title: Confidence matters: a Self-Determination Theory study of factors determining engagement in self-management support practices of UK clinicians.
abstract: Within a national quality improvement programme for self-management of long-term conditions, we surveyed clinicians working with patients with diabetes, chronic obstructive pulmonary disease, musculoskeletal pain and depression. We applied the Self-Determination Theory framework to explore what factors can facilitate and impede the clinicians' engagement in clinical self-management support (SMS), patient centredness and organizational support for self-management. We also investigated whether attending professional training for clinicians in the practice of self-management (SM) increases motivation to support SM and reported use of SM practices. The study included 482 clinicians who were surveyed once (cross-sectional design) and 114 clinicians who were surveyed before and after training (longitudinal cohort). We found that the high level of satisfaction of competence need predicts practising SMS in all three areas (clinical SMS: beta coefficient = 0.21; p < 0.0001; patient centredness: beta coefficient = 0.50; p < 0.001; organizational SMS: coefficient = 0.20; p < 0.0001). Internalized regulation to support SMS increases engagement in clinical and organizational SMS. Upon comparing the two samples we explored the possible predictors of clinicians' self-referring to attend the training. Clinicians who volunteer to attend the training spend more time working directly with patients with long-term conditions (chi(2) = 4.8; df = 1; p = 0.02), had less previous relevant training (chi(2) = 4.77; df = 1; p = 0.02), and they have less autonomy to support SM (t = 5.0; df = 476; p < 0.0001). However, they report more engagement in patient-centred practices (t = 1.9; df = 585; p = 0.05). These factors are a good fit with the aims of the programme. We confirmed that attending the training had a significant, positive impact on clinicians' engagement in clinical SMS and patient centredness, as well as their overall confidence to support SM. We conclude that to facilitate clinicians to practice SMS it is very important to provide relevant professional training, professional support and incentives to foster clinicians' perceptions of their competence in relation to these practices. Organizations should develop a culture that values SMS, offer training to clinicians to enhance their sense of competence to effectively deliver SMS and support clinicians in finding their own way of supporting SM; in other words to create an optimal context to internalize regulation to support SM.
authors.affiliation: Applied Research Centre for Health and Lifestyle Interventions, Coventry University, Coventry, UK. j.kosmala-anderson@coventry.ac.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Kosmala-Anderson
authors.forename: L M
authors.initials: LM
authors.lastname: Wallace
authors.forename: A
authors.initials: A
authors.lastname: Turner
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D003430:Cross-Sectional Studies; D004493:Education; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008962:Models, Theoretical; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care; D012648:Self Care / Q000523:psychology*; D006113:United Kingdom