The Basic Science of Behavior Change in COPD: Testing Self-Determination Theory to Support Home-Based Rehabilitation...

Home-based pulmonary rehabilitation (HBPR) with health coaching (HC) in people with chronic obstructive pulmonary disease (COPD) has been reported to produce behavior change by improving accelerometry-measured physical activity level and quality of life (QoL). However, a theoretical framework supporting the observed behavior change has not been tested in people with COPD. Therefore, the purpose of this secondary analysis was to examine the mechanism by which HBPR with HC improved physical and emotional QoL, by testing a theoretical framework that may support the positive effect of the intervention. The hypothesis was that the Self-Determination Theory (SDT) supports the behavior change observed after the 12-week HBPR with HC in patients with moderate to very severe COPD. This theory posits that by supporting the individual's experience of autonomy, competence, and relatedness can foster the most volitional and high-quality forms of motivation and engagement for a behavior change.

Structural Equation Models (Path Analysis) tested the underlying assumption that competence, autonomy, and relatedness were the factors associated with improvement in the physical and emotional QoL post-intervention.

The path models supported the effect HBPR with HC on physical and emotional QoL through a direct effect on competence and relatedness ( P <.01) and an indirect effect through autonomy via competence and relatedness.

The effect of HBPR with HC in patients with COPD is mechanistically supported by SDT. Addressing competence, relatedness, and autonomy during the pulmonary rehabilitation process may impact physical and emotional QoL, which is of utmost importance to these patients.