Self determination theory and preventive care delivery: a Research Involving Outpatient Settings Network (RIOS Net) study.

PURPOSE Traditional approaches to improving preventive care have had limited success. In response, researchers have adopted new ways of examining the primary care environment and clinical encounters to better understand the factors that impact care delivery. We examined how clinicians make preventive counseling decisions to ascertain if self-determination theory (SDT) may further clarify influences on clinicians' decisions to take time for preventive counseling. METHODS We studied clinical decision making through a mixed-method approach using obesity counseling as an example of preventive counseling. We conducted in-depth interviews and focus groups with 30 primary care clinicians in RIOS Net, a Southwestern US practice-based research network and distributed a survey, which was completed by 75% of 195 network members. We then used the components of SDT autonomy, competence, and relatedness to organize the factors that clinicians identified as most influential in their preventive counseling decisions. RESULTS We found that SDT provides an organizing structure for understanding some of the psychology of clinicians' decisions to provide preventive counseling in the brief primary care encounter. In the specific case of obesity counseling clinicians expressed a high degree of autonomy, but barriers to competence and generally low levels of relatedness with professional colleagues seemed to limit their delivery of preventive counseling. CONCLUSION SDT provides a new perspective on factors that impact preventive counseling delivery, with a focus on the psychology of clinical decision making. Further research testing the predictive value of SDT may open new avenues for enhancing the delivery of preventive services.