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Community Health Worker Adherence to Self-Determination Theory in the Women's Initiative Supporting Health
Antoinette T Nguyen1, Josephine Powers1, Peter Braick1
1University of Rochester Medical Center, Rochester, New York, USA.
Summary
Community health workers in the WISH intervention effectively used Self-Determination Theory (SDT) principles to support women
Area of Science:
- Implementation Science
- Health Behavior Change
- Public Health Interventions
Background:
- Self-Determination Theory (SDT) is a framework for behavior change focusing on autonomy, competence, and relatedness.
- The Women's Initiative Supporting Health (WISH) intervention trains community health workers (CHWs) with lived experience of incarceration to assist recently released women with HIV, hepatitis C, and substance use care.
- Assessing CHW fidelity to SDT, motivational interviewing, and trauma-responsive practices is crucial for intervention effectiveness.
Purpose of the Study:
- To evaluate community health worker (CHW) adherence to Self-Determination Theory (SDT) principles within the Women's Initiative Supporting Health (WISH) intervention.
- To explore CHW fidelity to motivational interviewing and trauma-responsive practices.
- To assess the impact of CHW support on patient autonomy, competence, and relatedness.
Main Methods:
- A mixed-methods approach was used, analyzing fifteen transcribed WISH intervention sessions.
- Thematic coding, guided by SDT constructs and supervisor field notes, was employed.
- The Health Care Climate Questionnaire (HCCQ) quantified autonomy-supportive behaviors, with analysis framed by the Health Equity Implementation Framework.
Main Results:
- CHWs demonstrated strong adherence to SDT principles, frequently supporting autonomy (56 instances), competence (54), and relatedness (39).
- Trauma-responsive approaches were observed in 22 cases, and all HCCQ scores averaged 8.4 (out of 10), indicating good clinical practice.
- While generally successful, occasional directive advice indicated areas for enhancing autonomy support.
Conclusions:
- CHWs successfully implemented SDT-based strategies, fostering key psychological needs in the WISH intervention.
- The findings support the use of SDT principles in training CHWs for complex health needs among vulnerable populations.
- Ongoing training and feedback are recommended to further enhance fidelity and sustainability of SDT-based interventions in community settings.
Keywords:
HIVcommunity health workersincarcerationself-determination theorysubstance use disorderwomen’s healthMore Related Videos
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