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Towards an integration of the health promotion models of self-determination theory and theory of planned behavior among people with chronic pain.
Open accessAbstract
PURPOSE: People with chronic pain and related disability often report motivational difficulties with engaging in health-promoting behaviors. Although health promotion models of self-determination theory (SDT) and theory of planned behavior (TPB) have been shown to explain the motivational processes behind health behaviors in the general population, there is limited theoretical research among persons with chronic pain. This study examined the integration of such theories relevant to physical activity and exercise behavior among pain populations. RESEARCH METHOD: Secondary data analyses were conducted using cross-sectional surveys from 198 participants with chronic musculoskeletal pain recruited from U.S. clinics and community networks. The primary outcome was self-reported physical activity and exercise participation. Predictor variables included pain intensity, functional disability, and SDT and TPB measures. Hierarchical regression analysis was conducted to examine the associations between these variables. RESULTS: Findings demonstrated that in the first step, functional disability was associated with physical activity and exercise; and in the second step, all SDT factors were associated with physical activity and exercise. In the final step of the model, only certain SDT and TPB factors were associated with physical activity and exercise. CONCLUSIONS: Despite preexisting pain and functional disability, the findings suggest that health behavior factors from both SDT and TPB are associated with physical activity and exercise participation. This line of research should encourage rehabilitation professionals to recommend regular physical activity and exercise, while simultaneously addressing and monitoring the SDT and TPB factors that are well-timed and appropriate for persons with chronic pain through motivation-oriented rehabilitation approaches. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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“Indeed, previous research indicated that promoting patients’ self-determination is related to benefits in terms of disease-related behaviors in psychosomatic medicine [113,114,115,116,117].”
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Lin, B., & Guan, C. (2021) · Journal of Environmental Management · doi:10.1016/j.jenvman.2021.113577 · Cited by 125
Cotter, L. M., Shah, D. V., Brown, K., Mares, M., Landucci, G., Saunders, S., Johnston, D. C., Pe‐Romashko, K., Gustafson, D. H., Maus, A., et al. (2024) · JMIR Aging · doi:10.2196/56923 · Cited by 27
“For example, self-determination factors increase positive health behaviors in the realms of exercise [16,17], mental health [18], and health communication [19].”
BackgroundNeed Satisfaction and Need Thwarting in Physical Education and Intention to be Physically Active
Cuevas, R., Bustos, J. G. F., González‐Cutre, D., & Martínez, A. H. (2020) · Sustainability · doi:10.3390/su12187312 · Cited by 23
“These data are in line with the findings of several studies that highlight the importance of promoting the satisfaction of competence in people to promote active lifestyles, given that this perception encourages enjoyment [36,62] and favours the practice of physical activity [16,17,28,29,51].”
BackgroundResultUsing self-determination theory to predict self-management and HRQoL in moderate-to-severe COPD
Knox, L., Norris, G., Lewis, K. E., & Rahman, R. J. (2021) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2021.1938073 · Cited by 21
“…(Ng et al., 2012; Ntoumanis et al., 2020; Ryan, Patrick, Deci, & Williams, 2008); including successfully predicting physical activity participation (Brooks et al., 2018; Rahman, Thøgersen-Ntoumani, Thatcher, & Doust, 2011; Rahman, Hudson, Thøgersen-Ntoumani, & Doust, 2015) and smoking cessation…”
Johnson, N. L., Steffensmeier, K. S., Garvin, L. A., Adamowicz, J. L., Obrecht, A. A., Rothmiller, S. J., Sibenaller, Z. A., Stout, L., Driscoll, M., & Hadlandsmyth, K. (2023) · Health Communication · doi:10.1080/10410236.2023.2207280 · Cited by 18
“When the basic psychological need for relatedness is supported, individuals will be more likely to feel they are part of a caring relationship, thus facilitating a cascade of supported needs to take autonomous action (Brooks et al., 2018).”
BackgroundInfluentialWatkins, R., Young, G., Western, M. J., Stokes, K., & McKay, C. D. (2020) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-020-03428-6 · Cited by 13
“Such findings suggest that SDT could become a foundation for the development of self-management interventions within health promotion and healthcare contexts, including those which promote PA [29, 34].”
BackgroundSuh, K. (2021) · BMC Public Health · doi:10.1186/s12889-021-11460-x · Cited by 9
Cojocaru, C.-M., Popa, C. O., Schenk, A., Jakab, Z., Suciu, B. A., Olah, P., Popoviciu, H., & Szasz, S. (2024) · Behavioral Sciences · doi:10.3390/bs14040327 · Cited by 7
Principles for Designing an mHealth App for Participatory Research and Management of Chronic Pain
Holowka, E. M., Woods, S., Pahayahay, A., Roy, M., & Khalili‐Mahani, N. (2021) · Lecture notes in computer science · doi:10.1007/978-3-030-77820-0_5 · Cited by 7
Sarini, M., Actis-Grosso, R., Magrin, M. E., Mari, S., Olivero, N., Paganin, G., & Simbula, S. (2022) · Healthcare · doi:10.3390/healthcare10050888 · Cited by 5
Pester, B., Caño, A., Kostecki, T. P., & Wurm, L. H. (2019) · Annals of Behavioral Medicine · doi:10.1093/abm/kaz047 · Cited by 5
Sheridan, K., O’Connor, S., & Whyte, E. F. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301861 · Cited by 5
Caglayan, I., Afacan, Y., & Aydıngün, G. (2024) · Smart innovation, systems and technologies · doi:10.1007/978-981-99-8501-2_6 · Cited by 2
Wu, J.-R., Chan, F., Tansey, T. N., Ditchman, N., Berven, N. L., & Hoyt, W. T. (2024) · Rehabilitation Counseling Bulletin · doi:10.1177/00343552241268735 · Cited by 2
“Connecting components of different health behavior theories to create hybrid or integrated motivational models is becoming increasingly common (Brooks et al., 2018; Hagger & Chatzisarantis, 2016; Schwarzer et al., 2011).”
Self-citationda Luz, C. M., Matias, T. S., de Paula, R. R., Araújo, J., Nascimento, F. C., de Oliveira, Y. V., Camargos, E., Freitas, C. D., & Karloh, M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0330446 · Cited by 3
“Therefore, interventions directed to individuals with less self-determination and BPN support need a proper design to address these elements, creating an environment that encourages them to feel naturally self-directed, skilled, and connected [10,24,37,47,48].”
Predicting Physical Activity Behavior Change Among Individuals Living With Severe Mental Illness
Huck, G. E., Chan, F., Brickham, D., Shelton, S., & Scafella, E. (2021) · Journal of Applied Rehabilitation Counseling · doi:10.1891/jarc-d-19-00024 · Cited by 1
Self-citationMagrin, M. E., Guarischi, M., Liga, F., Nicolotti, M., & Pielich, I. (2022) · Journal of Health Psychology · doi:10.1177/13591053221093447 · Cited by 1
“…motivation to be predictive both of intention to engage in myopia-preventive behaviors and actual behavior; similar results are obtained by Brooks et al. (2018) in relation to intention to exercise and actual physical activity in patients affected by chronic pain and persistent…”
ResultCojocaru, C. M., Popa, C. O., Schenk, A., Jakab, Z., Suciu, B. A., Olah, P., Popoviciu, H. V., & Szasz, S. (2023) · Preprints.org · doi:10.20944/preprints202312.1957.v1
Wu, Y. (2022) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/978-2-494069-31-2_13
Jiao, K., Pang, X., & Hu, W. B. (2023) · Research Square · doi:10.21203/rs.3.rs-3320839/v1
Dunleavy, K., Radunovich, H. L., Beneciuk, J. M., Hu, B., Yang, Y., Blythe, J. M., & Gurka, K. K. (2024) · JMIR Research Protocols · doi:10.2196/64817 · Cited by 2
“…options (Figures 4 and 5) and implementation strategies (Table 2) were selected using evidence, stakeholder interviews, and established theoretical frameworks (health beliefs [72,73], self-determination [74-76], social cognitive [77,78], and Bronfenbrenner’s Ecological Systems Theories [79]).”
Watkins, R., Young, G. B., Western, M., Stokes, K., & McKay, C. (2020) · Figshare · doi:10.6084/m9.figshare.12599289
Steeby, C., Zubieta, C. S., Shaikh, S., Zhu, G., & Pierce, J. M. (2025) · Journal of Clinical and Translational Science · doi:10.1017/cts.2025.10209 · Cited by 1
Kröger, E., Carmichael, P., Guillaumie, L., Jauvin, N., Dagenais, P., Lacasse, A., & Dionne, C. E. (2026) · Scientific Reports · doi:10.1038/s41598-025-33616-0
“One study on the integration of the self-determination theory (SDT) and the TPB among chronic pain patients found that behavior factors from both SDT and TPB relate to physical activity and participation in exercise programs, encouraging health professionals to recommend both activities 33 .”
Mookeng, M. J., & Mathebe, L. (2026) · Routledge Open Research · doi:10.12688/routledgeopenres.21488.1
Metadata
- Authors
- Brooks, J. M., Huck, G., Iwanaga, K., Chan, F., Wu, J.-R., Finnicum, C. A., Brinck, E. A., & Estala-Gutierrez, V. Y.
- Venue
- Rehabilitation Psychology
- Published
- 2018-11
- Volume
- 63
- Issue
- 4
- Pages
- 553-562
- ISSN
- 0090-5550 (ISSN-L)
- 1939-1544
- OpenAlex
- W2891757924
- Cited by
- 25
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 1
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Rehabilitation Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- US Department of Education (H133B100034)
- National Institute of Mental Health (T32 MH073553-11)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Psychology › Social Psychology › Motivation and Self-Concept in Sports
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- chronic pain, self-determination theory, theory of planned behavior, health promotion model, physical activity, exercise participation, motivation, functional disability, pain intensity, musculoskeletal pain
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Health Promotion, Humans, Male, Middle Aged, Models, Psychological, Motivation, Psychological Theory, Surveys and Questionnaires, Health Behavior, Exercise, Personal Autonomy, Young Adult, Self Report, Chronic Pain
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