The Impact of Resilience and Perceived Autonomy Support on Medication Adherence Among Rural Older Adults With Hypertension.

BACKGROUND: Adherence to antihypertension medications has been explored in previous studies; however, these studies generally focus on individuals who reside in urban areas. Improved understanding is needed regarding rural older adults who are self-managing medications for hypertension and the motivational factors that may influence adherence. OBJECTIVES: The purpose of this study was to examine medication adherence among rural older adults with hypertension and the association with motivational factors as defined in self-determination theory, including quality of motivation (autonomous vs controlled), perceived competence, perceived autonomy support, and basic psychological needs satisfaction. Rural nursing theory was also used to explore the concept of resilience. METHODS: This cross-sectional study involved 80 older adults (≥65 years old) self-managing at least 1 prescribed medication for managing their hypertension. Participants ranged in age from 65 to 89 (mean [SD], 74.04 [6.18]) years from rural areas in the northwest. Participants completed a demographic questionnaire, a measure of medication adherence, and questionnaires to assess perceived autonomy support, basic needs satisfaction, autonomous and controlled motivation, perceived competence, and resilience. RESULTS: Correlational analysis and multiple regression were used to examine associations and predict adherence. Perceived autonomy support, resilience, cost of medication, and medication regimen complexity were the only variables significantly associated with medication adherence and predicted adherence. Resilience mediated the relationship between perceived autonomy support and medication adherence. CONCLUSIONS: Overall, findings indicate high levels of adherence. Interventions that enhance perceptions of autonomy support and resilience may be useful in managing hypertension.

Evaluation of a technology-enhanced intervention for older women with HIV infection: a proof of concept study.

The syndemic effects of HIV infection, side effects of highly active antiretroviral medications, and age-related changes lead to increased risk for comorbidities and functional decline for older people with HIV. This proof of concept (PoC) study evaluated perceived usefulness, satisfaction, acceptability, intervention processes, resource management, and outcome effect variances of ThE CARE Intervention guided by the Self-Determination Theory. To test the utility of ThE CARE, we conducted a one-group pre/posttest intervention design with a convenience sample of 20 women, 50 years and older. The mean age was 56 years (SD = 11) and years since HIV diagnosis was 23.7 (SD = 8.6). ThE CARE intervention was found useful and participants "felt empowered" utilizing the app. Fourteen participants (70%) reported high-intensity distress and negative impact on life from neuropathic pain, anxiety (55%), fatigue (50%), and depressive symptoms (35%). Self-awareness and self-regulation also improved. Modest results of acceptability, usability, and positive trends in the outcome measures suggest possible effects. The interactivity and cultural relevance of ThE CARE would enhance women's autonomous motivation and perceived competence to actively engage in self-care. The PoC study provides important foundational information to advance science in mHealth interventions for older women with HIV.

US Physicians' Work Motivation and Their Occupational Health: A National Survey of Practicing Physicians.

BACKGROUND: Poor occupational health among physicians poses a serious risk both to physicians themselves and the patients under their care. Prior research has found that occupational health among nonphysicians is associated with both degree and type of work motivation. OBJECTIVE: The main purpose of this article was to assess the association between physician work motivation and their occupational health. RESEARCH DESIGN: This study was a national survey of practicing physicians. A split-sample method was used to validate a measure of work motivation adapted for physicians. SUBJECTS: In total, 3589 physicians were selected from the American Medical Association Physician Masterfile among whom 2247 physicians completed a survey (response rate of 62.6%). MEASURES: Eight-item measure adapted from the Work Extrinsic and Intrinsic Motivation Scale. Grounded in self-determination theory, this measure includes 2 superordinate subscales of autonomous and controlled work motivation (characterized by feeling free and volitional versus pressured or compelled, respectively). Indicators of physicians' occupational health included single-item measures of general health, burnout, job satisfaction, intention to leave their practice, and intention to leave medicine, and a 2-item measure of depression risk. RESULTS: Confirmatory factor analyses found that an 8-item, 2 superordinate (4 subordinate subscale) measure had good factor structure [χ(14, n=500)=35.62, P<0.001; χ(14, n=1747)=108.85, P<0.001]. Autonomous work motivation was found to be positively related to all 6 indicators of physicians' occupational health. Controlled work motivation was negatively related to 3 of 6 occupational health indicators. CONCLUSIONS: Physicians who are more autonomously motivated at work reported having better occupational health. Fostering a health care work environment that supports autonomous motivation may benefit the well-being of physicians and their patients.

Physician Perception of Pay Fairness and its Association with Work Satisfaction, Intent to Leave Practice, and Personal Health.

BACKGROUND: Primary care physicians generally earn less than specialists. Studies of other occupations have identified perception of pay fairness as a predictor of work- and life-related outcomes. We evaluated whether physicians' pay fairness perceptions were associated with their work satisfaction, turnover intention, and personal health. METHODS: Three thousand five hundred eighty-nine physicians were surveyed. Agreement with "my total compensation is fair" was used to assess pay fairness perceptions. Total compensation was self-reported, and we used validated measures of work satisfaction, likelihood of leaving current practice, and health status. Hierarchical logistic regressions were used to assess the associations between pay fairness perceptions and work/life-related outcomes. RESULTS: A total of 2263 physicians completed surveys. Fifty-seven percent believed their compensation was fair; there was no difference between physicians in internal medicine and non-primary care specialties (P = 0.58). Eighty-three percent were satisfied at work, 70% reported low likelihood of leaving their practice, and 77% rated their health as very good or excellent. Higher compensation levels were associated with greater work satisfaction and lower turnover intention, but most associations became statistically non-significant after adjusting for pay fairness perceptions. Perceived pay fairness was associated with greater work satisfaction (OR, 4.90; 95% CI, 3.94-6.08; P < 0.001), lower turnover intention (OR, 2.46; 95% CI, 2.01-3.01; P < 0.001), and better health (OR, 1.33; 95% CI, 1.08-1.65; P < 0.01). DISCUSSION: Physicians who thought their pay was fair reported greater work satisfaction, lower likelihood of leaving their practice, and better overall health. Addressing pay fairness perceptions may be important for sustaining a satisfied and healthy physician workforce, which is necessary to deliver high-quality care.

"What Goes Around Comes Around": Antecedents, Mediators, and Consequences of Controlling vs. Need-Supportive Motivational Strategies Used by Exercise Professionals.

BACKGROUND: Research into the factors associated with the use of different motivational strategies by exercise professionals is of empirical and practical utility. PURPOSE: Grounded in self-determination theory, this study sought to analyze putative antecedents, mediators, and work-related well- and ill-being consequences of two types of motivational strategies reported by exercise professionals. METHODS: Participants were 366 exercise professionals (193 males; experience = 7.7 ± 5.8 years). Questionnaires assessing psychological need satisfaction frustration, self-determined work motivation, motivational strategies (need-supportive vs. controlling), emotional exhaustion, and personal accomplishment were completed online. Path analysis was used to test the hypothesized model. RESULTS: Model with good fit [χ 2 (5) = 9.174, p> .05; CFI = .984; TLI = .936; RMSEA = .048; SRMR = .022] showed need satisfaction as positively associated with supportive strategies and personal accomplishment (ß between .267 and .399) and negatively with emotional exhaustion (ß = -.145). Need frustration was negatively associated with work motivation and personal accomplishment (ß = -.315; -.176), and positively with controlling strategies and emotional exhaustion (ß = .195; .226). Furthermore, supportive strategies and work motivation were positively associated with personal accomplishment (ß = .134; .184), whereas controlling strategies were positively associated with emotional exhaustion (ß = .178). CONCLUSIONS: Findings have theoretical implications, providing evidence of need satisfaction and frustration as being differently associated with work-related motivation, type of strategies used, and work-related emotional outcomes. Practical implications convey the importance of these variables in relation to the standard of motivational strategies provided and their role on work-related well- and ill-being indicators.

Immediate and Sustained Decrease in Smoking Urges After Acute Insular Cortex Damage.

INTRODUCTION: Smoking urges are fundamental aspects of nicotine dependence that contribute significantly to drug use and postquit relapse. Recent evidence has indicated that damage to the insular cortex disrupts smoking behaviors and claims to reduce urges associated with nicotine use, although tools that assess urge have yet to be used to validate these findings. We examined the effect of insular versus non-insular damage on urge using a well-accepted urge scale. METHODS: This 3-month observational prospective cohort study consisted of 156 current smokers hospitalized for acute ischemic stroke (38 with insular infarctions, 118 with non-insular infarctions). During hospitalization, the Questionnaire of Smoking Urges (QSU)-brief was assessed retrospectively based on experiences before the stroke (baseline, T0), prospectively immediately following the stroke (T1) and once more via telephone at 3-month follow-up (T2), with higher scores indicating greater urge. Bivariate statistics and multivariable linear regression were used to evaluate differences in QSU-brief scores, relative to baseline, between exposure groups, controlling for age, baseline dependence, stroke severity, use of nicotine replacement, and damage to other mesocorticolimbic regions. RESULTS: A greater reduction in QSU-brief score was seen in the insular group compared to the non-insular group from T0 to T1 (covariate-adjusted difference in means of -1.15, 95% CI: -1.85, -0.44) and similarly from T0 to T2 (covariate-adjusted difference in means of -0.93, 95% CI: -1.79, -0.07). CONCLUSIONS: These findings confirm the potential role of the insula in regulating nicotine-induced urges and support the growing evidence of its novelty as a key target for smoking cessation interventions. IMPLICATIONS: Human lesioning studies that evaluate the insula's involvement in maintaining nicotine addiction make inferences of the insula's role in decreasing urge, but do not use validated instruments that directly assess urges. This study corroborates prior findings using the continuous Questionnaire of Smoking Urges to quantify changes in urge from before lesion onset to immediate and 3-month follow-up time points.

Communication Skills Training for Practitioners to Increase Patient Adherence to Home-Based Rehabilitation for Chronic Low Back Pain: Results of a Cluster Randomized Controlled Trial.

OBJECTIVE: To assess the effect of an intervention designed to enhance physiotherapists' communication skills on patients' adherence to recommendations regarding home-based rehabilitation for chronic low back pain. DESIGN: Cluster randomized controlled trial. SETTING: Publicly funded physiotherapy clinics. PARTICIPANTS: A sample (N=308) of physiotherapists (n=53) and patients with chronic low back pain (n=255; 54% female patients; mean age, 45.3y). INTERVENTIONS: Patients received publicly funded individual physiotherapy care. In the control arm, care was delivered by a physiotherapist who had completed a 1-hour workshop on evidence-based chronic low back pain management. Patients in the experimental arm received care from physiotherapists who had also completed 8 hours of communication skills training. MAIN OUTCOME MEASURES: (1) Patient-reported adherence to their physiotherapists' recommendations regarding home-based rehabilitation measured at 1, 4, 12, and 24 weeks after the initial treatment session. (2) Pain and pain-related function measured at baseline and at 4, 12, and 24 weeks. RESULTS: A linear mixed model analysis revealed that the experimental arm patients' ratings of adherence were higher than those of controls (overall mean difference, .41; 95% confidence interval, .10-.72; d=.28; P=.01). Moderation analyses revealed that men, regardless of the intervention, showed improvements in pain-related function over time. Only women in the experimental arm showed functional improvements; female controls showed little change in function over time. The Communication Style and Exercise Compliance in Physiotherapy intervention did not influence patients' pain, regardless of their sex. CONCLUSIONS: Communication skills training for physiotherapists had short-term positive effects on patient adherence. This training may provide a motivational basis for behavior change and could be a useful component in complex interventions to promote adherence. Communication skills training may also improve some clinical outcomes for women, but not for men.

Study of monotherapy versus combination therapy for tobacco dependence among heavily addicted smokers.

OBJECTIVES: Combination therapy for tobacco dependence is becoming a standard of care. We sought to compare benefits and adverse events for combination therapy versus monotherapy for smokers in The Smokers' Health Project. METHODS: This secondary data analysis was derived from adult smokers (n = 198) who initially smoked 15 or more cigarettes per day and participated in The Smokers' Health Project. Participants were grouped as taking 1 medication or 2 concurrent medications for tobacco dependence for 1 year over the 2-year study period. Adverse events were compared between medication groups using chi-square tests. Crude and adjusted odds ratios were calculated for cessation at 6, 12, 18, and 24 months using logistic regression. RESULTS: No differences were seen in the proportion of incident adverse events between the monotherapy (28.3%) and combination therapy (32.3%) groups (P = 0.54). At 6 months, the odds of quitting were less in the combination therapy group relative to those taking monotherapy (adjusted odds ratio = 0.47 [95% CI 0.24-0.93]). At 12, 18, and 24 months, the odds of quitting did not differ between therapy groups (P = 0.07, 0.33, 0.55, respectively). CONCLUSION: Monotherapy and combination therapy for smoking cessation are similarly effective up to 24 months, and they exhibit similar adverse event attributes.

Outcomes of the Smoker's Health Project: a pragmatic comparative effectiveness trial of tobacco-dependence interventions based on self-determination theory.

A pragmatic comparative effectiveness trial examined whether extending the duration of a cost-effective, intensive tobacco-dependence intervention designed to support autonomy will facilitate long-term tobacco abstinence. Participants were randomly assigned to one of three tobacco-dependence interventions based on self-determination theory, namely, Intensive Treatment (IT; six contacts over 6 months), Extended Need Support (ENS; eight contacts over 12 months) and Harm Reduction (HR; eight contacts over 12 months with medication use if willing to reduce cigarette use by half). Among participants who completed the interventions, analyses revealed beneficial effects of ENS (15.7 versus 3.8%; χ 2(1) = 6.92, P < 0.01) and HR (13.6 versus 3.8%; χ 2(1) = 5.26, P < 0.05), relative to IT, on 12-month prolonged abstinence from tobacco. Also, analyses revealed beneficial effects of ENS (77.7 versus 43.0%; χ 2(1) = 24.90, P < 0.001) and HR (84.0 versus 43.0%; χ 2(1) = 37.41, P < 0.001), relative to IT, on use of first-line medications for smoking cessation. Hence, two new interventions were found to be efficacious particularly among participants who completed the interventions. Smokers who stay in treatment for an additional 6 months may benefit from an additional two contacts with practitioners, and thus it seems reasonable for policy makers to offer additional contacts given the health benefits associated with prolonged tobacco abstinence.

Effect of a self-determination theory-based communication skills training program on physiotherapists' psychological support for their patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE: To examine the effects of communication skills training on physiotherapists' supportive behavior during clinical practice. DESIGN: Randomized trial. SETTING: Hospital outpatient physiotherapy clinics. PARTICIPANTS: Physiotherapists (N=24) and patients (N=24) with chronic low back pain. INTERVENTIONS: Two hospital clinics were randomly assigned to the intervention arm. Physiotherapists (n=12) received 8 hours of communication skills training focused on supporting patients' psychological needs. Physiotherapists (n=12) from 2 other hospital clinics formed a waitlist control arm. MAIN OUTCOME MEASURES: Verbal communication between each physiotherapist and a patient was recorded on an audiotape, and independent, blinded raters used the Health Care Climate Questionnaire to assess physiotherapists' needs-supportive behavior (primary outcome). RESULTS: Independent raters' Health Care Climate Questionnaire scores favored the intervention arm (Cohen's d=2.27; P<.01). CONCLUSIONS: Compared with controls, independent ratings demonstrated that physiotherapists who completed the Communication style and exercise compliance in physiotherapy training were found to provide greater support for patients' needs in a single assessed session. Long-term maintenance of this needs-supportive behavior should be examined.

Psychometric properties of a brief measure of autonomy support in breast cancer patients.

BACKGROUND: The Health Care Climate Questionnaire measures patient perceptions of their clinician's autonomy supportive communication. We sought to evaluate the psychometric properties of a modified brief version of the Health Care Climate Questionnaire (mHCCQ) adapted for breast cancer patients. METHODS: We surveyed 235 women aged 20-79 diagnosed with breast cancer within the previous 18 months at two cancer specialty centers using a print questionnaire. Patients completed the mHCCQ for their surgeon, medical oncologist, and radiation oncologist separately, as well as the overall treatment experience. Exploratory factor analysis (EFA) using principal components was used to explore the factor structure. RESULTS: One hundred sixty out of 235 (68.1%) women completed the survey. Mean age was 57 years and time since diagnosis was 12.6 months. For surgeon, medical oncologist, and radiation oncologist ratings separately, as well as overall treatment, women rated 6 dimensions of perceived physician autonomy support. Exploratory factor analysis indicated a single factor solution for each clinician type and for the overall experience. Further, all six items were retained in each clinician subscore. Internal consistency was 0.93, 0.94, 0.97, and 0.92 for the overall, surgeon, medical oncologist, and radiation oncologist scales, respectively. Hierarchical factor analysis demonstrated that a summary score of the overall treatment experience accounts for only 52% of the total variance observed in ratings of autonomy support for the three provider types. CONCLUSIONS: These results describe the first use of the mHCCQ in cancer patients. Ratings of the overall treatment experience account for only half of the variance in ratings of autonomy support, suggesting that patients perceive and report differences in communication across provider types. Future research is needed to evaluate the relationship between physician communication practices and the quality of decision making, as well as other outcomes among cancer patients.

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial.

BACKGROUND: The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. METHODS: An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months. RESULTS: Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. CONCLUSIONS: Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed. TRIAL REGISTRATION: The trial is registered as Current Controlled trials ISRCTN07682833.

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

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

The Use of Holographic Memory Resolution® to Improve the Physical and Biopsychosocial Symptoms of Chronic Pain: A Feasibility, Mixed Methods Study.

Objective: Holographic Memory Resolution® (HMR®), a mind-based therapy, has been used for decades as a nonpharmacologic intervention for trauma imprinting to alleviate depression, anxiety, pain, and post-traumatic stress disorder (PTSD). No clinical studies were found examining the use of HMR®. This study examined the feasibility and preliminary efficacy of administering HMR® to individuals experiencing chronic pain and related biopsychosocial symptoms. Methods: A feasibility, mixed-methods study was conducted between October 2021 and July 2022 and included four HMR® sessions over 1-12 weeks. A convenience sample was comprised of 60 adults suffering from chronic physical or emotional pain of 4+ (0-10 scale) over 6+ months at two clinics in the U.S. Baseline and subsequent surveys after sessions 2, 3, and 4 assessed symptom response. Symptoms were longitudinally measured via self-report of depression, anxiety, somatic symptom burden, PTSD, and vitality. Results: 73% completed all four sessions, demonstrating feasibility. Ages ranged from 19 to 80 years, 85% were female, and 87% were Caucasian. 52% reported high risk for toxic stress. Four symptoms decreased significantly: depression (p = 0.05), anxiety (p = 0.03), symptom burden (p < 0.01) and PTSD symptoms (p = 0.01); vitality improved. Conclusions: HMR® may be a feasible intervention to address chronic pain and accompanying biopsychosocial symptoms; a randomized controlled trial is the next step to measure efficacy. Unlike other mind-based therapies, HMR® participants use their own internal language for identification and resolution of the pain. The trauma imprinting can then be gently addressed, and the memory-based components of pain resolved or reduced, which empowers participants to improve their well-being. Trial registration: ClinicalTrials.gov Identifier: NCT05001399.

Self-determination theory and the smoking cessation process: Daily electronic self-reports can identify the initiation of quit attempts.

OBJECTIVES: To examine the motivational predictors of the smoking cessation process at the between-persons and within-persons levels. METHODS: Mediation analyses were conducted on self-report data (N = 236) that were collected using interval contingent sampling over a 39-day study period. RESULTS: There was a high rate of attrition, as nearly 50% of participants were lost to follow-up. There were credible indirect effects of autonomous self-regulation on smoking behavior on the next day and seven-day abstinence through perceived competence and medication use. At the between-persons level, these models explained 17% of the variance in smoking behavior on the next day and 31% of the variance in seven-day abstinence; at the within-persons level, these estimates were 39% and 57%, respectively. CONCLUSIONS: Day-to-day changes in autonomous self-regulation, perceived competence, and medication use are important initiators of the smoking cessation process. PRACTICE IMPLICATIONS: Smokers might be more likely to make a quit attempt if practitioners "tune into" the day-to-day fluctuations of their patients' motivation for stopping smoking, perhaps using an electronic platform to assess and compare smokers' current reports to their previous experiences. Such "motivational attunement" can afford practitioners an opportunity to provide need support when patients are willing and able to initiate a quit attempt.

Design and rationale of behavioral nudges for diabetes prevention (BEGIN): A pragmatic, cluster randomized trial of text messaging and a decision aid intervention for primary care patients with prediabetes.

BACKGROUND: Among 96 million U.S. adults with prediabetes, adoption of evidence-based treatment to prevent diabetes remains low. Primary care represents an essential venue for preventing diabetes, yet providers in this setting have limited time to address prevention. This highlights the need for low-touch interventions that promote diabetes prevention and are not delivered by primary care providers. Text messaging and decision aids displaying disease risk and treatment information have improved outcomes in prior research. However, these approaches have not been definitively studied for managing prediabetes. METHODS: The Behavioral Nudges for Diabetes Prevention (BEGIN) trial is a pragmatic, cluster randomized trial testing the effectiveness of text messaging about diabetes prevention and a prediabetes decision aid. These interventions are being studied in 8 primary care clinics using a 2 × 2 factorial design, in which pairs of clinics are randomized in a 1:1:1:1 ratio to receive usual care, text messaging alone, prediabetes decision aid alone, or both interventions. A total of 656 patients are recruited to participate, receive the study interventions, and contribute data at baseline and 12 months. The primary outcome is 12-month weight change, and the secondary outcome is adoption of evidence-based treatment to prevent diabetes. Change in hemoglobin A1c is an exploratory outcome that will be assessed among participants with available values. CONCLUSION: Findings from the BEGIN trial will provide evidence about the effectiveness of two novel, low-touch interventions focused on diabetes prevention in primary care, where patients are diagnosed with prediabetes and there is little prior research. TRIAL REGISTRY: NCT04869917.

Self-determination theory: its application to health behavior and complementarity with motivational interviewing.

Mounting evidence implicates health behaviors (e.g., nutrition, physical activity, tobacco abstinence) in various health outcomes. As the science of behavior change has emerged, increasing emphasis has been placed on the use of theory in developing and testing interventions. Self-determination theory (SDT)-a theoretical perspective-and motivational interviewing (MI)-a set of clinical techniques-have both been used in health behavior intervention contexts. Although developed for somewhat different purposes and in relatively different domains, there is a good deal of conceptual overlap between SDT and MI. Accordingly, SDT may offer the theoretical backing that historically has been missing from MI, and MI may offer SDT some specific direction with respect to particular clinical techniques that have not been fully borne out within the confines of health related applications of SDT. Research is needed to empirically test the overlap and distinctions between SDT and MI and to determine the extent to which these two perspectives can be combined or co-exist as somewhat distinct approaches.