Date of Award

Spring 2010

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Richardean Benjamin

Committee Member

Linda Lilley

Committee Member

Harry Zhang


Problem statement. Behavioral intervention is used to improve adherence with medication in patients with cardiovascular diseases (CVD), but the effect was not sustainable. Patient-centered care (PCC) as a consumer movement has gained acceptance, but it lacks a theoretical framework. Self-determination theory (SDT) may provide an alternative to improve patients' adherence to chronic cardiovascular medication, as well as a theoretical framework for PCC. Both approaches to CVD management have not been evaluated.

Methods. The study was a quasi-experimental pretest posttest comparison design with consecutive sampling of a hospitalized cardiac patient population. Sixty patients each for the usual care (UC) group and the PCC group were recruited. The patient sample consisted of 83% Caucasian, 39% female, 93% insured, an average age of 68 years old, 43% had a NYHF classification of three and above, and an average of 9.7 prescriptions at discharge. A medication teaching intervention was supported by an interactive system designed for PCC. The intervention addressed patients' socioeconomic needs, health literacy adequacy, illness level, timing and amount of teaching, and psychological needs for competence, relatedness, and autonomous motivation. Patients were surveyed once before discharged from the hospital and once three months post discharge.

Results. The SDT motivation variables (perceived competence, perceived autonomous support and autonomous motivation) were significantly correlated with the adherence index. Stepwise multivariate regression analyses identified autonomous motivation as an independent predictor of adherence index, along with age, insurance coverage, adverse drug reaction, adequate health literacy, illness level and number of prescription doses taken per day. Patients in the PCC group had significantly higher scores on all three SDT motivation variables, adherence index and higher portion of adherence status than patients in the UC group. Sequential logistic regression analyses reported that PCC intervention, perceived competence and autonomous motivation were independent predictors of adherence status, as well as adverse drug reaction, illness level and number of doses taken per day.

Conclusion. Self-determination theory helped to explicate patients' adherence behavior. A patient-centered care environment designed with SDT improved patients autonomous motivation, which improved cardiac patients' adherence to CVD medications.