Objective: The general reticence of practitioners to deliver smoking cessation interventions has been identified as a critical component of the public health problem of smoking (AHRQ, 2000). Despite widespread knowledge about the deleterious effects of smoking on health, many clinicians fail to address the issue with their patients who smoke. Understanding the influence of both patient and practitioner motivation on patients’ smoking outcomes is, therefore, integral to intervening more effectively with people who smoke. The purpose of this study was to explore the influence of patients’ perceptions of their practitioners’ motivation for delivering smoking cessation intervention on the motivational processes that underlie smoking cessation.
Design: A descriptive, correlational design was used for the study, which was nested within a larger randomized clinical trial designed to test the effectiveness of a smoking cessation and diet change intervention based on a general theory of motivation, self-determination theory (SDT; Smokers’ Health Study or SHS, R01-MR59505, Geoffrey C. Williams, MD, PhD, Principal Investigator, funded by the National Institute of Mental Health and the National Cancer Institute).
Population, Sample, Setting, Years: Participants were 166 adult SHS participants who were recruited consecutively from an urban/suburban area in the northeast United States from December 2000 through April 2001 and who were assigned to any of the groups in that study. Participants were at least 18 years old and smoking a minimum of 5 cigarettes daily. They could not have dementia, psychosis or any other medical illness that might have precluded their participation in the study over an 18-month period.
Concept or Variables Studied Together: Practitioners’ autonomous motivation for delivering smoking cessation intervention was operationally defined as the extent to which the practitioner was perceived as both interested in (versus pressured about) the patient’s smoking and knowledgeable about ways to help people stop smoking. Perceptions of practitioners’ autonomous motivation were hypothesized to moderate several relationships that have previously been shown to positively influence patients’ autonomous motivation (desire to stop smoking because people want to improve their health rather than because they feel pressured or coerced to do so) and perceived competence (efficacy) for stopping smoking, both of which predict smoking cessation. Specifically, it was hypothesized that perceived practitioner motivation would moderate the relationships between patients’ autonomy orientation (a personality variable) and their autonomous motivation and between autonomy support (the extent to which patients perceive they have choices and options and feel understood by their care provider) and patients’ autonomous motivation as well as between autonomy support and perceived competence for stopping smoking.
Methods: Perceived practitioner motivation was measured using the Perceived Practitioner Motivation Scale, autonomy orientation with the autonomy subscale of the General Causality Orientation Scale, autonomy support with a modified version of the Health Care Climate Questionnaire, autonomous motivation by the autonomous reasons subscale of the Treatment Self-Regulation Questionnaire, and perceived competence with the Perceived Competence Scale. All instruments had good reliability and validity. Measures were obtained at baseline and 1 month. Procedures outlined by Baron and Kenny (1986) for testing moderators were used to analyze the data.
Findings: Perceived practitioner motivation moderated the relationship between autonomy support and autonomous motivation as well as between autonomy support and perceived competence. Both of these relationships were strongest in the presence of a practitioner who was experienced as more autonomously motivated for delivering smoking cessation intervention. Perceived practitioner motivation did not moderate the relationship between autonomy orientation and autonomous motivation.
Conclusions: Patients’ perceptions of their care providers’ autonomous motivation for delivering smoking cessation intervention influences both the type of motivation and the efficacy patients bring to bear on their smoking cessation efforts. The study provides further explanatory evidence for the motivational processes that underlie smoking cessation including how practitioners’ autonomous motivation potentially works in concert with patients’ motivational resources to influence smoking outcomes.
Implications: In addition to testing the influence of perceived practitioner motivation on the change processes underlying other health behaviors, studies are needed to explore how practitioners’ assessments of their own motivation for delivering smoking cessation intervention influences patients’ health outcomes. Because cessation rates for people who smoke can double to triple when clinicians provide appropriate interventions, development and testing of strategies that can enhance practitioners’ autonomous motivation for delivering such interventions are also needed.
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