Geoffrey Williams of the University of Rochester made a provocative statement at the recent Hx Refactored conference. He argued that if we really believe in a self-determination theory of motivation for health behavior change, then we can’t make a specific behavior the sign that an intervention has been successful.
Instead, he stated, a successful outcome is that the person feels empowered to make a choice for himself, even if that choice is not the one you recommend.
The outcome of a health intervention in this model could be giving the patient autonomy and choice, NOT the achievement of a health goal. If the patient is empowered to refuse treatment or choose non-compliance, that is also success, as long as they are doing so under their own volition because they have gained the knowledge, skills, or confidence to do so.
Williams also talked about a concept called volitional non-adherence, which is when a patient fails to take medication as described because they choose not to. While volitional non-adherence may be the result of factors like dislike of side effects, disbelief in the efficacy of a drug, or distrust in a diagnosis (as described by Laurie Bauman), it could also happen simply because a patient decides to make it so. It gets back to the question of whether we can or should impose our health goals on patients; Williams argues not only that we should not, but that we can take their rejection of these goals in favor of their own as a sign that our intervention was successful.
What do you think?