Self-determination theory holds that the intrinsic and extrinsic content of people's aspirations differentially affect their wellness. An evidence base spanning nearly 30 years indicates that focusing on intrinsic goals (such as for growth, relationships, community giving, and health) promotes well-being, whereas a focus on extrinsic goals (such as for wealth, fame, and beauty) deters well-being. Yet, the evidence base contains exceptions, and some authors have argued that focusing on extrinsic goals may not be universally detrimental. We conducted a systematic review and used multilevel meta-analytic structural equation modeling to evaluate the links between intrinsic and extrinsic aspirations with indices of well-being and illbeing. Across 92 reports (105 studies), 1,808 effects, and a total sample of N = 70,110, we found that intrinsic aspirations were linked positively with well-being, r = 0.24 [95% CI 0.22, 0.27], and negatively with ill-being, r = −0.11 [−0.14, −0.08]. When the variety of extrinsic aspiration scoring methods were combined, the link with well-being was not statistically significant, r = 0.02 [−0.02, 0.06]. However, when extrinsic aspirations were evaluated in terms of their predominance in the overall pattern of aspiring the effect was universally detrimental, linking negatively to well-being, r = −0.22 [−0.32, −0.11], and positively to ill-being, r = 0.23 [0.17, 0.30]. Meta-analytic conclusions about the associations between goal types and wellness are important because they inform how individuals could shape aspirations to support their own happiness and how groups and institutions can frame goals such that their pursuit is for the common good.

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Self-determination theory (SDT) is a theoretical framework for addressing human motivation and wellness that has been actively and increasingly researched over 4 decades. As a cumulative knowledge base, many of SDT's fundamental tenets have been repeatedly examined. We identified 60 meta-analyses that tested many of the propositions of SDT's six mini-theories, other theory-based hypotheses, and SDT's utility in applied domains. In this review, we examine what these meta-analyses establish, highlighting the support they lend to the validity of SDT's motivational taxonomy and its hypotheses regarding the respective effects of basic psychological need satisfaction and frustration on well-being and ill-being. Meta-analytic evidence also strongly supports the relevance of SDT for organizations, health care, parenting, and education among other domains, with identifiable gaps in the meta-analytic literature. We conclude by discussing the importance of broad theory and the use of meta-analytic knowledge as scaffolding for further theory and research, albeit with its own methodological limitations. Public Significance StatementThis systematic review includes a comprehensive narrative synthesis of 60 meta-analyses, each of which tests various principles from self-determination theory (SDT). Such a review is of broad public significance because SDT has become one of the most widely applied approaches to human motivation and is the basis for interventions in many domains including work and organizations, health care, education, physical activity, and sport, among others.

Self-determination theory (SDT) is a theoretical framework for addressing human motivation and wellness that has been actively and increasingly researched over four decades. As a cumulative knowledge base, many of SDT’s fundamental tenets have been repeatedly examined. We identified 60 meta-analyses that tested many of the propositions of SDT’s six mini-theories, other theory-based hypotheses, and SDT’s utility in applied domains. In this review we examine what these meta-analyses establish, highlighting the support they lend to the validity of SDT’s motivational taxonomy and its hypotheses regarding the respective effects of basic psychological need satisfaction and frustration on well-being and ill-being. Meta-analytic evidence also strongly supports the relevance of SDT for organizations, health care, parenting, and education among other domains, with identifiable gaps in the meta-analytic literature. We conclude by discussing the importance of broad theory and the use of meta-analytic knowledge as scaffolding for further theory and research, albeit with its own methodological limitations.

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Background Accelerated by the coronavirus disease 2019 (COVID-19) pandemic, Australia has shifted towards greater use of telehealth to deliver care for rural and remote communities. This policy direction might risk a shift away from the traditional model of informed person-centred care built around care relationships to a technology-mediated health transaction. Potential opportunity costs of widespread telehealth services on the quality of care for rural and remote communities remain understudied. Methods A qualitative study was conducted in three local health districts of rural New South Wales, Australia. Data were collected through in-depth interviews. A total of 13 participants was interviewed. Data were analysed using thematic analysis. Results Patient participants perceived telehealth as an alternative when specialist care was limited or absent. Both patients and clinicians perceived that the deeper caring relationship, enabled through face-to-face interactions, could not be achieved through telehealth services alone, and that telehealth services are often superficial and fragmented in nature. Patients in this study contended that virtual consultations can be distant and lacking in personal touch, and risk losing sight of social circumstances related to patients’ health, thereby affecting the trust placed in healthcare systems. Conclusions Simply replacing face-to-face interactions with telehealth services has the potential to reduce trust, continuity of care, and effectiveness of rural health services. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within an integrated service delivery model across diverse rural contexts in Australia.

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To understand the boundaries we set for ourselves in terms of environmental responsibility during competition, we examined a neural index of outcome valence (feedback-related negativity; FRN) in relation to earlier indices of visual attention (N1), later indices of motivational significance (P3), and, eventual behaviour. In Experiment 1 (n=36), participants either were (play) or were not (observe) responsible for action selection. In Experiment 2 (n=36), opponents additionally either could (exploitable) or could not (unexploitable) be beaten. Various failures in reinforcement learning expression were revealed including large-scale approximations of random behaviour. Against unexploitable opponents, N1 determined the extent to which negative and positive outcomes were perceived as distinct categories by FRN. Against exploitable opponents, FRN determined the extent to which P3 generated neural gain for future events. Differential activation of the N1 -FRN -P3 processing chain provides a framework for understanding the behavioural dynamism observed during competitive decision making.