Health-Care Self-Determination Theory Packet

Abstract

The Health-Care Self-Determination Theory Questionnaire Packet is a carefully curated compilation of three established psychological instruments designed to measure motivational and environmental factors related to health behaviors, all grounded in Self-Determination Theory (SDT). Developed by Geoffrey C. Williams, Richard M. Ryan, and Edward L. Deci, this packet includes the Treatment Self-Regulation Questionnaire (TSRQ), the Perceived Competence Scale (PCS), and the Health Care Climate Questionnaire (HCCQ). The primary utility of this packet is its focus on specific health-relevant actions, with versions tailored for smoking cessation, diet improvement, regular exercise, and responsible alcohol use.

The scales collectively evaluate a patient’s degree of autonomous motivation, their confidence in achieving health goals, and their perception of autonomy support from their health-care providers.

Keywords

Self-Determination Theory, SDT, Treatment Self-Regulation Questionnaire, TSRQ, Perceived Competence Scale, PCS, Health Care Climate Questionnaire, HCCQ, autonomous motivation, controlled motivation, health behavior change, health care climate, perceived autonomy support.

Authors

Geoffrey C. Williams, Richard M. Ryan, Edward L. Deci

Purpose

The central purpose of the Health-Care Self-Determination Theory Packet is to provide researchers and clinicians with integrated tools to assess the psychological processes underlying patient engagement and maintenance of healthy behaviors. These tools operationalize key SDT constructs within the demanding context of health care, helping to predict long-term adherence to medical advice and positive health outcomes.

The packet allows for simultaneous assessment of three critical psychological components: the quality of motivation (TSRQ), the patient’s belief in their capability (PCS), and the interpersonal context provided by their health-care providers (HCCQ). By combining these measures, the packet supports research into building effective, autonomy-supportive health-care partnerships.

Construct

The packet measures three distinct but interrelated constructs, forming a comprehensive assessment of the motivational environment in health care:

• Treatment Self-Regulation Questionnaire (TSRQ): This measures the degree of perceived autonomy underlying an individual’s engagement in a specific health behavior or treatment. It distinguishes between autonomous regulatory style (self-determined motivation, associated with better outcomes) and controlled regulatory style (driven by external pressures or internal obligation/guilt). It also includes a dimension for amotivation (lack of intention or motivation).

• Perceived Competence Scale (PCS): This is a short, four-item measure of perceived efficacy. It assesses the extent to which participants feel capable, confident, and able to successfully initiate or maintain a target healthy behavior or treatment regimen. Perceived competence is theoretically distinct from perceived autonomy but is a strong predictor of behavior change.

• Health Care Climate Questionnaire (HCCQ): This measures the patient’s perception of the interpersonal style of their health-care provider(s). It assesses the degree to which providers are experienced as autonomy supportive (e.g., offering choices, listening, understanding the patient’s perspective) versus controlling.

Validity

The scales within the packet have demonstrated strong validity, particularly in their ability to predict maintained behavior change, which is a key focus of SDT application in health. The autonomous style measured by the TSRQ has been consistently linked to long-term adherence (e.g., medication adherence, glucose control in diabetic patients) and positive health outcomes.

Crucially, studies confirm the discriminative validity of the constructs, showing that perceived autonomy (TSRQ) and perceived competence (PCS) are separate yet functionally related predictors of health outcomes. The theoretical structure of the TSRQ itself was formally validated across multiple health behaviors in 2007 (Levesque et al., 2007).

Reliability

Internal consistency data for the scales indicate high reliability across various health contexts:

• The Perceived Competence Scale (PCS) consistently reports high alpha reliability, typically around 0.90.
• The full 15-item version of the Health Care Climate Questionnaire (HCCQ) consistently yields an alpha reliability coefficient greater than 0.90.
• The 6-item short form of the HCCQ, included in this packet, is also highly reliable, with reported alpha coefficients of approximately 0.82.

Factor Analysis

The Treatment Self-Regulation Questionnaire (TSRQ) is explicitly designed to reflect the multi-dimensional nature of motivation articulated by Ryan and Connell (1989). The 15-item version contains items loading onto three distinct subscales: autonomous motivation (6 items), controlled motivation (6 items), and amotivation (3 items). These factors are positioned along the relative autonomy continuum, confirming the scale’s theoretical structure.

The use of the shorter 6-item version of the HCCQ is often favored in advanced statistical analyses, such as Structural Equation Modeling, where fewer indicators are needed to define the latent variable of perceived autonomy support, suggesting that the short form maintains a clean factor structure reflecting the overall climate.

Instrument

Test Type: Self-report psychological questionnaire packet.

Format: Three questionnaires (TSRQ, PCS, HCCQ). All items use a 7-point Likert scale, typically ranging from 1 (“not at all true”) to 7 (“very true”). The packet includes four versions of each scale, tailored for specific behaviors (smoking, diet, exercise, alcohol use).

Language Available: English (Original version).

Population Group: Patients, individuals, and outpatients engaged in health-related behavior change, adherence to treatment, or disease management.

Age Group: Adolescents and Adults (studies include teenage smoking cessation and adult diabetic patients).

Population Details: Widely used in clinical and health research settings including primary-care physician visits, weight-loss programs, diabetes treatment centers, and substance abuse treatment.

Test Methodology: Subscales are scored by averaging item responses. For the TSRQ, a separate Relative Autonomous Motivation Index can be calculated by subtracting the average controlled motivation score from the average autonomous motivation score.

Keywords

Health behavior, self-regulation, motivation, autonomy support, perceived competence, smoking cessation, exercise, diet, alcohol use, psychological assessment.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content. (Developed primarily by researchers affiliated with the University of Rochester.)

Permissions & Fee and Test Year

The scales are generally available for academic research purposes, often found on the official Self-Determination Theory website (linked in the source content). Specific fee information is not provided in the source text, but the packet structure was established to make the three critical health-care scales readily accessible for researchers.

The scales included represent tools developed and validated primarily between 1995 and 2007, building upon the foundational work of Deci & Ryan (1985).

Reference’s

Deci, E. L., & Ryan, R.M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum Publishing Co.

Levesque, C. S., Williams, G. C., Elliot D., Pickering, M. A., Bodenhamer, B., & Finley, P. J (2007). Validating the theoretical structure of the treatment self-regulation questionnaire (TSRQ) across three different health behaviors. Health Education Research, 21, 691-702.

Pelletier, L. G., Tuson, K. M., & Haddad, N. K. (1997). Client Motivation for Therapy Scale: A measure of intrinsic motivation, extrinsic motivation and amotivation for therapy. Journal of Personality Assessment, 68, 414-435.

Ryan, R. M., & Connell, J. P. (1989). Perceived locus of causality and internalization: Examining reasons for acting in two domains. Journal of Personality and Social Psychology, 57, 749-761.

Ryan, R. M., Plant, R. W., & O’Malley, S. (1995). Initial motivations for alcohol treatment: Relations with patient characteristics, treatment involvement and dropout. Addictive Behaviors, 20, 279-297.

Williams, G. C., Cox, E. M., Kouides, R., & Deci, E. L. (1999). Presenting the facts about smoking to adolescents: The effects of an autonomy supportive style. Archives of Pediatrics and Adolescent Medicine, 153, 959-964.

Williams, G. C., Deci, E. L., & Ryan, R. M. (1998). Building Health-Care Partnerships by Supporting Autonomy: Promoting Maintained Behavior Change and Positive Health Outcomes. In A. L. Suchman, P. Hinton-Walker, & R. Botelho (Eds.) Partnerships in healthcare: Transforming relational process (pp. 67-87). Rochester, NY: University of Rochester Press.

Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting autonomy to motivate glucose control in patients with diabetes. Diabetes Care, 21, 1644-1651.

Williams, G. C., Gagné, M., Ryan, R. M., & Deci, E. L. (1999). Supporting autonomy to motivate smoking cessation: A test of self-determination theory. Unpublished manuscript, University of Rochester.

Williams, G. C., Grow, V. M., Freedman, Z., Ryan, R. M., & Deci, E. L. (1996). Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology, 70, 115-126.

Williams, G. C., Rodin, G. C., Ryan, R. M., Grolnick, W. S., & Deci, E. L. (1998). Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychology, 17, 269-276.

Zeldman, A., Ryan, R. M., & Fiscella, K. (1999). Attitudes, beliefs and motives in addiction recovery. Unpublished manuscript, University of Rochester.

Items of the Health-Care‚ Self-Determination Theory Packet

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Treatment Self-Regulation Questionnaire (TSRQ)

(Concerning Motivation for Healthy Behaving)

TSRQ (Smoking)

The following question relates to the reasons why you would either stop smoking or continue not smoking. Different people have different reasons for doing that‚ and we want to know how true each of the following reasons is for you. All 15 response are to the same question.

Please indicate the extent to which each reason is true for you‚ using the following 7-point scale:

The reason I would not smoke is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I smoked.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I smoked.
5. I really don’t think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I smoked.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to not smoke.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don’t really know why.

TSRQ (Diet)

The following question relates to the reasons why you would either start eating a healthier diet or continue to do so. Different people have different reasons for doing that‚ and we want to know how true each of the following reasons is for you. All 15 response are to the same question.

Please indicate the extent to which each reason is true for you‚ using the following 7-point scale:

The reason I would eat a healthy diet is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I did not eat a healthy diet.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I did not.
5. I really don’t think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I did not eat a healthy diet.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to do so.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don’t really know why.

TSRQ (exercise)

The following question relates to the reasons why you would either start to exercise regularly or continue to do so. Different people have different reasons for doing that‚ and we want to know how true each of the following reasons is for you. All 15 response are to the one question.

Please indicate the extent to which each reason is true for you‚ using the following 7-point scale:

The reason I would exercise regularly is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I did not exercise regularly.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I did not.
5. I really don’t think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I did not exercise regularly.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to do so.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don’t really know why.

TSRQ (alcohol)

The following question relates to the reasons why you would control your use of alcohol. Different people have different reasons for doing that‚ and we want to know how true each of the following reasons is for you. All 15 response are to the one question.

Please indicate the extent to which each reason is true for you‚ using the following 7-point scale:

The reason I would use alcohol responsibly is:

1. Because I feel that I want to take responsibility for my own health.
2. Because I would feel guilty or ashamed of myself if I did not use alcohol responsibly.
3. Because I personally believe it is the best thing for my health.
4. Because others would be upset with me if I did not.
5. I really don’t think about it.
6. Because I have carefully thought about it and believe it is very important for many aspects of my life.
7. Because I would feel bad about myself if I did use alcohol responsibly.
8. Because it is an important choice I really want to make.
9. Because I feel pressure from others to do so.
10. Because it is easier to do what I am told than think about it.
11. Because it is consistent with my life goals.
12. Because I want others to approve of me.
13. Because it is very important for being as healthy as possible.
14. Because I want others to see I can do it.
15. I don’t really know why.

* * * * * * * * * * * * * * * * *

Perceived Competence Scales (PCS)

Perceived Competence (Not Smoking)

Please indicate the extent to which each statement is true for you‚ assuming that you were intending either to permanently quit smoking now or to remain permanently abstinent from smoking. Use the following scale:

1. I feel confident in my ability to not smoke.
2. I now feel capable of not smoking.
3. I am able to not smoke anymore.
4. I am able to meet the challenge of not smoking.

Perceived Competence (Maintaining a Healthy Diet)

Please indicate the extent to which each statement is true for you‚ assuming that you were intending either to permanently improve your diet now or to maintain a healthy diet. Use the following scale:

1. I feel confident in my ability to maintain a healthy diet.
2. I now feel capable of maintaining a healthy diet.
3. I am able to maintain a healthy diet permanently.
4. I am able to meet the challenge of maintaining a healthy diet.

Perceived Competence (Exercising Regularly)

Please indicate the extent to which each statement is true for you‚ assuming that you were intending either to begin now a permanent regimen of exercising regularly or to permanently maintain your regular exercise regimen. Use the following scale:

1. I feel confident in my ability to exercise regularly.
2. I now feel capable of exercising regularly.
3. I am able to exercise regularly over the long term.
4. I am able to meet the challenge of exercising regularly.

Perceived Competence (Using Alcohol Responsibly)

Please indicate the extent to which each statement is true for you‚ assuming that you were intending either to begin now permanently abstaining from alcohol use‚ to begin permanently using alcohol responsibly‚ or to permanently maintain your current abstinence or responsible use of alcohol. Use the following scale:

1. I feel confident in my ability to use alcohol responsibly.
2. I now feel capable of using alcohol responsibly.
3. I am able to use alcohol responsibly over the long term.
4. I am able to meet the challenge of using alcohol responsibly.

* * * * * * * * * * * *

Health Care Climate Questionnaire (HCCQ)

HCCQ (Not Smoking)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your smoking was discussed in any way. Health-care practitioners (doctors‚ nurses‚ counselors‚ etc.) have different styles in dealing with patients‚ and we would like to know very specifically about your experience of your provider(s) in any encounters when your smoking was discussed. Your responses will be kept confidential‚ so none of your practitioners will know about your responses. Please be honest and candid. In some cases‚ you may have met with only your physician; in other cases you may have discussed your smoking with several people. If you have met only with your physician‚ please respond with respect to him or her; if you have met with several practitioners concerning this issue‚ please answer in terms of your experience of all these practitioners together.

In answering the questions‚ please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about smoking (including not quitting).
2. I feel my health-care providers understand how I see things with respect to my smoking.
3. My health-care providers convey confidence in my ability to make changes regarding my smoking
4. My health care practitioners listen to how I would like to do things regarding my smoking.
5. My health-care practitioners encourage me to ask questions about my smoking.
6. My health-care practitioners try to understand how I see my smoking before suggesting any changes.

HCCQ (Healthy Diet)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your diet was discussed in any way. Health-care practitioners (doctors‚ nurses‚ counselors‚ etc.) have different styles in dealing with patients‚ and we would like to know very specifically about your experience of your provider(s) in any encounters when your diet was discussed. Your responses will be kept confidential‚ so none of your practitioners will know about your responses. Please be honest and candid. In some cases‚ you may have met with only your physician; in other cases you may have discussed your diet with several people. If you have met only with your physician‚ please respond with respect to him or her; if you have met with several practitioners concerning this issue‚ please answer in terms of your experience of all these practitioners together.

In answering the questions‚ please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about changing my diet (including not changing).
2. I feel my health-care providers understand how I see things with respect to my diet.
3. My health-care providers convey confidence in my ability to make changes regarding my diet.
4. My health care practitioners listen to how I would like to do things regarding my diet.
5. My health-care practitioners encourage me to ask questions about my diet.
6. My health-care practitioners try to understand how I see my diet before suggesting any changes.

HCCQ (Exercising Regularly)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your exercising was discussed in any way. Health-care practitioners (doctors‚ nurses‚ counselors‚ etc.) have different styles in dealing with patients‚ and we would like to know very specifically about your experience of your provider(s) in any encounters when your exercising was discussed. Your responses will be kept confidential‚ so none of your practitioners will know about your responses. Please be honest and candid. In some cases‚ you may have met with only your physician; in other cases you may have discussed your diet with several people. If you have met only with your physician‚ please respond with respect to him or her; if you have met with several practitioners concerning this issue‚ please answer in terms of your experience of all these practitioners together.

In answering the questions‚ please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about exercising regularly (including not exercising regularly).
2. I feel my health-care providers understand how I see things with respect to my exercising regularly.
3. My health-care providers convey confidence in my ability to make changes regarding my exercising regularly
4. My health care practitioners listen to how I would like to do things regarding my exercise.
5. My health-care practitioners encourage me to ask questions about my exercising.
6. My health-care practitioners try to understand how I see my exercising before suggesting any changes.

HCCQ (Using Alcohol Responsibly)

This questionnaire contains items that are related to your visits with a health-care practitioner (or group of practitioners) in which your use of alcohol was discussed in any way. Health-care practitioners (doctors‚ nurses‚ counselors‚ etc.) have different styles in dealing with patients‚ and we would like to know very specifically about your experience of your provider(s) in any encounters when your alcohol use was discussed.

Your responses will be kept confidential‚ so none of your practitioners will know about your responses. Please be honest and candid. In some cases‚ you may have met with only your physician; in other cases you may have discussed your alcohol use with several people. If you have met only with your physician‚ please respond with respect to him or her; if you have met with several practitioners concerning this issue‚ please answer in terms of your experience of all these practitioners together.

In answering the questions‚ please use the following scale:

1. I feel that my health-care practitioners have provided me with choices and options about using alcohol responsibly (including not changing my drinking).
2. I feel my health-care providers understand how I see things with respect to my using alcohol responsibly.
3. My health-care providers convey confidence in my ability to make changes regarding my use of alcohol
4. My health care practitioners listen to how I would like to do things regarding my responsible use of alcohol.
5. My health-care practitioners encourage me to ask questions about my alcohol use.
6. My health-care practitioners try to understand how I see my use of alcohol before suggesting any changes.