Intervention design using self-determination theory to promote activity in depressed patients, older adults, and slimmers

Increasingly public health is asking for evidence-based interventions targeted at individuals and their physical activity that are framed in an established behavior change theory. Recently self-determination theory (SDT) has been widely appraised and adopted. Its focus is on understanding and facilitating individual needs satisfaction and it provide a pathway of progression from external to internal motives for lasting behavior change. This is particularly attractive in settings such as physical activity promotion where health professionals are seeking strategies through which they can provide support for long term physical activity gains. This paper provides an exposition of the design and delivery of an intervention to increase physical activity in primary care patients with mild or moderate depression. TREAD was a pragmatic randomized controlled trial delivered in the UK by a physical activity facilitators (PAFs) based in primary care through face-to-face sessions and phone calls over an 8 month period. Targets in the intervention were competence/confidence, autonomy, social support and relatedness. Principles of motivational interviewing were adopted as it encourages patients to take responsibility for their own decision-making and is compatible with SDT. The intervention was successful in increasing physical activity in this challenging population although it did not have a significant impact on depression. Evaluation interviews were conducted with 19 patients at four months and with 12 of them again at 12 months. Patients confirmed that the approach and strategies used by PAFs had helped them feel more able to take charge of their physical activity, feel more competent, supported and more confident in their daily lives and these findings were supported by questionnaire data in the trial. We have also used SDT to underpin intervention design with older adults. Project ACE (Active, Connected and Engaged Neighborhoods) recruits, trains and coordinates volunteering (Activators) active older adults to build a small local case load of sedentary participants who wish to become more active. The intervention uses strategies to build competence and relatedness in the Activators as well as the participants. Finally, the application of SDT in a partnership with a national slimming organization to increase physical activity in women attempting to lose weight is described. Of particular interest is how abstract theoretical concepts are translated into meaning and attractive materials for a population who have given little consideration to exercise. The presentation is aimed at providing pointers to researchers and practitioners wishing to develop physical activity services requiring interaction between professional and patients.