Cited by 1,154Motivation and Self-Concept in SportsBehavioral Health and InterventionsDiabetes Management and Education

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A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health

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Ntoumanis, Nikos, Ng, Johan Y.Y., Prestwich, Andrew, Quested, Eleanor, Hancox, Jennie E., Thøgersen-Ntoumani, Cecilie, Deci, Edward L., Ryan, Richard M., Lonsdale, Chris, Williams, Geoffrey C.·2021·Health Psychology Review

DOI 10.1080/17437199.2020.1718529

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Abstract

There are no literature reviews that have examined the impact of health-domain interventions, informed by self-determination theory (SDT), on SDT constructs and health indices. Our aim was to meta-analyse such interventions in the health promotion and disease management literatures. Studies were eligible if they used an experimental design, tested an intervention that was based on SDT, measured at least one SDT-based motivational construct, and at least one indicator of health behaviour, physical health, or psychological health. Seventy-three studies met these criteria and provided sufficient data for the purposes of the review. A random-effects meta-analytic model showed that SDT-based interventions produced small-to-medium changes in most SDT constructs at the end of the intervention period, and in health behaviours at the end of the intervention period and at the follow-up. Small positive changes in physical and psychological health outcomes were also observed at the end of the interventions. Increases in need support and autonomous motivation (but not controlled motivation or amotivation) were associated with positive changes in health behaviour. In conclusion, SDT-informed interventions positively affect indices of health; these effects are modest, heterogeneous, and partly due to increases in self-determined motivation and support from social agents.

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Burgueño, R., Morales-Ortíz, E., Macarro-Moreno, J., Medina-Casaubón, J., & Cueto-Martín, B. (2020) · Sustainability · doi:10.3390/su12187477 · Cited by 7
Examination of Weight-Loss Motivators and Family Factors in Relation to Weight Management Strategies and Dietary Behaviors among Adolescents with Obesity
Biggs, B. K., Wilson, D. K., Quattlebaum, M. J., Kumar, S., Meek, A., & Jensen, T. B. (2021) · Nutrients · doi:10.3390/nu13051729 · Cited by 7
Participants’ Perspective of Engaging in a Gym-Based Health Service Delivered Secondary Stroke Prevention Program after TIA or Mild Stroke
Sammut, M., Haracz, K., English, C., Shakespeare, D. T., Crowfoot, G., Nilsson, M., & Janssen, H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111448 · Cited by 6
“, in the concept of “What it offered me”) resonated with the three basic psychological needs identified in the self-determination theory: (a) competence, (b) autonomy, and (c) relatedness [39].”
BackgroundInfluential
Cardiology clinic patient attitudes toward and potential personal utility of genetic testing: Findings from a unique multiracial clinical sample
Erickson, C. M., Clark, L. R., Umucu, E., Vo, N. H., Volgman, A. S., Chin, N. A., Ketchum, F. B., Jones, C. H., Gleason, C. E., & Aggarwal, N. T. (2022) · Journal of Genetic Counseling · doi:10.1002/jgc4.1573 · Cited by 6
Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities—HPTN 073
Nelson, L. E., Boyd, D. T., Beauchamp, G. G., Emel, L., Wilton, L., Whitfield, D. L., Ramos, S. R., Ajiboye, W., Hill, M. J., Conserve, D. F., et al. (2022) · Journal of Urban Health · doi:10.1007/s11524-022-00666-y · Cited by 6
“A meta-analysis of 73 studies that used experimental designs to test SDT-based interventions found that they consistently produced post-intervention increases in perceived autonomy, competence, and relatedness as well small-to-medium effects in clinical outcomes [24].”
BackgroundMethod
Academic Self-Concept
Basarkod, G., & Marsh, H. W. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197662359.003.0010 · Cited by 9
The Motivation of Medical Staff and the Work Interestedness in the Context of the COVID-19 Pandemic, in a Tertiary Hospital in Romania
Ilea, C. D. N., Daina, M. D., Venter, A. C., Șuteu, C. L., Sabau, M., Bădău, D., & Daina, L. (2023) · Healthcare · doi:10.3390/healthcare11060813 · Cited by 6
“In the early 1900s, it was believed that the main motivating factor for the employee was financial [19].”
Background
Beyond Individual Cognitions: Time for Intervention Science to Focus on Health Context and Audience
Chalabaëv, A., Cheval, B., Maltagliati, S., Saoudi, I., & Sniehotta, F. F. (2023) · Journal of Physical Activity and Health · doi:10.1123/jpah.2023-0072 · Cited by 9
“…socioeconomic background or clinical status as potential moderators (Choi et al., 2018; Cooke et al., 2016; Gillison et al., 2019; Hagger et al., 2022; N. Lin & Roberts, 2020; McDermott et al., 2015; Ntoumanis et al., 2021; Sheeran et al., 2020; Vasconcellos et al., 2020; Zhang et al., 2019).”
Cam Site Clients’ Perceptions of Changes to Their Communication Skills: Associations with Psychological Need Fulfillment
Bennett‐Brown, M., Kaufman, E. M., Marcotte, A. S., & Gesselman, A. N. (2023) · Sexuality & Culture · doi:10.1007/s12119-023-10121-y · Cited by 6
“According to SDT, experiences that fulfill one or all of these three psychological needs can promote optimal adjustment and successful development, including gaining and strengthening new skills (Ntoumanis et al., 2021).”
Relating different perspectives on how outcomes of behavior influence behavior
Houwer, J. D., Finn, M., Boddez, Y., Hughes, S., & Cummins, J. D. (2023) · Journal of the Experimental Analysis of Behavior · doi:10.1002/jeab.887 · Cited by 6
The Relationship Between Social Support and Physical Activity: A Moderated Mediation Model Based on the Self-Determination Theory
Ma, C. M. S., Law, M. Y. M., & Y., A. M. (2023) · Springer eBooks · doi:10.1007/978-981-99-7897-7_15 · Cited by 6
A family-based physical activity intervention guided by self-determination theory: Facilitators’ and participants’ perceptions
Zeng, T., Ng, J. Y. Y., Lubans, D. R., Lonsdale, C., Ng, F. F., & Ha, A. S. C. (2024) · International Journal of Educational Research · doi:10.1016/j.ijer.2024.102385 · Cited by 7
Self-citation
Motivation and physical activity levels in bariatric patients involved in a self-determination theory-based physical activity program
González‐Cutre, D., Jiménez-Loaisa, A., Alcaraz‐Ibáñez, M., Romero-Elias, M., Santos, I., & Beltrán‐Carrillo, V. J. (2020) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2020.101795 · Cited by 7
Causality Orientations and Supportive/Controlled Environment: Understanding Their Influence on Basic Needs, Motivation for Health and Emotions in French Hospitalized Older Adults
Souesme, G., Martinent, G., Akour, D., Giraudeau, C., & Ferrand, C. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.575489 · Cited by 6
“Ntoumanis et al. (2020) have also indicated that changes in autonomous motivation and perception of need support were associated with positive changes in health behaviors both at the end of the intervention and at follow up.”
Background
Identifying the Role of Social Relationships in Motivating Students to Learn
Wentzel, K. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197662359.003.0063 · Cited by 9
Evolution of Physical Activity Habits After a Context Change: the Case of COVID-19 LockdownPreprint
Maltagliati, S., Rebar, A. L., Fessler, L., Forestier, C., Sarrazin, P. G., Chalabaëv, A., Sander, D., Sivaramakrishnan, H., Orsholits, D., Ntoumanis, N., et al. (2020) · doi:10.31236/osf.io/e6jfw · Cited by 6
Self-citation
Motivating the learner: developing autonomy, competence and relatedness through forest school practice
Cudworth, D., & Tymms, M. (2023) · Journal of Outdoor and Environmental Education · doi:10.1007/s42322-023-00146-0 · Cited by 5
“When intrinsically motivated that child is more likely to engage more positively and more often with that environment, and with that they build competence, which in turn promotes the sense that they are capable of being autonomous (Ntoumanis et al., 2021).”
Biopsychosocial and contextual pressures: Contributions to a metatheoretical disorder theory from neuroscience, evolutionary, developmental, and ecological perspectives
Faustino, B. (2025) · Applied Neuropsychology Adult · doi:10.1080/23279095.2025.2469249 · Cited by 6
Self-determination theory interventions in self-care of cardiovascular disease: A systematic review
Saeedian, Y., Agarwal, A., Jansons, P., Fuller‐Tyszkiewicz, M., & Maddison, R. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.108794 · Cited by 5
Motivation and physical activity across Chinese adolescents: Based on latent profile analysis
Zhao, Y., Wu, Q., & Zheng, W. (2025) · PLoS ONE · doi:10.1371/journal.pone.0328383 · Cited by 8
Defensive reactions to a meat reduction intervention
Graça, J., Fanter, E., Hopwood, C. J., & Hoeks, J. C. J. (2025) · Appetite · doi:10.1016/j.appet.2025.108354 · Cited by 6
Mapping the landscape of teachers’ basic psychological needs: A systematic review of supporting and thwarting factors and associated outcomes
Roa, M. R., Guerrero, P. A., & Vangrieken, K. (2025) · Educational Research Review · doi:10.1016/j.edurev.2025.100739 · Cited by 10
The association between health anxiety and frequency of participation in physical education classes and physical activity in Chinese university students
Xu, B., & Amini, H. (2025) · BMC Public Health · doi:10.1186/s12889-025-25508-9 · Cited by 5
“From the perspective of self-determination theory (SDT), persistent health anxiety may reflect frustration of basic psychological needs for autonomy, competence, and relatedness, which can diminish intrinsic motivation for physical activity [9].”
Leadership
den Broeck, A. V., & Slemp, G. R. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197600047.013.47 · Cited by 6
Dimensionality, Invariance, and Nomological Network of the Need Satisfaction and Frustration Scale (NSFS): An Extensive Psychometric Investigation in a Swedish Work Cohort
Holmquist, S., Stenling, A., Tafvelin, S., Ntoumanis, N., & Schéle, I. (2023) · Journal of Personality Assessment · doi:10.1080/00223891.2023.2258960 · Cited by 6
“Furthermore, there is a growing number of publications addressing the effects of need supportive interventions, including in the work domain (Ntoumanis et al., 2021; Slemp et al., 2021), that require longitudinal comparisons of ratings.”
Self-citation
Pilot Randomized Controlled Trial of Lymfit: A Theory-Guided Exercise Intervention for Young Adults with Lymphoma
Tock, W. L., Johnson, N. A., Andersen, R. E., Salaciak, M., Angelillo, C., Loiselle, C. G., Hébert, M., & Maheu, C. (2024) · Healthcare · doi:10.3390/healthcare12111101 · Cited by 8
“SDT is relevant to understanding the mechanisms of health behavior change, including the maintenance of exercise [27–29].”
BackgroundResult
Autonomy support in an exercise intervention with colorectal cancer patients during chemotherapy: a qualitative perspective
Romero-Elias, M., González‐Cutre, D., Ruiz‐Casado, A., Tortosa‐Martínez, J., & Beltrán‐Carrillo, V. J. (2024) · Psychology and Health · doi:10.1080/08870446.2024.2367984 · Cited by 6
“The findings of this article are in line with the request of Wang and Hagger (2023), who highlighted the need to elucidate the specific techniques used in SDT-based interventions that are more effective and the mechanisms involved, in order to train social agents to adopt autonomy-supportive behaviors.”
Influential
I can't get no (need) satisfaction: Using a relatedness need‐supportive intervention to improve applicant reactions to asynchronous video interviews
Moore, H. I., Dunlop, P. D., Holtrop, D., & Gagné, M. (2024) · International Journal of Selection and Assessment · doi:10.1111/ijsa.12493 · Cited by 7
Examining barriers and reasons for sport retirement in women's soccer: A qualitative study
Flores-Cidoncha, A., Sanz-Remacha, M., González‐Ponce, I., & López-Gajardo, M. Á. (2024) · Women s Studies International Forum · doi:10.1016/j.wsif.2024.103006 · Cited by 5
Healing Through Empowerment and Active Listening: Experience‐Based Co‐Design of a Nurse‐Led Personalised Self‐Care Support Intervention for Primary Care Patients With Diabetic Foot Ulcers
Zhu, X., Lee, E. S., Chan, F. H. F., Yin, R., Koh, R. W. S., Lim, P. X. H., Judith, C., Lim, V. H., Low, R. S. Y., Chen, Y. C., et al. (2025) · Health Expectations · doi:10.1111/hex.70386 · Cited by 5
“SDT has been widely applied in healthcare research, with evidence indicating that greater psychological need support and autonomous motivation are associated with positive changes in health behaviours [22].”
A theory‐driven design framework for smartphone applications to support healthy and sustainable grocery shopping
Blanke, J., Billieux, J., & Vögele, C. (2021) · Human Behavior and Emerging Technologies · doi:10.1002/hbe2.307 · Cited by 6
“Autonomous motivation has been found to be positively influencing changes in health behaviour (Ntoumanis, et al., 2021) as well as sustainability (Schösler, de Boer, & Boersema, 2014).”
Background
Factors influencing the self-management of kidney transplant patients based on self-determination theory: a cross-sectional study
Sim, M. K., Son, S. Y., & Ju, M. K. (2022) · Korean Journal of Transplantation · doi:10.4285/kjt.22.0002 · Cited by 5
“Many published studies have applied SDT to health-related contexts, especially in the fields of physical activity and tobacco abstinence [9].”
Background
Reliability and validity of the Japanese treatment self-regulation questionnaire for Japanese workers
Ishii, K., Morita, K., & Sumita, H. (2022) · BMC Public Health · doi:10.1186/s12889-022-14281-8 · Cited by 5
“The reason for the low reliability of item 10 may be the characteristics of Japanese people [11].”
Background
Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073
Boyd, D. T., Nelson, L. E., Hill, M. J., Whitfield, D. L., Ramos, S. R., Akyirem, S., Emel, L., Wilton, L., Hightow‐Weidman, L., SHOPTAW, S. J., et al. (2023) · AIDS Patient Care and STDs · doi:10.1089/apc.2022.0139 · Cited by 6
“22,23 For example, the results of a randomized controlled trial of an online SDT-based intervention among adolescents in a primary care setting indicated that it produced signiﬁcant increased cardiorespiratory ﬁtness and health-related quality of life, as well as exhibited a preventive effect…”
The Antecedent of E-Learning Adoption
Indriana, I., Alamsyah, D. P., Chang, A., & Sudirman, I. D. (2022) · International Conference on Cybernetics and Intelligent System (ICORIS) · doi:10.1109/icoris56080.2022.10031362 · Cited by 5
“Psychological motivation is generally defined as a process of indirectly increasing the activities of students in supporting their performance [17], [27].”
Background
“A source of empowerment and well-being”: Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders
Högström, S., Eriksson, M. H., Mörelius, E., & Duberg, A. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1040713 · Cited by 8
Retirement planning and types of healthy lifestyle after retirement: a Nationwide Survey in Taiwan
Huang, N.-C., Kuo, P., Hsu, W.-C., & Hu, S. C. (2023) · Health Promotion International · doi:10.1093/heapro/daad044 · Cited by 6
Development and Feasibility Test of a Theory- and Evidence-Based Multicomponent Intervention to Reduce Student Smoking at Danish Vocational Schools
Andersen, S., Holt, D. H., Vinther, J. L., Danielsen, D., Jakobsen, G. S., Holmberg, T., Jensen, M. P., Pisinger, C. H., & Krølner, R. F. (2023) · Youth · doi:10.3390/youth3020047 · Cited by 5
“A recent meta-analysis showed that SDT-informed interventions could change health behaviours, and the authors concluded that these changes were explained by changes in autonomous motivation and perceptions of the need for support [30].”
Background
The Role of Basic Need Satisfaction for Motivation and Self-Regulated Learning During COVID-19
Pelikan, E. R., Grützmacher, L., Hager, K., Holzer, J., Korlat, S., Mayerhofer, M., Schober, B., Spiel, C., & Lüftenegger, M. (2023) · Zeitschrift für Psychologie · doi:10.1027/2151-2604/a000531 · Cited by 5
Evaluation of the reliability and validity of the health regulatory focus scale in Chinese samples
Lyu, X., Yang, T., Fan, Y., Hong, H., & Fu, C. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1215209 · Cited by 6
Self-Determination Theory Applications in Culturally Responsive Voice Therapy
Castro, M. E., Enclade, H., & Biel, M. (2024) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2023_persp-23-00168 · Cited by 5
Evaluating an Adapted Physical Activity Program for University Students and Staff Living with a Physical Disability and/or Chronic Condition through a Self-Determination Theory Lens
Liska, T. M., Pastore, O. L., Bedard, G. D., Ceh, C., Freilich, L., Desjourdy, R., & Sweet, S. N. (2024) · Disabilities · doi:10.3390/disabilities4020024 · Cited by 6
“Moreover, the need-supportive environment of the FAM program likely supported the participants’ satisfaction of autonomy, relatedness and competence, increasing their motivation and LTPA, which is consistent with recent reviews of SDT-based interventions [20,34].”
Immunological Insights Into Nutritional Deficiency Disorders
Azraida, H., Swathi, N. L., & Ali, A. (2024) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/979-8-3693-2947-4.ch004 · Cited by 6
From bars to breakthroughs: the application of self-determination theory to offender programs
Youssef, C. (2024) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789949.2024.2390122 · Cited by 8
“SDT is particularly relevant to long-term behaviour change (Ntoumanis et al., 2021).”

Authors: Ntoumanis, N., Ng, J. Y. Y., Prestwich, A., Quested, E., Hancox, J. E., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Lonsdale, C., & Williams, G. C.
Affiliations: Curtin University (AU)
Chinese University of Hong Kong (HK)
University of Leeds (GB)
University of Nottingham (GB)
School of Psychology, Curtin University, Perth, Australia
University of South-Eastern Norway (NO)
Australian Catholic University (AU)
University of Rochester Medicine (US)
Corresponding author: Ntoumanis, Nikos
ORCID: Ntoumanis, Nikos
Ng, Johan Y.Y.
Prestwich, Andrew
Quested, Eleanor
Hancox, Jennie E.
Thøgersen-Ntoumani, Cecilie
Deci, Edward L.
Ryan, Richard M.
Lonsdale, Chris
Williams, Geoffrey C.
Venue: Health Psychology Review
Publisher: Informa UK Limited
Published: 2020-02-03
Volume: 15
Issue: 2
Pages: 214-244
ISSN: 1743-7199 (ISSN-L)
1743-7202
DOI: 10.1080/17437199.2020.1718529
OpenAlex: W3002054708
Cited by: 1,154
References: 118
Citations by year: 2026: 237 · 2025: 209 · 2024: 181 · 2023: 264 · 2022: 124 · 2021: 107 · 2020: 31
FWCI: 21.15
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (unspecified)
Locations: Health Psychology Review (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Repository@Nottingham (University of Nottingham) (publishedVersion, cc-by-nc-nd)
University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc-nd)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-nd)
Topics: Social Sciences › Psychology › Social Psychology › Motivation and Self-Concept in Sports
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords: self-determination theory, health promotion, disease management, autonomous motivation, need support, controlled motivation, amotivation, health behavior, physical health, mental health
MeSH terms: Health Promotion, Humans, Mental Health, Motivation, Health Behavior, Personal Autonomy

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A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health

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