Patient-initiated Strategies for Self-management of Depression and Low Mood: Understanding Theory and Changing Behaviour

Abstract

Background: Depression is a major health concern and self-management of depressive symptoms using patient-initiated strategies has the potential to reduce the burden of this condition. A better understanding of behaviour change related to these patient-initiated strategies is needed. Method: This randomized controlled trial study used an online survey and Knowledge Translation and Transfer theory-based educational intervention to examine the Theory of Planned Behavior model in the context of nine patient-initiated strategies for the self-management of depression and low mood. Results: Perceived Behavioural Control was identified as the single greatest predictor of Intentions to engage in strategies. Attitudes predicted Intentions to a lesser degree. Subjective Norms were not identified as unique predictors. Theory of Planned Behavior antecedent variables together explained over one third of the variance in Intentions. Intentions to engage in patient-initiated strategies were shown, in some cases, to significantly predict actual engagement in strategies. Level of depressive symptoms did not meaningfully impact any of the antecedent variables or Intentions. Results also suggest that an educational intervention based on Knowledge Translation and Knowledge Transfer principles significantly improved both Attitudes and Subjective Norms – Physician towards patient-initiated strategies. Perceived Behavioural Control and Intentions were not improved as a result of the educational intervention. Theoretical Conclusions: Findings suggest that the Theory of Planned Behavior functions well in the context of patient-initiated strategies for depression and low mood. Perceived Behavioural Control was identified as the greatest predictor of Intentions to engage in patient-initiated strategies. Results also suggest mood difficulties are not captured by the model’s antecedent variables but instead should be included as an additional variable in this model. The findings of the current study support an integrated model of Knowledge Translation and Transfer and Theory of Planned Behavior. Practical Conclusions: The current study’s findings provide a better understanding of behaviour change in the context of patient-initiated strategies and will help guide interventions aimed at improving engagement in these behaviours. Findings also provide support and recommendations for the use of Knowledge Translation and Transfer theory-based educational interventions to improve self-management of depression and low mood.