,196 college students (Study 1) and 1,409 adults (Study 2) who reported past-month cannabis to complete online surveys; a random sample of 501 adults in Study 2 completed a follow-up survey one month later.

RESULTS

We found support for a 3-factor exploratory structural equation model of a 26-item TSRQ representing autonomous motivation, controlled motivation, and amotivation. Associations of the TSRQ with cannabis outcomes were consistent with SDT such that greater autonomous motivation was associated with more frequent cannabis PBS use (e.g. 'Limit use to weekends'). In contrast, greater controlled motivation and amotivation were associated with more negative cannabis-related consequences and more severe cannabis use. Differences emerged for instructions referencing responsible cannabis use versus cannabis PBS in Study 1.

CONCLUSIONS

The results support the use of the expanded and adapted TSRQ to assess motivations per SDT for cannabis harm reduction behaviours. These findings warrant replication and suggest that responsible cannabis use is conceptualized to be distinct from cannabis PBS.

The influence of self-determined motivation on patient safety competency among nurses: The chain mediating effect of psychological contract and psychological capital

BACKGROUND

Self-determined motivation and patient safety competency are vital capabilities among registered nurses. Little research has been done on the relationships between nurses' self-determined motivation, psychological contract, psychological capital, and patient safety competency.

AIMS

To examine the relationship among self-determined motivation, psychological capital, psychological contract, and patient safety competency of registered nurses in general hospitals.

DESIGN

A descriptive, cross-sectional study design.

SETTINGS

This study was conducted at three tertiary general hospitals in Lanzhou, northwest China.

PARTICIPANTS

A convenient sample of 589 registered nurses was recruited from November 2023 to February 2024.

METHODS

Physician-tailored Work Extrinsic and Intrinsic Motivation Scale (P-WEIMS), Employee Psychological Contract Scale (E-PCS), Revised Psychological Capital Questionnaire (PCQ-R), and Patient Safety Competency Nurse Evaluation Scale (PSNCES) were used for data collection. Pearson correlation and multiple regression analysis were also employed. Analysis of Moment Structures (AMOS) version 28.0 software was used to construct structural equation models. This report followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

RESULTS

Nurses' self-determined motivation, psychological contract, and psychological capital were positively correlated with patient safety competency. Psychological contract and psychological capital mediated the relationship between self-determined motivation and patient safety competency, accounting for 51 % and 24 % of the total effect. Furthermore, psychological contract and psychological capital played a chain mediation role between self-determined motivation and patient safety competency, accounting for 16 % of the total effect.

CONCLUSION

Self-determined motivation supports and enhances nurses' psychological contract and psychological capital, thereby increasing nurses' patient safety competency. Clinical nursing managers should establish supportive environments and optimize policies to enhance nurses' patient safety competencies, and nurses require education to improve their skills and self-assurance.

Self-determination theory interventions in self-care of cardiovascular disease: A systematic review

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of death and disability worldwide. Effective self-care behaviours are critical for the secondary prevention of CVD, however many individuals fail to engage in these self-care activities in the long-term. Self-determination theory (SDT) offers a robust theoretical framework for understanding motivations for engaging in self-care. SDT-based interventions may improve self-care in people with CVD but has yet to be systematically reviewed.

OBJECTIVES

A systematic review was conducted to determine the effectiveness of SDT-based interventions on global measures of self-care of CVD, as well as specific self-care activities.

METHODS

A literature search was conducted in August 2024 using MEDLINE, CINAHL, Embase, Global Health, APA PsycINFO, and SocINDEX. The inclusion criteria involved randomised controlled trials and cluster randomised trials that tested the effect of SDT-based interventions on self-care activities among adults with CVD.

RESULTS

A total of 251 publications were screened and 7 studies included in the review. Results revealed inconsistent application of SDT principles across the included studies. While some incorporated all psychological needs according to SDT, others focused on only selected needs. Nevertheless, supporting people's autonomy emerged as a consistent core component across all interventions. Three studies reported improvements in global self-care, two found improvements in physical activity, while one found no significant effect on physical activity, and another found no significant effect on dietary habits and smoking behaviours. There was considerable variation in the measurement of self-care with some studies focussed on global measures, while others targeted specific aspects of self-care such as diet or exercise, which prohibited meta-analysis.

CONCLUSIONS

Findings from this systematic review showed that SDT-based intervention demonstrated potential for enhancing self-care in individuals with CVD. However, the limited number of eligible studies and methodological heterogeneity preclude definitive conclusions about their effectiveness for improving self-care.

PRACTICE IMPLICATIONS

Healthcare professionals should foster competence, relatedness, and autonomy support while adopting a holistic approach to self-care. Combining group and one-to-one interventions and integrating health education and goal-setting can promote maintained self-care adherence.

Development and preliminary validation of a Chinese Physical Activity Parenting Practices Scale (3-6 years)

Background

This study aimed to develop a scale to assess the physical activity (PA)-related parenting practices of Chinese parents of children aged 3-6 years based on general parenting theory.

Methods

A pool of scale items (123 items) was constructed based on a literature review and in-depth personal interviews. The pretest scale (60 items) was developed using Delphi correspondence and a presurvey. After two rounds of item screening of the pretest scale using exploratory factor analysis (EFA) and analysis of variance, we deleted 30 items. We ultimately developed a formal version of the Chinese Physical Activity Parenting Practices Scale (CPAPPS) using the remaining 30 items. We examined the structure of the scale using factor analysis and evaluated its reliability, validity, and discriminant ability using data from 899 parents of children aged 3-6 years.

Results

The CPAPPS includes 30 items in 6 dimensions scored on a 5-point Likert scale. The 6 dimensions are education, autonomy promotion, modeling, demands, expectations, and rewards. Both exploratory and confirmatory factor analyses confirmed the construct validity of the scale. Furthermore, the scale had adequate internal consistency, split-half reliability, test-retest reliability, and concurrent validity. Parents younger than 30 scored significantly lower on the demand dimension than parents aged 40-50 (p < 0.05). The differences in rewards and expectations between parents of different ethnicities were statistically significant (p < 0.05). Compared with married parents, parents who were currently single had lower scores for education, rewards, modeling, and autonomy promotion (p < 0.05). There was a significant difference in scores across all dimensions between parents with different places of residence (p < 0.05).

Conclusion

The CPAPPS satisfies the conditions for reliability and validity in accordance with psychometric requirements. The scale can be employed to evaluate the characteristics of Chinese parents' physical activity-related parenting practices and to design family-based PA interventions.

Effects of school-based interventions on all 24-hour movement behaviours in young people: a systematic review and meta-analysis of randomised controlled trials

Objective

This systematic review and meta-analysis examined the effects of school-based interventions on all 24-hour movement behaviours.

Design

Systematic review and meta-analysis.

Data sources

Studies published in English, French, and Spanish from four databases from inception to February 2024 were identified.

Eligibility criteria for selecting studies

Eligible articles were randomised controlled trials (RCTs) that targeted and assessed physical activity (PA), sedentary behaviour (SB) and sleep duration among school-aged youth (3-17 years). Risk of bias and quality assessment were assessed using the Risk of Bias Tool 2 and Quality Assessment of Controlled Intervention Studies tool, respectively. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool evaluated the certainty of evidence. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (ID: removed for peer review).

Results

Of the 5141 records initially identified, 41 studies remained for full-text review. After full reading, 7 RCTs, comprising 8234 participants (49% girls), were included. Results indicated no effect in PA-related outcomes (Hedge's g=0.12, -0.05 to 0.28), a small reduction in SB-related outcomes (g=-0.33, -0.51 to -0.16) and a small increase in sleep duration (g=0.30, 0.16 to 0.43) according to Hedges' g (small effects (0≤g ≤0.50)). The GRADE, risk of bias and quality assessment tools indicated that most of the studies have a low risk of bias and are of good quality.

Conclusions

More school-based interventions promoting all movement behaviours are needed to determine if schools are optimal for encouraging 24-hour movement behaviours among young people.

Determinants and barriers to women's participation in breast cancer screening activities in Jordan: an in-depth study

BACKGROUND

Breast cancer is a highly prevalent cancer in women worldwide. Accumulated evidence supports the considerable benefits of screening practices in early cancer detection, which can be associated with improved survival.

PURPOSE

The study aims to identify the factors that determine and hinder women's involvement in screening activities in Jordan.

METHODS

A cross-sectional design was employed to survey 650 women from various settings across multiple cities in Jordan.

RESULTS

Participation in breast cancer screening activities was found to be poor. The study identified that the significant individual determinants influencing breast cancer screening participation were uneasiness with one's own body, barriers related to mammography, and exposure barriers. Health motivation was identified as a determinant with a high level of perception among the participants. The primary non-individual determinants were perceived environmental barriers, the influence of religious beliefs regarding cancer, and perceived social barriers. Logistic regression analysis revealed that being married, being older, having higher confidence in performing breast self-exams, having fewer barriers to exposure to the examination, and having fewer barriers to conducting the self-exam contributed to higher participation in self-exams. On the other hand, a higher likelihood of doing mammography was associated with older age, a higher perception of susceptibility to breast cancer, a higher perception of breast mammography benefits, fewer barriers related to religious beliefs about cancer, and fewer environmental barriers.

CONCLUSION

The study identified individual and non-individual factors influencing women's involvement in breast cancer screening services. The findings underscore the need for targeted interventions to address these barriers and enhance women's participation in screening.

Sports atmosphere and psychological resilience in college students: mediating role of growth mindset

Introduction

The mental health of college students has garnered increasing attention currently, and psychological resilience is recognized as a crucial factor in coping with pressure and challenges. However, the influencing factors of psychological resilience require further exploration. This study aims to investigate the relationship between sports atmosphere and psychological resilience among college students, as well as the mediating role of a growth mindset.

Methods

A questionnaire survey was conducted with 315 college students using the Outdoor Sports Atmosphere Scale, Growth Mindset Scale, and Brief Resilience Scale.

Results

The findings revealed significant positive correlations between sports atmosphere, growth mindset, and psychological resilience. Regression analysis showed that a positive sports atmosphere significantly predicted both psychological resilience (β = 0.371, t = 8.648, p < 0.01) and growth mindset (β = 0.462, t = 10.227, p < 0.01). Structural equation modeling further confirmed that growth mindset played a significant mediating role in the relationship between sports atmosphere and psychological resilience [β = 0.182, 95% CI (0.036, 0.189), p < 0.05].

Discussion

These results highlight the importance of a supportive sports atmosphere in fostering psychological resilience among college students, with growth mindset acting as a key intermediary factor. By cultivating a growth mindset, students may better translate the benefits of an encouraging sports atmosphere into improved psychological resilience and adaptability. These insights provide actionable strategies for educators and policymakers to design interventions that promote psychological wellbeing.

Clinical, Psychological, Physiological, and Technical Parameters and Their Relationship With Digital Tool Use During Cardiac Rehabilitation: Comparison and Correlation Study

Background

Home and telehealth-based interventions are increasingly used in cardiac rehabilitation, a multidisciplinary model of health care. Digital tools such as wearables or digital training diaries are expected to support patients to adhere to recommended lifestyle changes, including physical exercise programs. As previously published, the EPICURE study (effect of digital tools in outpatient cardiac rehabilitation including home training) analyzed the effects of digital tools, that is, a digital training diary, adherence monitoring, and wearables, on exercise capacity during outpatient cardiac rehabilitation phase III (OUT-III) which includes an approximately 12-week home-training phase. The study encompassed 149 Austrian patients, of which 50 used digital tools.

Objective

The present paper takes a deeper look into the EPICURE data to better understand the relation between the use of digital tools and various psychological, clinical, and physiological parameters, and the relation between these parameters and the improvement of exercise capacity during cardiac rehabilitation.

Methods

For this work, we analyzed questionnaires concerning the patients' cardiac rehabilitation. On all these parameters we performed 2 analyzes: (1) Comparison of the 2 groups with and without digital tools and (2) correlation with the change in the maximum workload as achieved during the exercise stress test. If data pre- and post OUT-III were available, the change in the respective parameter during OUT-III was determined and group analysis and correlation were applied on data pre OUT-III, data post OUT-III, and the change during OUT-III.

Results

We found significant improvements in quality of life in both groups, with no discernible differences between patients with or without digital tools (P=.53). Patients with digital tools perceived significantly higher competence during cardiac rehabilitation (P=.05), and they anticipated higher cardiac risks if nonadherent to physical activity (P=.03). Although, the overall subjectively reported adherence was not significantly different in the 2 groups (P=.50), specific items differed. Patients with digital tools were significantly more likely to do their exercises even when they were tired (P=.01) and less likely to forget their exercises (P=.01). Concerning reasons for (non-) adherence, patients with digital tools reported significantly more often to do their exercises because they enjoyed them (P=.01), whereas they were significantly less likely to stop exercising when muscular pain was worse (P=.01) and to continue doing their exercises when muscular pain improved (P=.02). Finally, patients who reported a high level of concrete planning achieved significantly higher improvements in exercise capacity (r=0.14, P=.04).

Conclusions

This comprehensive analysis provides valuable insights into the multifaceted impact of digital tools on outpatient cardiac rehabilitation including home training, shedding light on the importance of digital tools for increased competence and a higher risk perception during cardiac rehabilitation. In addition, the impact of digital tools on adherence and their influence on patient outcomes were assessed in the evolving landscape of digital health interventions.

Defending Behavior in Bullying and Defenders' Psychosocial Outcomes among Children and Adolescents: A Series of Three-Level Meta-Analyses

Defending behavior in bullying plays a vital role in mitigating bullying. However, previous research has reported inconsistent findings regarding the potential psychosocial risks faced by defenders. The current study aimed to systematically examine and quantify the associations between defending behavior in bullying and defenders' psychosocial outcomes through a series of three-level meta-analyses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive systematic search, manual search, and citation tracking were conducted across several databases. The search yielded 290 effect sizes from 62 studies, encompassing data from 102,574 children and adolescents. The analyses revealed that defending behavior in bullying was weakly, but significantly positively correlated with concurrent internalizing problems and victimization. The analyses also showed a small, but reliable positive correlation between defending behavior in bullying and concurrent social relationships, as well as associations with both concurrent and longitudinal social status. These associations were moderated by culture, types of defending, the reporter of defending, and social status types. Positive association between defending behavior and internalizing problems increased with individualism scores. Aggressive defending showed a stronger positive association with internalizing problems than other defending behavior. Both direct defending (particularly aggressive defending) and self-reported defending demonstrated stronger positive correlations with victimization. Defending behavior was more positively linked to likability than popularity. Peer-reported defending was more strongly associated with social status than self-reported defending. However, significant correlations were not observed between defending behavior and externalizing problems or academic achievement. Given the dual nature of defending behavior in bullying, implications for future research directions and bystander intervention programs are discussed.

Identifying moderators of physical literacy interventions using meta-regression

Physical literacy is a unifying concept that encompasses the physical competence, knowledge and understanding, motivation and confidence for engagement in life-long physical activity. In this study, we conducted a random-effects meta-analysis with meta-regression to examine (a) whether existing interventions were effective in enhancing individual's physical literacy and physical activity engagement, and (b) which factors moderated effectiveness of the interventions. The protocol of the meta-analysis was pre-registered in PROSPERO (Ref: CRD42020213898) on November 22, 2020. Specifically, a comprehensive literature search was conducted, and studies that evaluated any controlled intervention aimed to enhance physical literacy were included. Studies using either randomized or non-randomized designs were included. Intervention effects pertaining to each physical literacy component and activity engagement were pooled using a meta-analytical approach. Using meta-regressions, we investigated if study effects were moderated by characteristics of the interventions. Of the 29 studies included in the analyses, interventions successfully increased: physical competence (k = 18, g = 0.57), knowledge and understanding (k = 13, g = 0.55), motivation and confidence (k = 12, g = 0.44), global physical literacy (k = 27, g = 0.52), and engagement in physical activity (k = 13, g = 0.14). Intervention effects were weaker in school or university settings compared to non-educational settings and a positive bias for studies with smaller samples was found. While these findings were robust, long-term effectiveness of interventions should be further examined, as most included studies only evaluated short-term effects. Systematic approaches for the design and reporting of intervention components are also needed to help researchers design effective and scalable interventions in the future.

Emerging Adults Report Internal, External, and Social/Environmental Motivations for Weight-Related Self-Monitoring Application Use

OBJECTIVE

To describe the factors that motivate emerging adults to engage in weight-related self-monitoring (WRSM) and to determine the age of initiating WRSM.

DESIGN

Mixed-methods cross-sectional study, including quantitative survey and semi-structured interviews.

PARTICIPANTS

Tracking-EAT participants came from the population-based sample of Project EAT (Eating and Activity over Time); 138 participants (mean age=26.5 years; range 22-29) completed a survey, 25 of which also completed a semi-structured interview.

MAIN OUTCOME MEASURE

Internal and external motivations for WRSM and the age when participants began WRSM were assessed quantitatively. Semi-structured interviews assessed how participants were introduced to and why they used WRSM.

ANALYSIS

Descriptive statistics for quantitative measures. Inductive thematic analysis for qualitative analyses.

RESULTS

Participants reported internal (e.g., trying to lose weight, change body shape), external (e.g., advice from health professionals, friends/or family), and social/environmental motivations (e.g., WRSM being ubiquitous in our culture). A sense of moral obligation to strive for health contributed to participants' motivation to engage in WRSM. Participants reported self-monitoring dietary intake and weight as young as 8 years old and exercise as young as 9 years old.

CONCLUSIONS AND IMPLICATIONS

Numerous factors converge to normalize and encourage WRSM, including internal, external, and social/environmental motivations. Future research could explore how the age of introduction and motivation for use affect the health impacts of WRSM.

The role of family health climate in physical activity and sedentary behaviour in primary care patients with diabetes - a cross-sectional study

BACKGROUND

The shared perceptions and cognitions of a family toward health such as exercise are termed the family health climate (FHC), and they may influence individual physical activity levels. This study aimed to examine the associations between the FHC and physical activity and sedentary behaviour in adult patients with diabetes while accounting for sociodemographic factors and self-determined motivation.

METHODS

This cross-sectional study was conducted at a polyclinic in Singapore. The participants completed anonymized, self-administered questionnaires that collected data on sociodemographic variables, family health climate for physical activity (FHC-PA), self-reported physical activity and sedentary behaviour (Global Physical Activity Questionnaire), and self-determined motivation (Behavioural Regulation in Exercise Questionnaire‑2). The data were analysed descriptively, and logistic regression was performed to examine the sociodemographic, FHC and motivational covariates of physical activity and sedentary behaviour.

RESULTS

A total of 345 participants were included in the analysis. The majority were male (60.3%), Chinese (67.5%), and working (72.8%). The mean age was 61.56 (SD 10.71) years. A minority of the participants had sufficient physical activity (41.2%), and most were sedentary (62%). After we adjusted for sociodemographic factors and self-determined motivation, the FHC-PA score and its subdomains were not associated with physical activity levels (p > 0.05) or sedentary behaviour (p > 0.05). Those with higher identified regulation scores had higher odds of being sufficiently active, whereas those with higher external regulation scores, from larger households and who were employed had lower odds of sufficient physical activity. Higher degrees of autonomous motivation were associated with reduced sedentary behaviour, whereas being employed was associated with increased sedentary behaviour.

CONCLUSION

The FHC-PA, in the presence of self-determined motivation and sociodemographic factors, was not associated with the individual physical activity levels of adults with diabetes. Further studies can be conducted to determine whether it plays a mediating role. As identified regulation was associated with both physical activity and sedentary behaviour, interventions can be mapped to target this motivational domain.

Association of Daily Physical Activity With Motivation in Prefrail and Frail Older Adults Living in Retirement Communities

Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time. External motivation was negatively associated with the square root of daily step count (β = -4.57; p < .001) and square root of daily stepping time (β = -0.49; p < .001). Older adults living in retirement communities demonstrated low levels of daily activity, with a negative association between external motivation and daily activity. Strategies are needed to make an active lifestyle supportive and enticing for older adults in these communities.

Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use

BACKGROUND

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic.

METHODS

Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents.

RESULTS

This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05).

CONCLUSION

Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

Applying theories, models, and frameworks to help genetic counselors and students achieve clinical and professional goals

Some genetic counselors (GCs) may find theories, models, and frameworks (TMFs) useful in clinical skills selection and when reflecting on or evaluating genetic counseling practice. This paper aims to demonstrate how TMFs can be used to postulate how different skills may impact patients'/clients' decisions, behaviors, and outcomes and consider how multiple TMFs can inform the use of various skills or strategies to achieve different goals. Additionally, we provide examples of TMFs that may help GCs in nonclinical aspects of their work, such as implementing and evaluating new interventions or service delivery models. To guide the selection of appropriate TMFs, we provide a set of questions to consider and include examples of skills and approaches that align with different TMFs. While TMFs provide a structured approach and valuable guidance that may help advance genetic counseling practice, they have certain limitations. Additional research is necessary to determine the effectiveness of using TMFs to guide clinical practice and improve patient/client outcomes.

What is Home? Creating a Psychological-Based Framework of Home With Basic Psychological Needs Theory

While psychologists regularly study the home environment, they less often study home as a concept, despite the benefits that psychology can both receive from and give to the study of home. The psychological well-being of many peoples cannot be understood without recognizing their integral relation with the concept of home. Likewise, several questions remain in the study of home without unifying answers, including the most essential: What is home? And why is home important to the self? To resolve these tensions, we integrate the qualitative methodologies of metasynthesis and the integrative review to apply basic psychological needs theory and create a psychological-based framework of home. We argue that dwellings satisfy basic physical needs, whereas homes also satisfy basic psychological needs. We use scholarship on home and examples in popular media to argue that prior conceptualizations of home align with the needs for competence, autonomy, and relatedness. At the same time, we incorporate need strength to argue that not all needs are necessary for a dwelling to be a home, but it instead depends on the needs that the inhabitant values at a given time. We lastly suggest that home can be unmade by the frustration of basic psychological needs. By achieving these goals, we provide a unifying framework for the study of home, enabling a multitude of avenues for the study of home in psychology. We also provide considerations for the importance of our integrative qualitative review methodology, which can be adapted to investigate similarly important research questions in psychology.

The Relationship Between Motivation for Physical Activity, Physical Activity Level, and Body Mass Index for University Students

The object of the study was to identify the relationship between the motivation for physical activity, the physical activity index (PAI), and the body mass index (BMI) for a sample of university students, taking into consideration the gender difference. The study subjects were 813 (340 men and 473 women), and the age range of the participants varied between 18 and 25 years. The RM 4-FM (Motivation for Physical Activity and Exercise) and PAI online questionnaires were applied to measure the motivation and the physical activity level. The study's novelty focused on analyzing how intrinsic and extrinsic motivation interact and correlate BMI and physical activity levels (PAI). Regarding gender, we approached the identification of motivational differences and the level of physical activity of students from non-sports faculties to identify relevant aspects for promoting proactive behaviors. Results revealed significant gender differences: men had a higher PAI (53.48 ± 28.11) than women (36.67 ± 23.92, p < 0.01); BMI (23.25 vs. 21.69, p < 0.01). The Cohen's value of RAI of RM 4-FM, BMI, and PAI were > 0.5, indicating a large effect size. The analysis presents a unique perspective of the interactions between psychological factors, motivation, and physical characteristics, providing insight into developing strategies to improve and promote a proactive lifestyle.

Effectiveness and acceptance of virtual reality vs. traditional exercise in obese adults: a pilot randomized trial

Introduction

Obesity is a significant global health concern, increasing the risk of various diseases and health complications. Effective and engaging exercise interventions are urgently needed for obesity management. This pilot study examines the effectiveness of virtual reality (VR)-based exercise compared to traditional exercise, both combined with Self-Determination Theory (SDT)-based counseling, individuals with obesity.

Methods

Forty individuals with overweight/obesity were randomly assigned to either a VR-based exercise group (intervention) or a traditional exercise group (control), with both groups receiving SDT-based counseling over 4 weeks. Assessments were conducted pre- and post-intervention.

Results

Participants in the VR-based exercise group showed significant reductions in BMI (2.6%) and body fat mass (5.3%) and consequently in hips circumference, compared to the control group. They also exhibited greater increases in physical activity levels, and improved psychological outcomes, including basic psychological needs (BPN), self-efficacy, self-esteem, and attitudes toward the program comparing with the control group. Moreover, the intervention group scored higher in interest/enjoyment and attitudes towards exercise compared with the control group and showed great results in perceived enjoyment, intention for future use, usability, and positive perceptions of using the VR system. Based on the participants' interviews, VR-based exercise was found to be more enjoyable and engaging.

Discussion

These findings suggest that VR-based exercise combined with counseling is more effective than traditional exercise in reducing weight, increasing physical activity, and improving psychological outcomes individuals with obesity. The immersive nature of VR may enhance motivation and adherence to exercise programs, offering a promising alternative for obesity management. However, the study's small sample size, short duration, and reliance on self-reported measures may limit its generalizability. Future research should explore long-term adherence, effectiveness in diverse populations, psychological mechanisms behind engagement, and comparisons with emerging fitness technologies like AI-powered platforms.

Identifying Common Patterns in the Time of Day of Mindfulness Meditation Associated with Long-Term Maintenance

Forming a habit of practicing mindfulness meditation around the same time of day is one strategy that may support long-term maintenance and in turn improve physical and mental health. The purpose of this study was to identify common patterns in the time of day of meditation associated with long-term meditation app use to assess the importance of temporal consistency for maintaining meditation over time. App usage data were collected from a random sample of 15,000 users who had paid for an annual membership to a commercial meditation app in 2017. We constructed three measures of temporal consistency in the time of day of meditation sessions in order to categorize users into one of three behavioral phenotypes: Consistent, Inconsistent, or Indeterminate. Panel data models were used to compare temporal consistency across the three phenotypes. Of the 4205 users (28.0%) in the final analytic sample, 1659 (39.5%) users were Consistent, 2326 (55.3%) were Inconsistent, and 220 users (5.23%) were Indeterminate. Panel models confirmed that temporal consistency had contrasting relationships with meditation maintenance among these three phenotypes (p < 0.01). These findings revealed that temporal consistency was associated with meditation maintenance for less than half of app users, which suggests that other behavioral mechanisms in addition to temporally consistent habits can support meditation app use over time. This has important implications for researchers and policymakers trying to promote the maintenance of meditation and other complex health behaviors, such as increased physical activity and healthier diets.

Biopsychosocial and contextual pressures: Contributions to a metatheoretical disorder theory from neuroscience, evolutionary, developmental, and ecological perspectives

Human internal and external pressures that drive cognition, emotion, motivation, and interpersonal behavior are critical aspects of clinical psychology and psychotherapy's perspectives on psychopathology. Different theoretical orientations suggest that difficulties with emotional needs, interpersonal motivations, psychosocial stages, and maturational tasks lie at the core of psychopathology. From an evolutionary and neurobiological perspective, several affective systems were shaped through the interaction between genetic and environmental pressures and can be described as the neural basis for several emotion-based behavioral tendencies. However, efforts to integrate these constructs from basic neural science, evolutionary psychology, and clinical psychology have been sparse. In this sense, the present article aims to briefly review the literature on such clinically relevant constructs and make a proposal in a coherent metatheoretical perspective to integrate and make sense of these phenomena as an unified rationale. From affective neuroscience to evolutionary psychology, developmental psychopathology, and ecological systems perspectives, biopsychosocial and contextual pressures are suggested as a heuristic for a contemporary, coherent, and transtheoretical theory of the disorder.

Efficacy-focused and autonomy-supportive messaging in social media vaccine campaigns: insights from a Facebook split test

BACKGROUND

In the context of social media vaccine campaigns, understanding the impact of message framing on audience engagement is crucial. This study examines the efficacy of messages centered on efficacy versus autonomy, informed by theoretical frameworks: the Extended Parallel Process Model (EPPM) and Self Determination Theory (SDT).

METHODS

Utilizing the Facebook A/B Split Test (FBST) feature, an online experiment was conducted to compare the response to two different messages: one emphasizing vaccine efficacy (EPPM-informed) and the other focusing on individual autonomy in making vaccine decisions (SDT-informed). The primary measure of interest was the number of clicks on a link directing to a pro-vaccine website.

RESULTS

The findings indicated that the autonomy-centered (SDT-informed) message resulted in a significantly higher click-through rate to the pro-vaccine website, particularly among users aged 65 and above. Furthermore, analysis of comments from Facebook users identified factors potentially contributing to vaccine hesitancy, with mistrust being the most dominant.

CONCLUSIONS

The study underscores the importance of tailoring social media vaccine campaigns to address the autonomy needs of the target audience while considering trust-related issues to mitigate vaccine hesitancy. Emphasizing individual autonomy in vaccine decision-making processes can enhance engagement with pro-vaccine content, especially in older demographics.

Linking Cardiac Psychology and Cardiovascular Medicine via Self-Determination Theory and Shared Decision-Making

Despite considerable progress in recent years, research in cardiac psychology is not widely translated into routine practice by clinical cardiologists or clinical health psychologists. Self-determination theory (SDT), which addresses how basic psychological needs of autonomy, competence, and relatedness contribute to the internalization of motivation, may help bridge this research-practice gap through its application to shared decision-making (SDM). This narrative review discusses the following: (a) brief background information on SDT and SDM, (b) the application of SDT to health behavior change and cardiology interventions, and (c) how SDT and SDM may be merged using a dissemination and implementation (D&I) framework. We address barriers to implementing SDM in cardiology, how SDM and SDT address the need for respect of patient autonomy, and how SDT can enhance D&I of SDM interventions through its focus on autonomy, competence, and relatedness and its consideration of other constructs that facilitate the internalization of motivation.

The impact of COVID-19 on physical activity and mental health: A mixed-methods approach

This mixed-methods study investigated how and why physical activity (PA), anxiety, depression and self-perceived loneliness are related, and the feasibility of social prescribing (SP). Whilst SP may involve PA with broader effects on health and wellbeing, there is little research exploring perceptions of this intervention. Data from the UCL-Penn Global COVID Study wave 1 (17 April-17 July 2020, N = 1037) were analysed. Twenty-one UK adults who self-identified as low (n = 15) and high (n = 6) on PA at wave 1 were interviewed at wave 4 (18 March-1 August 2022). At wave 1, depression was associated with higher odds of low-PA (OR = 1.05; 95% CI 1.01-1.10, p = 0.02). Both high/low-PA groups cited the threat of contracting COVID-19, general impacts of COVID-19 policies and heightened awareness of the mind-body connection. Five recommendations are made to address challenges in engaging with SP.

Intervention effects on physical activity identity: a systematic review and meta-analysis

Physical activity (PA) identity (i.e., categorisation of oneself in a particular role) has been linked to PA behaviour in observational research, yet experimental research has seen less attention. The purpose of this meta-analysis was to examine the effectiveness of interventions to change identity and subsequent PA. Eligible studies were published in a peer-reviewed journal in English, included an experimental or quasi-experimental design in the PA domain with a measure of identity as the dependent variable, among an adult (>18 yrs.) sample. A literature search was completed in March 2024 using five common databases. The search yielded 40 independent effect sizes, representing 4939 participants. Random-effects meta-analysis showed positive changes in identity favouring the intervention over the control group g = 0.18 (95% CI = 0.11-0.24) and positive changes in a sub-sample (k = 30) of these studies that also measured PA g = 0.61 (95% CI = 0.41-0.81). Changes in identity did not have significant (Q = 43.08, p = 0.30) heterogeneity, yet changes in PA showed heterogeneity (Q = 204.62, p < .001) and follow-up moderator analyses found potential publication bias, and differences by methods (comparison group, length of intervention) and theoretical approach. Overall, PA identity can change as a result of interventions, but the effect may be smaller than changes in behaviour in these interventions.

Financial incentives for physical activity in adults: Systematic review and meta-analysis update

OBJECTIVE

To update the evidence on the effects of financial incentives (FI) on physical activity (PA) in adults.

METHODS

A systematic search of nine databases (Medline, EMBASE, PsychINFO, Scopus, Web of Science, CINAHL, EconLit, SPORTDiscus, and Cochrane) was conducted to identify randomised controlled trials (RCTs) and pilot RCTs published between June 1, 2018 and March 31, 2024 examining FI-for-PA interventions. 'Vote counting' and random-effects meta-analyses assessed short- (<6 months) and long-term (≥6 months) FI effects, as well as impact during follow-up (incentive withdrawal). Meta-regressions examined moderator effects.

RESULTS

Twenty-nine studies (n = 21 RCT, n = 8 pilot RCTs; median FI size = $1.19 USD/day) involving 9604 participants were included (60.8 % female, mean age = 42.7 years). 17 of 21 studies reported positive short-term effects. 5 of 5 and 3 of 8 studies, respectively, reported positive long-term and follow-up effects. Among the 15 studies included in daily step count meta-analyses (most commonly reported PA outcome), FI had a moderate effect during short-term interventions (standardized mean difference [SMD] [95 % CI] = 0.52 [0.25-0.78], p < 0.001) and a small effect in follow-up (SMD [95 % CI] = 0.20 [0.01-0.40], p = 0.04). Too few long-term studies reported daily step count to conduct pooled analyses (n = 1). Meta-regressions suggest study length, incentive size, wearable device-use, and goal setting moderate FI effects (p < 0.05).

CONCLUSIONS

Twenty-nine studies were identified over a 6-year span. Short-term FI interventions increase PA. The impact on daily step count is clinically significant (≥1000 steps/day). Key contextual factors moderate effects. Evidence is limited regarding long-term and follow-up effects.

Improving follow-up care for people after minor stroke using early personalised care: A protocol for a randomised, mixed-methods, feasibility study

Background

Of the 150 000 people per year in the UK who have strokes, third to half will experience a so-called 'minor stroke'. Although appearing benign these strokes put a person at increased risk of further strokes and survivors are usually considered 'too good' for referral onto community stroke services. When back at home the hidden effects of stroke like fatigue and changes in mood and cognition become apparent and impact return to work, relationships and everyday activities. Alongside this, managing the risk of recurrence, highest early after an initial stroke, is a priority. People with stroke report feeling abandoned after discharge with unmet information and support needs.

Methods

To address this issue, we reviewed the literature, met with people with stroke and other stakeholders to develop an early, personalised follow-up programme of care for those who currently only receive routine medical follow-up appointments. The design of this complex intervention is informed by the NIHR/MRC framework for complex intervention development and the framework of action described by O'Cathain and colleagues. The intervention is underpinned by self-determination theory. We will be conducting a randomised, mixed methods, single-centre feasibility study to explore the acceptability and feasibility of the intervention. Sixty participants will be recruited from a Hyperacute Stroke Unit and Rapid Assessment Clinic and randomised to the intervention or control group. The intervention group will receive personalised follow-up appointments at two- and six-weeks post-discharge. All participants will have outcome measures taken at baseline and twelve-weeks post-stroke. Patient reported outcomes will be reviewed to assess their suitability for a later definitive trial. Qualitative interviews will be conducted to gain a deeper understanding of life after stroke from those who did and did not receive the intervention.

Conclusions

Study findings will be used to further refine the intervention, methods and outcome measurements used. These refinements will inform a future multicentre randomised controlled trial.

Impact of In-Person and Mobile Exercise Coaching on Psychosocial Factors Affecting Exercise Adherence in Inactive Women With Obesity: 20-Week Randomized Controlled Trial

BACKGROUND

Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity.

OBJECTIVE

This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ≥30 kg/m2).

METHODS

Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m2) were allocated into 3 groups of in-person coaching-weekly (n=47), twice weekly (n=47), and once monthly (n=47)-and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]).

RESULTS

A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater "change in health last year" than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P≤.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P≤.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P≤.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30).

CONCLUSIONS

We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657.

Problem Recognition as A Discrete Concept for Change Processes in Problematic Alcohol Use

Purpose of review

Alcohol problem recognition reflects the extent to which a person with any level of problematic alcohol use (PAU), including hazardous alcohol use, acknowledges the associated risks/harms as potentially/actually problematic with a relative degree of objectivity. Notably, alcohol problem recognition is typically low amongst people with PAU not engaged in treatment or support. This review evaluates existing PAU problem recognition measures and related concepts such as ambivalence, readiness to change, motivation, cognitive biases and other self-evaluative appraisal processes.

Recent findings

Alcohol problem recognition has been operationalised via various measures but is often conflated with other related but theoretically distinct concepts. Limited conceptual work examines the nature of problem recognition as a discrete concept and its function in relation to behaviour change outcomes and key variables.

Summary

Problem recognition is proposed as an important theoretically distinct process that warrants further conceptual development and testing for advancing understanding of change processes across the PAU spectrum.

Self-selected vs. prescribed aerobic exercise intensity: impacts on pleasure in women with obesity

Introduction

Self-selection of aerobic training intensity is an approach that allows practitioners to develop autonomy (choice of pace), improve physical fitness, and contribute to better affective responses and training adherence. However, it is still unclear whether self-selection of training intensity in group settings is comparable to individual training conditions. The aim of the present study was to compare the effect of three aerobic training protocols on psychophysiological responses in physically inactive adult obese women.

Methods

The sample consisted of 90 women with a mean age of 48.3 ± 5.5 years and BMI of 31.2 ± 4.8 kg/m2, who participated in three treadmill aerobic training protocols: 1- Control group (IPI) with individually prescribed intensity (64 to 76% of HRmax), 2- Small group (SGS) with self-selected intensity, and 3- Individual with self-selected intensity (ISS). Heart rate (HR), total session volume (VL), affective valence was determined by feeling scale (FS), enjoyment was determined by Physical Activity Enjoyment Scale (PACES), intention to repeat the exercise session (INT), and Basic Psychological Needs Satisfaction Scale (BPNFS) were evaluated. Statistical analyses were conducted using two-way ANOVA for HR and FS, and one-way ANOVA for VL, PACES, INT, and BPNFS with Tukey post hoc test and significance criteria (p < 0.05).

Results

The results showed that HR and VL were similar (p > 0.05) between the protocols IPI, SGS and ISS, while FS, PACES, and INT were significantly higher in SGS and ISS than IPI protocols (p < 0.05). BPNFS also presented better results for the SGS and ISS protocols (p < 0.05).

Discussion

These findings suggest that the intensity and training volume were similar among different protocols. Affective responses were more positive perceived in SGS and ISS protocols.

Conclusion

We conclude that intensity self-selection is a safe, effective, and comparable strategy to prescribed intensity at moderate levels, providing a more enjoyable experience that may contribute to greater adherence to aerobic training.

Applying self-determination theory to internalized weight stigma and mental health correlates among young and middle adult women: A structural equation model

Limited research has explored the relationship between self-determination theory constructs (basic psychological needs, autonomous/controlled regulation) and internalized weight stigma (IWS). This cross-sectional, online study surveyed 480 U.S. women aged 18-40 between 2021 and 2022. We hypothesized that need frustration and controlled weight regulation would relate to higher IWS, which would be associated with dysfunctional eating, distress, and lower life satisfaction. Conversely, we predicted that need satisfaction, autonomous regulation, and body satisfaction would be associated with reduced IWS, dysfunctional eating and distress, and higher life satisfaction. Structural equation modeling demonstrated an acceptable model fit (CMIN/DF = 2.95, CFI = 0.90, RMSEA = 0.06, SRMR = 0.07), accounting for 74% of IWS variance. Findings indicate the relevance of self-determination theory in understanding IWS, supporting a dual-process model whereby adverse and adaptive outcomes follow distinct pathways. Longitudinal studies are warranted to validate psychological needs and regulatory styles as mechanisms for IWS development and to assess generalizability across diverse populations.

A Motivational Technology Perspective on the Use of Smart Wrist-Worn Wearables for Postpartum Exercise and Weight Management

Exercise and weight management is crucial in preventing postpartum depression and long-term obesity that carries the risk of chronic illness among postpartum women. Although communication devices, such as a smart wrist-worn wearable (SWW), can help users be more physically active, the extent to which postpartum women might benefit from this technology is unknown. We examined how SWWs promoted exercise and helped postpartum women return to pre-pregnancy weight. We tested a model based on the premise that a motivational device that prompts users to engage with it can establish healthy daily routines. An online survey of 309 postpartum women who were living in the United States and were current users of SWWs revealed that the device encouraged them to spend time completing workout goals. Technological affordances (i.e. customization, navigability, and interactivity) and subsequent user engagement with the device positively predicted total workout hours among postpartum women. We present practical implications for postpartum care programs and smart wearable developers.

Associations Between Intrinsic Motivation, Exercise Attitudes, Physical Activity, and Mental Health in Young Adolescents: An Integrated Motivational Perspective

Purpose: Physical activity (PA) and mental health (MH) are priorities for health promotion during early adolescence. This study explored associations between intrinsic motivation for PA, exercise attitudes, PA and MH in young adolescents. Methods: Participants were 315 students (Mage = 11.41; SD = 2.09; 45.1% girls) conveniently sampled from two private British schools in Dubai. Data were collected via a survey and analyzed using structural equation modeling. Results: As hypothesized, higher intrinsic motivation was directly associated with more favorable exercise attitudes, and attitudes was directly associated with increased PA. Unexpectedly, however, PA was not associated with better MH outcomes. A better fitting model was specified in which attitudes was directly associated with both PA and MH. Conclusions: Further research examining associations between exercise attitudes, PA, and MH in young adolescents is warranted.

Examining associations between body appreciation and positive well-being among young adults: A cross-sectional analysis

Interest in positive body image stems from its contrast with negative body image. Research shows self-compassion and physical activity enhance body appreciation and positive well-being, yet their interaction in young adults is not well understood. This study examined connections between self-compassion, planned physical activity and intrinsic exercise motivations in 386 adults aged 18-39 (Mage = 27.54; SD = 5.58). Path analysis and serial mediation analysis revealed positive associations between self-compassion, planned physical activity, body appreciation and positive well-being, with notable sex differences. In men, self-compassion was linked to planned physical activity through intrinsic exercise motivations, which improved positive well-being via body appreciation. For women, planned physical activity indirectly influenced positive well-being through body appreciation. These findings underscore the importance of integrating sex-specific factors into health psychology interventions aimed at promoting positive body image. They also suggest avenues for future research to enhance well-being through targeted self-compassion and physical activity strategies.

Proposing and refining a physical activity intervention for individuals living with COPD

Preliminary test a two stage, self-determination theory (SDT) and participation-based physical activity and peer support intervention for individuals with Chronic Obstructive Pulmonary Disease (COPD). In Stage 1, four focus groups were conducted to provide insights about individuals' needs and experiences with physical activity. In Stage 2, four individuals with COPD aged 76-90 years (50% female) participated in an eight-week online physical activity and peer support intervention. Pre-post assessments evaluated acceptability, feasibility, and functioning. Participants (n = 14; 36% female) identified that a physical activity-based program using functional task-based exercises and peer support is acceptable for adults with COPD in Stage 1. Three of the four participants improved their satisfaction with and self-reported participation in physical activity in Stage 2. Participants reported the intervention supported their psychological needs, associated with SDT. The online, peer support, participation-based physical activity intervention is feasible in its virtual delivery for physical activity promotion for individuals with COPD.

Investigating the role of goal motives in predicting bedtime procrastination using a daily diary study design: a registered report

OBJECTIVES

Previous operationalisations of bedtime procrastination were incongruent with its definition. We addressed this gap in knowledge by testing a new operationalisation that incorporates the three necessary and sufficient conditions of bedtime procrastination. We investigate the motivational antecedents of bedtime procrastination in daily life with this new operationalisation.

METHODS AND MEASURES

Participants (n = 336) self-reported goal motives, chronotype, and typical sleep metrics on a Sunday evening. For the following 7-days, participants self-assessed their 24-h sleep metrics, goal-regulatory variables, and psychological needs.

RESULTS

The bedtime discrepancy scores from the new assessment correlate in expected direction with sleep quantity and chronotype. However, our findings pertaining to motivational correlates of bedtime procrastination showed low compatibility with our expectations.

DISCUSSION

We introduced a new operationalisation of bedtime procrastination that aligns with its definition, and which can complement existing approaches that primarily encompass trait-like elements. Incorporating all three necessary and sufficient conditions of bedtime procrastination at the daily level suggests previous prevalence estimates of this sleep-related behaviour obtained with trait-like operationalisations may be overestimated. The low compatibility between our expectations regarding the motivational antecedents of bedtime procrastination suggest a need for congruence between the levels at which antecedents are captured with this sleep-related behaviour.

Exploring motivation, goals, facilitators, and barriers to adopt health behaviors at retirement age: a focus group study

BACKGROUND

This study qualitatively investigates retirement-age adults' perspectives on engaging in health behaviors such as physical activity or a healthy diet, distinguishing facilitators, barriers, goals, and motivations (the two later in line with Self-Determination Theory).

METHODS

Two clinical psychologists conducted four focus groups with Spanish adults around retirement age. We conducted inductive and deductive content analysis.

RESULTS

The main facilitators and barriers identified were the presence and absence of social support/social network, mental health, willpower, time, and motivation. Participants reported different types of motivation (e.g., intrinsic motivation in the enjoyment of the activity of exercise or cooking) and goals (intrinsic and extrinsic); except for the goal of health management, which presented both types of motivation, participants regulated intrinsic goals autonomously, and extrinsic ones with controlled motivation. A process of internalizing the source of motivation was identified inductively by participants.

CONCLUSIONS

Facilitating social networks and addressing mental health issues could aid engagement in health behaviors among this population. Additionally, health management appeared as a significant goal, where autonomous motivation can develop even if the behavior initially arises from controlled motivation or external triggers, such as medical advice.

Adaptation and Psychometric Properties of the Behavioral Regulation in Exercise Questionnaire (BREQ-3) for Motivation Towards Incidental Physical Activity

This study aimed to adapt and analyze the psychometric properties of the Exercise Behavior Regulation Questionnaire (BREQ-3) for assessing motivation towards incidental physical activity. An instrumental study in a sample of 346 university students (21.1 ± 2.6 years, and 61.3% women) from various universities in Chile was undertaken. An adaptation of the BREQ-3 was applied, and a confirmatory factor analysis was performed using a robust weighted least squares estimator to assess the construct validity of the scale. Also, the convergent validity was evaluated using the average variance extracted, the discriminant validity using composite reliability, and the internal consistency using Cronbach's alpha (α) and McDonald's omega (ω) coefficients. The six-factor structure of intrinsic motivation (α = 0.96, ω = 0.96), integrated regulation (α = 0.95, ω = 0.95), identified regulation (α = 0.89, ω = 0.90), introjected regulation (α = 0.75, ω = 0.77), external regulation (α = 0.80, ω = 0.83), and amotivation (α = 0.75, ω = 0.79), with acceptable fit indices after eliminating items 8 and 11, was confirmed-χ2/df: 2.196, CFI: 0.99, TLI: 0.99, RMSEA: 0.059 (90% CI; 0.051-0.067). Adaptation of the BREQ-3 appears to be a reliable measure for assessing motivation in the context of incidental physical activity. Its use will contribute to understanding the explanatory mechanisms underlying this behavior.

Patient empowerment: a critical evaluation and prescription for a foundational definition

Introduction

The evolution of healthcare continues to display an incongruence between delivery and outcomes. Current healthcare paradigms for patient empowerment warrants analysis. A lacking operational application for and agree upon assessment of patient empowerment contributes to healthcare's incongruence. Interchangeable psychosocial concepts and specific patient contextual factors associated with health-related behavioral change have escaped an applicable definition of empowerment. The aim of this theoretical perspective review is to support a comprehensive and contextual understanding of patient empowerment that frames a definition for future consensus research.

Methods and mechanisms

A theoretical perspective review of patient empowerment including interchangeable concepts and patient contextual factors such as personal suffering and resilience; self-determined meaning and purpose; and autonomy, competence, and self-efficacy are critically analyzed. This analysis builds on adjacent concepts including therapeutic alliance, communication, motivation, and trust. The inclusion of specific patient contextual factors that relate to behavioral change elevate the need to reinforce coping and self-management skills as mechanism for patient empowerment. Practice gaps for those experiencing chronic disease, pain, and mental health disorders in rehabilitation setting are specific populations who benefit from healthcare providers unifying the variables associated with patient empowerment.

Results and discussion

The review of associated concepts synthesized an actionable definition of patient empowerment that serves as a foundation for future research. Behavior related changes occur through the evolution in one's identity, perceptions, and abilities. Interventions that inspire autonomy, competence, and relatedness with a renewed sense of purpose establish resilience and self-efficacy. The totality of this inspired self-determined plan of care establishes the mechanisms required for behavioral change and sustainable transformation. The cumulative experience becomes patient empowerment.

Autonomy support in prenatal consultation: A quantitative observation study in maternity care

INTRODUCTION

Maternity care professionals need to guide women through an increasing number of decision-making processes during pregnancy. Professionals tend to focus more on providing information than on decision support. According to the self-determination theory (SDT), professionals could help women make their own choices by fulfilling their three basic psychological needs: autonomy, competence, and relatedness through autonomy-supportive interactions. This study aimed to quantify autonomy-supportive and autonomy-thwarting interactions that professionals use during prenatal consultations and their association with women's perceptions of the healthcare climate during consultations.

METHODS

A quantitative observation study with a cross-sectional design was conducted in the Netherlands from March to October 2020. Twenty-three maternity care professionals in 2 hospitals and 16 midwifery practices were purposefully sampled. During 104 prenatal consultations, professional interactions were audiotaped and coded using the Coding and Observing Need-Supportive Consultation in Maternity Care Consultations. The woman's perceived healthcare climate was assessed using the Healthcare Climate Questionnaire.

RESULTS

We observed that professionals derive their autonomy-supportive interactions from a small repertoire. They tend to use more autonomy-supportive interactions (mean=2.31, SD=0.58) that give room to the woman than interactions that stimulate active engagement (mean=1.41, SD=0.80). During structuring interactions, they tend to use more informative (mean=1.81, SD=0.59) than supportive interactions (mean=0.94, SD=0.55). Women generally perceived the healthcare climate as positive.

CONCLUSIONS

Women were rarely stimulated to be actively engaged in the consultations, while active woman engagement is vital in offering women-centered decision-making support. Professionals could improve their autonomy-supportive consultation climate by paying explicit attention to interactions involving women and offering structure.

Developing and testing the feasibility of a theory-based brief counseling intervention to promote physical activity in breast cancer survivors enrolled in the PAC-WOMAN trial

BACKGROUND

Despite the benefits of physical activity (PA), cancer survivors report engagement barriers, and existing interventions often lack comprehensive solutions. Theory-based interventions using evidence-based behavior change techniques (BCTs) have been shown to be effective in promoting PA for breast cancer survivors, although their feasibility and acceptability lack evidence. The PAC-WOMAN trial is a three-arm randomized controlled trial aimed at promoting short- and long-term PA and improving the quality of life of breast cancer survivors. This study describes the development of a brief counseling theory-based motivational intervention from the PAC-WOMAN trial, assessing its feasibility and acceptability.

METHODS

A broad search of theory-based interventions for people with chronic diseases was conducted. Key strategies from each intervention helped shape the main components and BCTs used in the eight bimonthly sessions of the PAC-WOMAN brief counseling intervention, which was based on self-determination theory principles and aimed at empowering participants to develop self-regulation resources for PA through basic psychological needs satisfaction. A toolkit and manuals for intervention facilitators and participants were developed. A feasibility study was conducted to monitor implementation fidelity, acceptability, adherence, and participants' experiences (via a focus group).

RESULTS

Twelve women (mean age 55.9 ± 6.7 years) participated. Implementation monitoring indicated that the intervention was feasible. The attrition rate was 25%. Focus-group discussion suggested that weekly sessions would increase attendance, highlighted the helpfulness of self-monitoring and the importance of role models for PA, and identified the session on safely exercising at home as key in improving PA levels.

CONCLUSIONS

This research aims to enhance systematic reporting in intervention development by detailing the specific BCTs used, translating them into implementation strategies, providing comprehensive resources for facilitators/participants, and supporting the implementation, dissemination, and adoption of a theory-based intervention informed by previous research. Feasibility testing suggests that the intervention was well accepted by participants and feasible, although it could benefit from adjustments in format to increase compliance.

TRIAL REGISTRATION

NCT05860621, registered 20 April 2023 - retrospectively registered, https://clinicaltrials.gov/study/NCT05860621 . Registered 21 April 2023 - retrospectively registered, https://doi.org/10.17605/OSF.IO/ZAQ9N . UMIN000050945, registered 27 April 2023 - retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058070 .

Assessing self-determined motivation for drinking alcohol via the Comprehensive Relative Autonomy Index for Drinking

Introduction

Self-Determination Theory (SDT) examines human motivation in multiple domains; however, the only existing measure assessing SDT-informed behavioral regulations for drinking focuses on responsible drinker behaviors, rather than drinking per se, which is important given the alignment between SDT and harm reduction approaches to alcohol use. The aim of this study was to test the structural validity of the SDT-informed Comprehensive Relative Autonomy Index for Drinking (CRAI-Drinking) among college students.

Methods

Participants included two convenience samples with a total of 630 adult drinkers (Mage = 21.5, 55% female, 88% undergraduates). Participants rated drinking behavioral regulations on the 24 original CRAI-Drinking items on a 5-point Likert Scale. Multi-dimensional scaling analyses and factor analyses were used to investigate the underlying autonomy continuum and factor structure of the CRAI-Drinking.

Results

In Sample 1 (n = 274), multi-dimensional scaling analyses confirmed that CRAI-Drinking item and subscale order aligned with SDT's autonomy continuum. Confirmatory factor analyses supported a five factor, 19-item model of the CRAI-Drinking with factors for intrinsic, identified, positive introjected, external, and amotivation regulations (Cronbach's α: 0.68-0.85). In Sample 2 (n = 356), a confirmatory factor analysis confirmed that the 19-item model fit was comparable to Sample 1.

Discussion

This study provides evidence for the structural validity of CRAI-Drinking scores for assessing SDT-based behavioral regulations for drinking in adults.

Developing an Evidence- and Theory-Informed Mother-Daughter mHealth Intervention Prototype Targeting Physical Activity in Preteen Girls of Low Socioeconomic Position: Multiphase Co-Design Study

BACKGROUND

Preteen girls of lower socioeconomic position are at increased risk of physical inactivity. Parental support, particularly from mothers, is positively correlated with girls' physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people's physical activity. However, the effects of these interventions on girls' physical activity are often inconsistent, with calls for more rigorous, theory-informed, and co-designed family-based interventions to promote physical activity in this cohort.

OBJECTIVE

This study aimed to use co-design methods to develop an evidence- and theory-informed mother-daughter mobile health intervention prototype targeting physical activity in preteen girls.

METHODS

The intervention prototype was developed in accordance with the United Kingdom Medical Research Council framework, the Behaviour Change Wheel, the Theoretical Domains Framework, and the Behaviour Change Techniques Ontology. The Behaviour Change Intervention Ontology was also used to annotate the intervention characteristics. The co-design process incorporated three phases: (1) behavioral analysis, (2) the selection of intervention components, and (3) refinement of the intervention prototype. Throughout these phases, workshops were conducted with preteen girls (n=10), mothers of preteen girls (n=9), and primary school teachers (n=6), with additional input from an academic advisory panel.

RESULTS

This 3-phase co-design process resulted in the development of a theory-informed intervention that targeted two behaviors: (1) mothers' engagement in a range of supportive behaviors for their daughters' physical activity and (2) daughters' physical activity behavior. Formative research identified 11 theoretical domains to be targeted as part of the intervention (eg, knowledge, skills, and beliefs about capabilities). These were to be targeted by 6 intervention functions (eg, education, persuasion, and modeling) and 27 behavior change techniques (eg, goal setting and self-monitoring). The co-design process resulted in a mobile app being chosen as the mode of delivery for the intervention.

CONCLUSIONS

This paper offers a comprehensive description and analysis of using co-design methods to develop a mother-daughter mobile health intervention prototype that is ready for feasibility and acceptability testing. The Behaviour Change Wheel, Theoretical Domains Framework, and Behaviour Change Techniques Ontology provided a systematic and transparent theoretical foundation for developing the prototype by enabling the identification of potential pathways for behavior change. Annotating the Behaviour Change Intervention Ontology entities represents the intervention characteristics in a detailed and structured way that supports improved communication, replication, and implementation of interventions.

Development of the ARENA training programme for resilient performance in defense and security settings

Defense and Security Personnel (DSP) often have to operate in the presence of stressful demands. Prior research has identified factors and processes associated with DSP being able to perform resiliently in demanding situations and settings. The aim of the present study was to develop a resilient performance training programme for UK defense and security operators. An intervention mapping (IM) method was used to guide the development of the programme. Typically, IM follows six sequential phases. In the present work, these phases were shaped by insights from prior research (e.g. systematic review and end user interviews), the input of a dedicated working group (N = 13) and from practitioner focus groups. During the IM process, the importance of programme flexibility was emphasized by practitioners. As such, the enAbling REsilieNt performAnce (ARENA) training programme was designed to be agile and include both face-to-face training and online learning modules. Theoretical behavior change principles, closely aligned to findings of earlier work on resilient defense and security performance, were used to underpin programme content and delivery. Future research should seek to gather data on the impact of the ARENA programme, in the targeted biological, psychological and social factors that previously been associated with resilient performances.

Fostering health behaviour change in overweight male football fans through the European Fans in Training (EuroFIT) program: A Self-Determination Theory perspective

The European Fans in Training (EuroFIT) program integrated need-supportive motivational strategies from Self-Determination Theory (SDT) in the design of a healthy lifestyle program delivered to overweight or obese male football fans (n = 1113; mean age of 45.9 [SD = 9.0] years old and BMI of 33.2 kg/m2 [SD = 4.6]) in professional football club settings in the UK, Portugal, Norway and the Netherlands. With a critical realist approach, we developed a structured thematic framework analysis based on Self-Determination Theory (SDT) to investigate the process of change in men who participated in the EuroFIT randomized controlled trial (RCT). We examined whether men's experiences of the social context of EuroFIT, and whether their engagement with the program's motivational strategies supported or frustrated their basic psychological needs while attempting to change their lifestyle behaviours. We found that men in all countries perceived the social contexts of the EuroFIT program as mostly needs-supportive, and that they found engagement with most of the program components helpful in supporting their psychological needs when initiating health behaviour changes. However, some of the program elements in the EuroFIT program were perceived as needs-frustrating by some participants and need-supportive by others. Implications for the use of need-supportive motivational strategies in designing future lifestyle interventions in sport settings to promote health behaviour change among male football fans are discussed.

Effect of a Male-Targeted Digital Decision Support Application Aimed at Increasing Linkage to HIV Care Among Men: Findings from the HITS Cluster Randomized Clinical Trial in Rural South Africa

Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial conducted among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-computer interaction design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after a positive HIV diagnosis if not linked to care. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after > 3 months of care interruption) at local clinics within 1 year of a home visit, ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. A total of 13,894 men were eligible (i.e., aged ≥ 15 years and resident in the 45 communities). The mean age was 34.6 (±16.8) years, and 65% were married or in an informal union. Overall, 20.7% received HBHCT, resulting in 122 HIV-positive and 6 discordant tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ between the arms randomized to EPIC-HIV and those without EPIC-HIV (adjusted risk ratio = 1.05; 95% CI:0.86-1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. The reach was low, although the acceptability and usability of the app were very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment among men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.

Impact of fitness coach behavior on exercise motivation, commitment, and enjoyment: A longitudinal study

Fitness coaches seem to play an essential role in the field of exercise as they help prevent sedentary lifestyles and promote overall health, quality of life, and well-being. This study aimed to explore the effects of fitness coaches' behavior perceptions, intrinsic motivation, and enjoyment of exercisers on their long-term fitness and health, as well as their commitment to exercise. A total of 202 individuals participated in the study that was developed over three data gathering occasions (baseline, three months and six months). To this end, three psychometric scales were used as part of a multi-section survey: FCBS-Fit (perception of the fitness coach's behavior), IMIp (intrinsic motivation of exercisers), and PACES (enjoyment in exercise), along with the assessment of four health/fitness variables: anthropometry (i.e., waist-hip ratio), strength (i.e., handgrip strength), flexibility (i.e., sit-and-reach), and cardiorespiratory fitness (i.e., VO2máx.). Overall, the results suggested that the perception of the fitness coach's behavior, the exerciser's intrinsic motivation, and enjoyment were predictors of the health/fitness outcomes, and seemed to be related to the exercise commitment at the end of three and six months. The novelty of this study is the examination of psychological and physiological factors in an integrated and longitudinal manner within the scope of exercise in fitness and health clubs. Therefore, these findings shed light on fitness coaches as an important element in the propagation and maintenance of exercise habits, accomplishment of tangible outcomes by exercisers, health promotion and the fitness sector's growth.

Validity and Reliability of the Basic Psychological Need Satisfaction and Frustration Scale Among Cancer Survivors in Korean Healthcare Contexts

BACKGROUND/OBJECTIVES

Basic psychological needs are essential for fostering motivation, self-regulated behaviors, and overall well-being. For cancer survivors, fulfilling these needs is crucial for coping with the various challenges of survivorship and for enhancing psychosocial health. This study aimed to assess the validity and reliability of the Korean version of the Basic Psychological Needs Satisfaction and Frustration Scale (K-BPNSFS) in a cancer survivor population.

METHODS

A cross-sectional design was employed, involving 367 community-dwelling cancer survivors. Construct validity was assessed using confirmatory factor analysis with multiple fit indices, while convergent validity was examined through Pearson's correlation coefficients. Reliability was evaluated using internal consistency, inter-item correlations, and item-total correlations.

RESULTS

The findings confirmed a robust six-factor structure of the K-BPNSFS, which includes satisfaction and frustration dimensions corresponding to autonomy, relatedness, and competence needs. Convergent validity was supported by significant correlations with relevant constructs, aligning with the scale's theoretical underpinnings. Reliability analysis demonstrated high internal consistency across all dimensions, with strong Cronbach's alpha values and substantial item-total and inter-item correlations.

CONCLUSIONS

This study establishes the K-BPNSFS as a valid, reliable, and culturally relevant instrument for assessing the basic psychological needs of Korean cancer survivors. Application of this scale provides critical insights into the unique psychological needs of this population, supporting the development of targeted healthcare strategies to enhance intrinsic motivation, self-care, and overall quality of life.

Self-Determined Motivation for Alcohol Use and Drinking Frequency, Intensity, and Consequences

Objective: Drinking motives predict drinking behaviors and outcomes among adults. Drinking motives are rarely studied using self-determination theory (SDT), which aligns with harm-reduction approaches to alcohol use, but SDT can offer a complementary theoretical framework to existing drinking motives frameworks that may help explain the observed heterogeneity in drinking motives and account for more variance in drinking outcomes. This study examined the associations between five SDT-based drinking motives with drinking frequency, intensity, and consequences. Method: A total number of 630 adults (Mage = 21.5, 55% female, 88% undergraduates) rated drinking motives using the Comprehensive Relative Autonomy Index for Drinking (CRAI-Drinking) and the Drinking Motives Questionnaire (DMQ), typical alcohol consumption, and negative and positive drinking consequences. Results: Poisson regressions indicated that intrinsic (IRR = 1.13) and identified (IRR = 1.11) regulations were significantly associated with drinking frequency, identified (IRR = 0.94) and positive introjected (IRR = 1.07) regulations were significantly associated with drinking intensity, and amotivation (IRR = 1.16) and intrinsic regulation (IRR = 1.09) were associated with negative and positive consequences, respectively, after controlling for other CRAI-Drinking and DMQ scores, sex, and drinking intensity. After accounting for DMQ scores and sex, CRAI-Drinking scores accounted for 1.7%-9.9% additional deviance in drinking behaviors and consequences. Conclusions: Adults high in autonomous reasons for drinking reported low-risk, high-enjoyment drinking experiences. In contrast, adults with higher scores for amotivation for drinking reported more negative consequences, even after accounting for drinking intensity, suggesting that high amotivation for drinking may be a novel signal for future alcohol-related risks. These findings support the idea that SDT provides a useful framework for understanding drinking motives, behaviors, and consequences.