Can Self-Determination Theory be used to understand patients' experience and perceived effectiveness of the Glasgow 'Deep End' Links Worker Programme?

Problem

Multimorbidity (both physical and mental) is a major clinical and public health challenge, and is associated with socioeconomic deprivation. Social prescribing interventions are one potential approach to supporting patients with complex multimorbidity. Analyses of patient views of interventions, and theoretical frameworks with which to analyse and understand them, are scarce in the current literature. One possible candidate theory for understanding such interventions is Self-Determination Theory (SDT). SDT states that wellbeing and behaviour change requires satisfaction of three phsychological needs: autonomy, relatedness and competence. This study aimed to assess the perceived impact of the Glasgow ‘Deep-End’ Community Links Worker (CLW) programme; to explore the role of the Community Links Practitioner (CLP); and to assess if Self-Determination Theory may be used to understand the presence or lack of improvement in wellbeing described by participants.

Approach

Semi-structured interviews were conducted for a purposive sample of 12 patients participating in the CLW programme. Participants with physical, mental or social multimorbidity were sampled. The perceived impact of the intervention was assessed using the Outcome Related to Impact on Daily Living (ORIDL) instrument. A broad content analysis was conducted prior to development of a coding frame based on SDT. A thematic analysis was then performed for all interviews.

Findings

Perceived impact of the programme ranged from ‘no change’ (4/12) to ‘moderate-major improvement affecting daily life’ (6/12). Some saw the CLP as a ‘catalyst’ for change leading to behavior change, while others viewed them an a ‘councilor’ or ‘organiser’. Some described reliance on the CLP, while in contrast others described independent activities and behaviours leading to improved wellbeing following initial interaction with the CLW. Empathy was also seen as of central importance, but alone did not appear sufficient for change. Satisfaction of the three psychological needs identified in SDT – relatedness, competence, and autonomy – was linked to greater perceived improvement and evidence of behavior change. Those who described satisfaction of these needs also described more ‘integrated’ motivation developing as a result of their interaction with CLW. Participants with no evidence of change did not describe satisfaction of at least one of the three domains of SDT. However, complex social circumstances were also barriers to change, and did not always fit with explanation by SDT.

Consequences

SDT may be a useful theoretical construct which could be used in the development and evaluation of interventions for complex multimorbidity, including social prescribing. People with positive change resulting from the CLW programme gave narratives that fit with an understanding of behavior change using SDT. SDT may be limited, however, in its utility to understand complex social circumstances that may be barriers to the effectiveness of such interventions.