Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Center for Child Health Policy and Advocacy, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
J Adolesc Health. 2021 Oct;69(4):653-659. doi: 10.1016/j.jadohealth.2021.04.004. Epub 2021 May 29.
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 (R = .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.
患有慢性疾病的青少年和年轻人必须学习技能，以便在准备过渡到成人护理时成功管理自己的健康。自我决定理论（SDT）是一种经验主义的人类动机理论，它假设能力（感觉有效）、自主性（执行行为的意愿）和相关性（来自他人的自主性支持）会影响行为改变。本研究评估了 SDT 结构在预测招募到促进成功医疗过渡干预措施中的青少年和年轻人过渡准备情况方面的效用。
从儿科肾脏、胃肠病学或风湿病学临床服务中招募了 137 名年龄在 17-23 岁的患者，完成了基线评估。调查衡量了过渡准备情况（过渡准备评估问卷）以及 SDT 结构，包括能力（患者激活测量）；提供者相关性和父母自主支持（医疗保健气候问卷）；和与医疗保健相关的自主权（治疗自我调节问卷）。使用线性回归评估 SDT 结构与过渡准备情况之间的关系。
每个服务部门招募了 44 到 48 名参与者。过渡准备与 SDT 结构之间的双变量相关系数为能力（r =.44）、自主自治（r =.34）、控制自治（r =.27）、提供者相关性（r =.46）和父母自主支持（r =.35）（p <.01）。年龄与过渡准备呈正相关（r =.47，p <.001）。在控制年龄、性别和临床服务后，能力（p <.001）和提供者相关性（p =.008）成功预测了过渡准备（R =.423；F 变化；p <.001）。
这项横断面研究的结果支持 SDT 结构在促进慢性病青少年和年轻人过渡准备方面的效用，强调在这个关键时期建立能力和提供者对自主权的支持的重要性。
