Categories: Healthcare Education, Physiotherapy

Evaluating a Self-Determination Theory–Based Module to Improve Physiotherapy Students’ Interaction Styles: A Quasi-Experimental Study

Evaluating a Self-Determination Theory–Based Module to Improve Physiotherapy Students’ Interaction Styles: A Quasi-Experimental Study

Introduction

Effective interaction between health care professionals (HCPs) and patients with chronic diseases shapes motivation, adherence, and health outcomes. The Self-Determination Theory (SDT) provides a framework for understanding how HCPs’ interaction styles support or thwart patients’ basic psychological needs—autonomy, competence, and relatedness. A growing body of work suggests that SDT-based training can foster more need-supportive, patient-centered care. This article summarizes a quasi-experimental study that evaluated a SDT-based course module integrated into the physiotherapy curriculum, with the goal of improving students’ (de)motivating interaction styles and related self-management competencies.

Background: interaction styles and self-management support

SDT distinguishes four interaction styles: autonomy-support and structure (motivating) and control and chaos (demotivating). Autonomy-supportive HCPs acknowledge patients’ interests and offer meaningful choices, while structure emphasizes guidance that enhances patients’ competence. Conversely, controlling interactions pressure patients, and chaotic interactions leave them uncertain. The study also situates these styles within the 5As model of behavior change — assess, advise, agree, assist, arrange — which underpins self-management support.

Why physiotherapy students?

Physiotherapists play a pivotal role in helping patients self-manage chronic conditions, yet prior work shows physiotherapists’ competencies in supporting self-management are suboptimal. Training future practitioners to apply SDT-based interaction styles can translate theory into practice during internships and clinical care.

Method: design and intervention

The study used a nonequivalent pre-test post-test control group design with two Flemish Belgian universities. First-year Master of Science in Rehabilitation Sciences and Physiotherapy students were assigned to an intervention group (Ghent University) or a control group (Hasselt University). The intervention consisted of an SDT-based module embedded in the existing course “Exercise is Medicine,” including theoretical content (SDT, behavior change theories) and a practical, reflective component designed to promote self-reflection and peer feedback. The module culminated in video-recorded treatment sessions analyzed with the COUNSEL-CCE tool to assess interactions, followed by reflective cycles using the Korthagen and Vasalos framework.

The control condition lacked the SDT content but included standard internship feedback and CanMEDS-based communication assessments. Data were collected at baseline and after three months. Primary outcomes were the four interaction styles measured by the SIS-HCP questionnaire. Secondary outcomes covered SDT-based beliefs (effectiveness and feasibility) and self-management support competencies (SEPSS-36).

Results: what changed after the SDT-based module?

Analyses revealed a positive Group*Time effect for several key outcomes. Notably, intervention participants showed increased autonomy-support in the post-measure, indicating a shift toward more inviting language and greater offering of meaningful choices. This change held even when accounting for baseline differences, suggesting a meaningful impact of the SDT-based module beyond initial levels. A similar trend emerged for the structuring interaction style, though the effect was only marginal after correction for multiple testing.

Demotivating styles declined more in the intervention group than in controls. In contrast, the control group exhibited a rise in both control and chaotic styles over time, underscoring the risk of drift toward demotivating interactions without targeted training. Secondary outcomes also supported the intervention’s promise: effectiveness beliefs about SDT-based strategies and self-management support self-efficacy improved in the intervention group. Some feasibility beliefs and performance subscales did not show Group*Time differences, possibly reflecting broader educational gains in the control group or a focus of the module on SDT principles rather than every self-management subskill.

Discussion: implications for healthcare education

The study demonstrates that embedding SDT-based training within physiotherapy education can enhance future practitioners’ capability to engage in need-supportive interactions. The observed improvements in autonomy-support and reductions in demotivating styles align with SDT’s predictions and point to potential downstream benefits for patient motivation and adherence. While the structuring style’s gains were less robust after correction, the overall pattern supports integrating theory-based communication training with practical reflection and feedback, including video-based assessment.

Key strengths include a theory-grounded design, validated measures, and a robust mixed-model approach that leverages incomplete data. Limitations involve reliance on self-reports, short follow-up, and non-randomized group allocation, which may affect generalizability. Future work could incorporate care recipient feedback, examine long-term effects, and extend the approach to other health professions and contexts.

Practical implications

Healthcare education stakeholders should consider integrating SDT-based modules into curricula to strengthen HCPs’ interaction styles and self-management support competencies. The module’s mix of lectures, reflective exercises, peer feedback, and video-based practice is adaptable to both on-campus and online formats, enabling broader reach with scalable training. Privacy considerations for video recordings are essential, but alternative feedback mechanisms—such as post-session care recipient surveys—could mitigate barriers.

Conclusion

The SDT-based course module appears effective in enhancing physiotherapy students’ need-supportive interaction styles and related self-management competencies. While further research is needed to confirm durability and transfer to clinical practice, these findings support adopting theory-driven, reflective training to improve patient-centered care in physiotherapy and potentially other health professions.