More Than Just Talk: The Role of Therapist Interactions in Patient Adherence

Communication of healthcare professionals (HCPs) plays an important role in patient therapy experiences. According to Self-Determination Theory, HCPs' motivating interaction styles foster these experiences. However, empirical evidence on how patients perceive their HCP's interaction styles and how these perceptions relate to their basic psychological needs, therapy motivation, and therapy adherence remains limited.

This cross-sectional study included patients who received physiotherapy or occupational therapy (N=346). Participants completed valid and reliable questionnaires to assess their perceptions of their HCP's motivating (autonomy-support, structure) and demotivating (control, chaos) interaction styles, their basic psychological needs (satisfaction, frustration), motivation toward therapy (intrinsic motivation, integrated, identified, introjected, external regulation, amotivation), and therapy adherence. Data were analyzed using Structural Equation Modeling (SEM)-analysis.

The SEM analysis revealed that perceived autonomy-support was positively related to need satisfaction and negatively to need frustration. Perceived control was positively related to need frustration. Need satisfaction, in turn, was positively related to intrinsic motivation, integrated, identified and introjected regulation, while need frustration showed a negative relationship with intrinsic motivation and introjected regulation, and a positive association with external regulation and amotivation. Integrated and identified regulations were positively related to adherence, while external regulation and amotivation showed negative associations.

These findings suggest the importance of HCPs adopting an autonomy-supportive interaction style to foster patients' need satisfaction, promote self-determined motivation, and enhance therapy adherence. Conversely, controlling interaction style undermines patient therapy experiences by increasing need frustration, reducing self-determined motivation and lowering adherence. It is recommended to focus on these components during training.