Innate psychological needs of autonomy, competence, and provider communication as determinants of patients' satisfaction and self-rated health.

Background: Reports from patient experience and satisfaction surveys are currently being used to target health quality improvement. The patient's healthcare experience is indicative of the interpersonal quality of care and significantly correlates with patient satisfaction as an evaluative measure. Guided by Self-Determination Theory (SDT), this study aims to explore the association of predictor constructs in the theoretical model of STD-perceived provider communication (PPC) and other innate psychological constructs of competence and autonomy with self-rated health (SRH) and healthcare satisfaction (HS). Of particular interest is the SDT construct of relatedness. For this study, it was operationalized as the perceived health communication of a provider. Items relevant to SDT in the Health and Retirement Study (HRS) survey were tested, first, for whether they fall into the predicted SDT constructs and, second, whether and how these constructs were associated with self-reported health and patient HS.

Methods: Two-stage data were analyzed using subsamples from the 2018 and 2019 HRS. Independent variables included items measuring SDT constructs about PPC, psychological well-being, and self-efficacy. Outcome variables included SRH and dimensions of HS, such as cost, quality, and providers. In the first stage, descriptive analyses and exploratory factor analysis were performed to identify the underlying factor structure. Principal axis factoring was used to extract factors. In the second stage, these factors were used in structural equation modeling to examine the relationship between SRH and HS.

Results: Three factors with high internal consistencies (a > 0.8) and item-total correlations (r > 0.5) were identified. Data from the sample fit the structural model (χ2 = 0.00, CFI = 0.954, TLI = 0.946, RMSEA = 0.058, SRMR = 0.047). The structural phase indicated that PPC and competence were positively associated with SRH and HS. However, autonomy was only significantly associated with SRH but not with HS.

Discussion/conclusion: Individuals who rated PPC behaviors and their sense of competence more highly also showed higher satisfaction with multiple healthcare domains and their SRH status. Patient-centered determinants of health outcomes are complex, and more studies are needed to understand their nuances.