Capturing motivating versus demotivating self-management support: Development and validation of a vignette-based tool...

The trend towards more active involvement of patients in the management of their chronic condition requires professionals to interact in a way that facilitates patients' autonomy and motivation. A self-assessment tool that measures simultaneously motivating and demotivating interaction styles in counselling chronic ill patients is currently not available.

Grounded in Self-Determination Theory, this study aimed to develop and validate a self-report tool that captures healthcare professionals' motivating (i.e., autonomy-support and structure) and demotivating (i.e., control and chaos) interaction styles while supporting patients towards self-management.

The Situations In Self-management support - HealthCare Professionals (SIS-HCP) was developed throughout a five-phased psychometric validation study with (1) construct definition, (2) development of the vignette-based questionnaire, (3) ecological validation and piloting, (4) psychometric evaluation (round 1) by multidimensional scaling analysis, and (5) psychometric evaluation (round 2) by internal and construct validity, and reliability testing procedures in 5 independent samples (total N = 1133), between August 2015 and March 2018.

Multidimensional scaling analysis provided evidence for a two-dimensional structure, with motivating, relative to demotivating counselling and high, relative to low, directive counselling representing the two axes. Four styles could be distinguished: autonomy-support (rather motivating and non-directive), structure (rather motivating & directive), control (rather demotivating & directive) and chaos (rather demotivating & non-directive) within self-management support. The SIS-HCP demonstrated good construct validity, and high internal consistency and test-retest reliability.

The SIS-HCP is a vignette-based tool, which allows to explore, in an integrative way, which motivating (i.e., autonomy-support and structure) and demotivating (i.e., control and chaos) styles healthcare professionals use when counselling patients living with a chronic illness. The SIS-HCP might enhance professionals' awareness of their (de)motivating counselling styles and the extent to which they promote ownership among patients. The SIS-HCP represents an interesting addition to existing instruments which measure what professionals do in the field of self-management support, and how confident they feel doing so. The thorough process of development and validation led to a theoretical underpinned tool, with the identified (de)motivating dimensions yielding strong psychometric properties. The SIS-HCP can be used as a reflective tool for professionals and for tailored training.