A Causal Model of Autonomous Motivation to Modify Dietary Behavior among People with Early-stage Chronic Kidney Disease


  • Anucha Taiwong PhD (Candidate), Faculty of Nursing, Chiang Mai University, Thailand.
  • Tipaporn Wonghongkul Faculty of Nursing, Chiang Mai University, Thailand.
  • Chiraporn Tachaudomdach Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Chomphoonut Srirat Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.




Autonomous motivation, Causal model, Dietary behavior modification, Early-stage chronic kidney disease, Thailand


Dietary behavior is significant for delaying chronic kidney disease progression but is difficult to modify. Autonomous motivation is one of the key concepts that seem to be useful for behavior modification. Thus, this descriptive cross-sectional study was purposed to develop and test a causal model of autonomous motivation to modify dietary behavior among people with early-stage chronic kidney disease. Participants comprised 308 people with early-stage chronic kidney disease from ten tertiary hospitals in Thailand. Data collection employed a demographic and health information form, the Regulation of Eating Behaviour Scale: Autonomous Motivation Subscale, the General Causality Orientation Scale: Autonomy Orientation Subscale, the Health Care Climate Questionnaire Short-Form, the Importance Domain of the Aspiration Index: Intrinsic Life Aspiration Subscale, the Importance Domain of the Aspiration Index: Extrinsic Life Aspiration Subscale, and the Basic Need Satisfaction in General Scale. Data were analyzed through descriptive statistics and structural equation modeling using M-plus.
The results showed the final model explained 57% of the variance in autonomous motivation to modify dietary behavior. Intrinsic life aspiration, autonomy support from healthcare providers, and autonomy orientation had a positive direct effect on autonomous motivation and an indirect effect through basic psychological need satisfaction. Basic psychological need satisfaction had a positive direct effect on autonomous motivation. On the other hand, extrinsic life aspiration had neither a direct nor an indirect effect on autonomous motivation. Nurses can use these findings to design and test nursing interventions by integrating autonomy orientation, autonomy support from healthcare providers, and intrinsic life aspirations for enhancing autonomous motivation to modify the dietary behavior of this population.


Lv JC, Zhang LX. Prevalence and disease burden of chronic kidney disease. Renal fibrosis: mechanisms and therapies. Adv Exp Med Biol. 2019;1165:3-15. doi: 10.1007/ 978-981-13-8871-2_1. DOI: https://doi.org/10.1007/978-981-13-8871-2_1

Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022;12(1):7- 11. doi: 10.1016/j.kisu.2021.11.003. DOI: https://doi.org/10.1016/j.kisu.2021.11.003

Liyanage T, Toyama T, Hockham C, Ninomiya T, Perkovic V, Woodward M, et al. Prevalence of chronic kidney disease in Asia: a systematic review and analysis. BMJ Glob Health. 2022;7(1):e007525. doi: 10.1136/bmjgh-2021-007525. DOI: https://doi.org/10.1136/bmjgh-2021-007525

Cha’on U, Tippayawat P, Sae-Ung N, Pinlaor P, Sirithanaphol W, Theeranut A, et al. High prevalence of chronic kidney disease and its related risk factors in rural areas of Northeast Thailand. Sci Rep. 2022;12(1):18188. doi: 10.1038/s41598-022-22538-w. DOI: https://doi.org/10.1038/s41598-022-22538-w

Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(Suppl 4):S1-115. doi: 10.1016/j.kint.2020.06.019. DOI: https://doi.org/10.1016/j.kint.2020.06.019

Nephrology Society of Thailand. Clinical recommendations for evaluation and management of chronic kidney disease in adults 2022. Bangkok: Nephrology Society of Thailand; 2022 (in Thai).

Marijn Stok F, Renner B, Allan J, Boeing H, Ensenauer R, Issanchou S, et al. Dietary behavior: an interdisciplinary conceptual analysis and taxonomy. Front Psychol. 2018;9: 1689. doi: 10.3389/fpsyg.2018.01689. DOI: https://doi.org/10.3389/fpsyg.2018.01689

Naber T, Purohit S. Chronic kidney disease: role of diet for a reduction in the severity of the disease. Nutrients. 2021;13(9):3277. doi: 10.3390/nu13093277. DOI: https://doi.org/10.3390/nu13093277

Pereira RA, Ramos CI, Teixeira RR, Muniz GA, Claudino G, Cuppari L. Diet in chronic kidney disease: an integrated approach to nutritional therapy. Rev Assoc Med Bras (1992). 2020;66(Suppl 1):s59-67. doi: 10.1590/1806-9282.66.S1.59. DOI: https://doi.org/10.1590/1806-9282.66.s1.59

Ryan RM, Deci EL. Self-determination theory. In: Maggino F, editor. Encyclopedia of quality of life and well-being research. Springer; 2022. pp.1-7. doi: 10.1007/978- 3-319-69909-7_2630-2. DOI: https://doi.org/10.1007/978-3-319-69909-7_2630-2

Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: interventions based on self-determination theory. Eur Health Psychol. 2008;10:2-5. Available from: www.ehps.net/ehp

Oumrait NG, Daivadanam M, Absetz P, Guwatudde D, Berggreen-Clausen A, Alvesson HM, et al. Can self-determination explain dietary patterns among adults at risk of or with type 2 diabetes? A cross-sectional study in socio-economically disadvantaged areas in Stockholm. Nutrients. 2020;12(3):620. doi: 10.3390/nu12030620. DOI: https://doi.org/10.3390/nu12030620

De Man J, Wouters E, Delobelle P, Puoane T, Daivadanam M, Absetz P, et al. Testing a self-determination theory model of healthy eating in a South African township. Front Psychol. 2020;11:2181. doi: 10.3389/fpsyg.2020.02181. DOI: https://doi.org/10.3389/fpsyg.2020.02181

Guertin C, Pelletier L. Motivational dynamics in the prediction of self-regulation strategies for the quality and quantity of eating, eating behaviors, and life satisfaction: a longitudinal investigation. Food Qual Prefer. 2023;107:104829. doi: 10.1016/j.foodqual.2023.104829. DOI: https://doi.org/10.1016/j.foodqual.2023.104829

Hoffman RK, Jobe MC, Dodge T. A brief self-persuasion intervention to strengthen health-promoting dietary intentions through autonomous motivation. Appetite. 2023;180:106371. doi: 10.1016/j.appet.2022.106371. DOI: https://doi.org/10.1016/j.appet.2022.106371

van Pelt A. Psychosocial factors related to sodium adherence among patients with chronic kidney disease. Netherlands: Leiden University; 2015.

Yamamoto K, Okumiya A. Factors that promote autonomous and controlled motivation in self-management behavior of hemodialysis patients. J Health Sci. 2018;6:393-405. doi: 10.17265/2328-7136/2018.06.001. DOI: https://doi.org/10.17265/2328-7136/2018.06.001

Koponen AM, Simonsen N, Suominen S. How to promote fruits, vegetables, and berries intake among patients with type 2 diabetes in primary care? A self-determination theory perspective. Health Psychol Open. 2019;6(1):2055 102919854977. doi: 10.1177/2055102919854977. DOI: https://doi.org/10.1177/2055102919854977

Guertin C. A self-determination theory perspective on the success and failure of eating regulation in women: does planning and self-monitoring the quality versus the quality of eating matter? [master's thesis]. [Ottawa, Canada]: University of Ottawa; 2020. 266 p.

Ng JY, Ntoumanis N, Thøgersen-Ntoumani C, Deci EL, Ryan RM, Duda JL, et al. Self-determination theory applied to health contexts: a meta-analysis. Hair, J.F., Black, W.C., Babin, B.J. and Anderson, R.E. (2010) Multivariate Data Analysis. 7th Edition, Pearson, New York. Perspect Psychol Sci. 2012;7(4):325-40. doi: 10.1177/1745691612447309. DOI: https://doi.org/10.1177/1745691612447309

Deci EL, Ryan RM. The general causality orientations scale: self-determination in personality. J Res Pers. 1985;19(2):109-34. DOI: https://doi.org/10.1016/0092-6566(85)90023-6

Williams GC, Grow VM, Freedman ZR, Ryan RM, Deci EL. Motivational predictors of weight loss and weight-loss maintenance. J Pers Soc Psychol. 1996;70(1):115-26. doi: 10.1037//0022-3514.70.1.115. DOI: https://doi.org/10.1037//0022-3514.70.1.115

Souesme G, Martinent G, Akour D, Giraudeau C, Ferrand C. Causality orientations and supportive/controlled environment: understanding their influence on basic needs, motivation for health and emotions in French hospitalized older adults. Front Psychol. 2020;11:575489. doi:10.3389/fpsyg. 2020.575489. DOI: https://doi.org/10.3389/fpsyg.2020.575489

Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. New York: Guilford Press; 2017. doi: 10.1521/978.14625/28806. DOI: https://doi.org/10.1521/978.14625/28806

Chen MF, Chang RE, Tsai HB, Hou YH. Effects of perceived autonomy support and basic need satisfaction on the quality of life in hemodialysis patients. Qual Life Res. 2018;27(3): 765-73. doi: 10.1007/s11136-017-1714-2. DOI: https://doi.org/10.1007/s11136-017-1714-2

Jeong HW, So HS. Structural equation modeling of self-care behaviors in kidney transplant patients based on self-determination theory. J Korean Acad Nurs. 2018;48(6):731-42. doi: 10.4040/jkan.2018.48.6.731 (in Korean). DOI: https://doi.org/10.4040/jkan.2018.48.6.731

Behzadnia B, Deci EL, DeHaan CR. Predicting relations among life goals, physical activity, health, and well-being in elderly adults: a self-determination theory perspective on healthy aging. In: Ng B, Ho G, editors. Self-determination theory and healthy aging. Singapore: Springer; 2020. pp. 47-71. DOI: https://doi.org/10.1007/978-981-15-6968-5_4

Deci EL, Ryan RM. The” what” and” why” of goal pursuits: human needs and the self-determination of behaviour. Psychol Inq. 2000;11(4):227-68. doi: 10.1207/ S15327965PLI1104_01. DOI: https://doi.org/10.1207/S15327965PLI1104_01

Bégin C, Fecteau A, Côté M, Bédard A, Senécal C, Ratté C. Disordered eating behaviors through the lens of self-determination theory. Eur J Psychol. 2018;14(3): 571-80. doi: 10.5964/ejop.v14i3.1577. DOI: https://doi.org/10.5964/ejop.v14i3.1577

Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis: a global perspective. 7th ed. Upper Saddle River: Pearson Prentice Hall; 2010.

Kahn RL, Goldfarb AI, Pollack M, Peck A. Brief objective measures for the determination of mental status in the aged. Am J Psychiatry. 1960;117(4):326-8. doi:10.1176/ajp.117.4.326. DOI: https://doi.org/10.1176/ajp.117.4.326

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-91. doi: 10.1097/00007632200012150-00014. DOI: https://doi.org/10.1097/00007632-200012150-00014

Pelletier LG, Dion SC, Slovinec-D’Angelo M, Reid R. Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motiv Emot. 2004;28(3):245-77. doi: 10.1023/B:MOEM.0000040154.40922.14. DOI: https://doi.org/10.1023/B:MOEM.0000040154.40922.14

Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol. 2004;23(1):58-66. doi: 10.1037/0278-6133.23.1.58. DOI: https://doi.org/10.1037/0278-6133.23.1.58

Serametakul D, Wonghongkul T, Klunklin P, Mesukko J. A causal model of self-management behavior for adolescents with asthma. Pacific Rim Int J Nurs Res. 2019;23(4):320- 33. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/151662

Kasser T, Ryan RM. Further examining the American dream: differential correlates of intrinsic and extrinsic goals. Pers Soc Psychol Bull. 1996;22(3):280-7. doi: 10.1177/0146167296223006. DOI: https://doi.org/10.1177/0146167296223006

Gagne M. Autonomy support and need satisfaction in the motivation and well-being of gymnasts. J Appl Sport Psychol. 2003;15(4):372-90. doi: 10.1080/714044203. DOI: https://doi.org/10.1080/714044203

Schumacker RE, Lomax RG. A beginner’s guide to structural equation modeling. Mahwah, NJ: Lawrence Erlbaum Associates; 2004. DOI: https://doi.org/10.4324/9781410610904

Miežienė B, Šinkariova L, Adomavičiūtė E. The importance of perceived autonomy support and previous behaviour for autonomous motivation in patients with type 1 diabetes. Int J Psychol Biopsychosoc Approach. 2015;17:57-78. doi: 10.7220/2345-024X.17.4. DOI: https://doi.org/10.7220/2345-024X.17.4

Schüler J, Baumann N, Chasiotis A, Bender M, Baum I. Implicit motives and basic psychological needs. J Pers. 2019; 87(1):37-55. doi: 10.1111/jopy.12431. DOI: https://doi.org/10.1111/jopy.12431




How to Cite

Taiwong A, Wonghongkul T, Tachaudomdach C, Srirat C. A Causal Model of Autonomous Motivation to Modify Dietary Behavior among People with Early-stage Chronic Kidney Disease. PRIJNR [Internet]. 2024 Mar. 21 [cited 2024 May 23];28(2):280-95. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/266184