The Utility of Self-Determination Theory in Predicting Transition Readiness in Adolescents With Special Healthcare Needs

• Published in: Journal of adolescent health 2021-10, Vol.69 (4), p.653-659
• Main Authors: Stephens, Sara B., Raphael, Jean L., Zimmerman, Cortney T., Garland, Beth H., de Guzman, Marietta M., Walsh, Seema M., Hergenroeder, Albert C., Wiemann, Constance M.
• Format: Article
• Language: English
• Subjects: Adolescents; Adolescents and young adults with special healthcare needs; Autonomy; Behavior change; Chronic illnesses; Clinical assessment; Clinical medicine; Competence; Health care; Healthcare self-management; Healthcare transition; Motivation; Questionnaires; Relatedness; Rheumatology; Self determination; Self regulation; Self-determination theory; Sovereignty; Teenagers; Transition readiness; Young adults
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2021.04.004

Adolescents and young adults with chronic health conditions must learn skills to successfully manage their health as they prepare to transition into adult-based care. Self-determination theory (SDT), an empirically based theory of human motivation, posits that competence (feeling effective), autonomy (volition to perform behaviors), and relatedness (support for autonomy from others) influence behavioral change. This study evaluates the utility of SDT constructs in predicting transition readiness among adolescents and young adults recruited into an intervention to promote successful healthcare transition. Baseline assessments were completed by 137 patients aged 17–23 years recruited from pediatric renal, gastroenterology, or rheumatology clinical services. Surveys measured transition readiness (Transition Readiness Assessment Questionnaire) as well as SDT constructs, including competence (Patient Activation Measure); provider relatedness and parent autonomy support (Health Care Climate Questionnaire); and health care–related autonomy (Treatment Self-Regulation Questionnaire). Relationships between SDT constructs and transition readiness were evaluated using linear regression. Between 44 and 48 participants were recruited from each service. Bivariate correlation coefficients between transition readiness and SDT constructs were competence (r = .44), autonomous autonomy (r = .34), controlled autonomy (r = .27), provider relatedness (r = .46), and parental autonomy support (r = .35) (p < .01). Age positively correlated with transition readiness (r = .47, p < .001). After controlling for age, gender, and clinical service, competence (p < .001) and provider relatedness (p = .008) successfully predicted transition readiness (R2 = .423; F change; p < .001). Findings from this cross-sectional study support the utility of SDT constructs in promoting transition readiness among adolescents and young adults with chronic conditions, underscoring the importance of building competence and provider support for autonomy during this critical period.