Using self-determination theory to understand the social prescribing process: a qualitative study

Sara Bhatti; Jennifer Rayner; Andrew D Pinto; Kate Mulligan; Donald C Cole

doi:10.3399/BJGPO.2020.0153

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Figure 1. Theoretical framework of self-determination theory applied to the social prescribing pathway.
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Figure 2. The Alliance for Healthier Communities' Model of Health and Wellbeing.

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Table 1. Patient participant characteristics (N = 96)

Characteristics	n	%
Age, years
26–40	11	11.5
41–60	24	25.0
61–80	55	57.3
≥81	6	6.3
Sex
Female	59	61.5
Male	29	30.2
Other (intersex, transgender, two spirit, other)	8	8.3
Income
$0–$39 999	56	58.3
$40 000–$59 999	14	14.6
$60 000–$150 000	5	5.2
Other (do not know, prefer not to answer)	21	21.9
Education
No formal education	2	2.1
Primary or equivalent	9	9.4
Secondary or equivalent	49	51.0
Post-secondary or equivalent	21	21.9
Other (do not know, prefer not to answer)	15	15.6
Household composition
Multiple occupants	52	54.2
Single	28	29.2
Other (do not know, prefer not to answer)	16	16.7
Ethnic group
White	63	65.6
Black	5	5.2
Asian	4	4.2
Indigenous	2	2.1
Latin American	3	3.1
Middle Eastern	1	1.0
Other (do not know, prefer not to answer)	18	18.8

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Table 2. Context subthemes with examples (n = 18/29 transcripts)

Subtheme	Examples
Individualised care(n = 12/29 transcripts)	'They always make you feel like--when you go there, especially the medical side, they make you feel like […] you have their undivided attention and they seem to be--you know, they’re concerned for your wellbeing. It makes you feel good when you go to them, because nothing worse than going to a doctor and feeling like, oh, you’re just a number …' (Centretown patient)
CHC is a safe space(n = 6/29 transcripts)	'Yes, another thing that I find for which I’m very grateful and surprised is how understanding people here are. It’s about one of the very few places that I feel welcome and respected as I am.' (Centretown patient)

CHC = community health centre.

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Table 3. Processes and relevance to self-determination theory components (n = 18/29 transcripts)

Subtheme	Examples	SDT component(s) ^a
Aligned with interests(n = 18/29 transcripts)	' I’m diabetic, so type 2 diabetes and the stress eating one was referred to me by my doctor because she knew that I had at the time a very stressful call centre job, so--and you have a tendency to just eat while you’re stressed and I had an interest in controlling it.' (Centretown patient) '[…] I had been hesitant to volunteer about doing something specifically, committing--for a variety of my own personal reasons, so this idea of being able to give back in a way that I was comfortable with, that wasn’t dictated to me in any way, that could draw upon my strengths, my needs, and could be fairly flexible. That was one of the things I was looking for.' (South Georgian Bay health champion)	A, C
Supportive staff(n = 18/29 transcripts)	'I’m not a very trustful person, and I’m not a very open person, to be honest, even though it may seem it. They just--they seemed to be more--I don’t know, they just give you more a sense of comfort and that they’re not there to say, okay, well you should have done this, this and this, or you should do this, kind of more bossy or anything. They seemed more open to things and more willing to sit there and listen to you, and not--like, I’ve had doctors in the past where I’ve been in an abusive relationship and I’m afraid to say anything to them, where with these guys I’m more willing to sit there and tell them what’s going on, if there’s something wrong, and not worry that they’re going to judge me or force me to do something that I may not be ready to do at the time.' (West Elgin patient) 'Yes, another thing that I find for which I’m very grateful and surprised is how understanding people here are. It’s about one of the very few places that I feel welcome and respected as I am.' (Centretown patient)	R

^aA = autonomy. C = competence. R = relatedness. SDT = self-determination theory.

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Table 4. Outcomes and relevance to self-determination theory components (n = 25/29 transcripts)

Subtheme	Examples	SDT component(s) ^a
Social connections(n = 24/29 transcripts)	'For myself, when I first started coming here, they gave me the opportunity to understand what the situation was, to understand what stress is, what type of stresses there were, and they gave me all these tools to how to help. But along with that, just within the groups I found that it’s not just attacking stress, it’s the friendships there that I’ve gained, the community, the laughter, everything attributes to this problem that they never mentioned in the course. These are things that also would help my stress.' (Centretown patient)	C, R
Sense of community(n = 14/29 transcripts)	'By giving of my time, I have felt much more integrated into the community … So by going out and doing things, I have felt--multiple things, not just this volunteer work, I feel like I’m getting back to being myself, to establishing what I used to be … and this is feeling like home.' (South Georgian Bay health champion)	C, R
Improvement in self-management of health (n = 15/29 transcripts)	'Sometimes you can feel so overwhelmed by the challenges you’re facing, but when you get involved with a group and with other people and you share, it can just be totally transforming of your life.' (Centretown patient)	C, R
Improvement in mental health (n = 25/29 transcripts)	'So this is kind of giving me a feeling of, you know what, you’re not useless. You don’t need a computer to be useful. There are other ways you can be useful and helpful, so that’s really important to me because it’s been many years for me now since I’ve really felt like, yeah, you know what, if I don’t have my part-time evening job, there’s something else that I can do.' (Guelph health champion)	C
Positive impact on others(n = 12^b/29 transcripts)	'[…] it makes me feel good because I feel like I have helped other people, and that they are getting something from something that I’m doing. So it’s very valuable to the other people, and by them feeling good, it makes me feel like I’ve done something good.' (Belleville and Quinte West health champion)	B

^aB = beneficence. C = competence. R = relatedness. SDT = self-determination theory.
^b100% of health champion transcripts mentioned beneficence.

Supplementary Data

BJGPO.2020.0153.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.