Self-determination theory interventions in self-care of cardiovascular disease: A systematic review.

Abstract

Cardiovascular disease (CVD) is a leading cause of death and disability worldwide. Effective self-care behaviours are critical for the secondary prevention of CVD, however many individuals fail to engage in these self-care activities in the long-term. Self-determination theory (SDT) offers a robust theoretical framework for understanding motivations for engaging in self-care. SDT-based interventions may improve self-care in people with CVD but has yet to be systematically reviewed. A systematic review was conducted to determine the effectiveness of SDT-based interventions on global measures of self-care of CVD, as well as specific self-care activities. A literature search was conducted in August 2024 using MEDLINE, CINAHL, Embase, Global Health, APA PsycINFO, and SocINDEX. The inclusion criteria involved randomised controlled trials and cluster randomised trials that tested the effect of SDT-based interventions on self-care activities among adults with CVD. A total of 251 publications were screened and 7 studies included in the review. Results revealed inconsistent application of SDT principles across the included studies. While some incorporated all psychological needs according to SDT, others focused on only selected needs. Nevertheless, supporting people's autonomy emerged as a consistent core component across all interventions. Three studies reported improvements in global self-care, two found improvements in physical activity, while one found no significant effect on physical activity, and another found no significant effect on dietary habits and smoking behaviours. There was considerable variation in the measurement of self-care with some studies focussed on global measures, while others targeted specific aspects of self-care such as diet or exercise, which prohibited meta-analysis. Findings from this systematic review showed that SDT-based intervention demonstrated potential for enhancing self-care in individuals with CVD. However, the limited number of eligible studies and methodological heterogeneity preclude definitive conclusions about their effectiveness for improving self-care. Healthcare professionals should foster competence, relatedness, and autonomy support while adopting a holistic approach to self-care. Combining group and one-to-one interventions and integrating health education and goal-setting can promote maintained self-care adherence.