Self-Determination Theory-based behavior change techniques were rated as highly important by Brazilian hospital physical therapists but used inconsistently, with a 14 percentage point application gap.
Cross-Sectional (n=203)
Yes
Brazilian hospital-based physical therapists report high theoretical recognition of SDT-based behavior change techniques but demonstrate variable implementation, highlighting a need for professional development in structured motivational strategies.
Abstract Rationale Physical inactivity and insufficient exercise guidance are common in hospital settings, increasing readmission risk but also presenting a critical opportunity to promote behavior change. Grounded in Self-Determination Theory (SDT), supporting patients’ basic psychological needs (BPNs) (autonomy, competence, and relatedness) enhances their motivation for physical activity. Physical Therapists (PTs) are central to this process but often rely on intuitive rather than structured behavioral strategies. Therefore, this study examined how hospital-based PTs apply SDT-based Behavior Change Techniques (BCTs). The objective was to assess the knowledge and application of BCTs among Brazilian PTs working in hospitals. Methods An electronic survey study was conducted. The questionnaire assessed the use and relevance of 22 SDT-based BCTs on a Likert scale. Inclusion criteria required PTs to be actively employed in Brazilian hospitals, providing care to adult and geriatric patients, with a minimum of one month of experience, proficiency in Brazilian Portuguese, and possession of a valid, active professional license. Descriptive statistical analysis was used. Results A total of 203 individuals participated (59% female, 31±8 years old, 6±7 years of experience). Significantly, 164 (80%) of participants reported no knowledge of any behavior change technique. All techniques were rated as highly important (74-95%) but were used inconsistently (35-92%), with an average gap of + 14 percentage points (p.p.) between perceived importance and actual application. The most frequently applied techniques were recognizing patients’ perspectives (92%), active listening (91%), and unconditional support (88%). The least applied included providing continuous support materials (35%), shared planning (46%), and group activities (46%). Gaps were smallest for interpersonal strategies (+0.5 to + 6 p.p.) and largest for structured/autonomy-supportive techniques (+25-47 p.p.). Competence-supportive techniques showed the lowest mean use (65.9%) and the largest mean gap (+22.5 p.p.), followed by autonomy-supportive (66.2%, +17.5 p.p.) and relatedness-supportive techniques (78.8%, +10.3 p.p.). Techniques involving empathy showed high use (≥85%), while organizational strategies were less frequent (35-55%). By practice mode, intuitive/interpersonal techniques (n = 8) showed higher mean use (74%) and smaller gaps (+6 p.p.) than deliberate/structured techniques (n = 14; 68%, +20 p.p.). Conclusions Brazilian hospital-based PTs report high theoretical recognition of SDT-based BCTs but demonstrate variable implementation in practice. Interpersonal and relational strategies are commonly applied, while competence-supportive and structured techniques show the lowest use and largest gaps. These findings underscore the urgent need for professional development focused on deliberate, SDT-based motivational and communication strategies in hospital rehabilitation. This abstract is funded by: FAPESC
Karloh et al. (Fri,) conducted a cross-sectional in Hospital-based Physical Therapists (n=203). Self-Determination Theory-based behavior change techniques were rated as highly important by Brazilian hospital physical therapists but used inconsistently, with a 14 percentage point application gap.