Community Health Worker Adherence to Self-Determination Theory in the Women’s Initiative Supporting Health Intervention-Based Study

Self-determination theory (SDT) is a behavior change framework emphasizing autonomy, competence, and relatedness. The Women's Initiative Supporting Health (WISH) intervention trains community health workers (CHWs) with lived experience of incarceration to support recently released women in accessing care for HIV, hepatitis C, and substance use. This article aims to assess CHW adherence to SDT principles within the WISH intervention and explore fidelity to motivational interviewing and trauma-responsive practices. Fifteen recorded WISH intervention sessions were transcribed and analyzed using a mixed-methods approach. Thematic coding was guided by SDT constructs and supplemented with supervisor field notes. Each session was also evaluated using the Health Care Climate Questionnaire (HCCQ) to quantify autonomy-supportive behaviors. Analysis was framed using the Health Equity Implementation Framework. CHWs demonstrated strong adherence to SDT principles, with frequent support for autonomy (56 instances), competence (54), and relatedness (39). Trauma-responsive approaches were noted in 22 cases. All HCCQ scores exceeded 7.0 on a 10-point scale (mean = 8.4), indicating good clinical practice. CHWs successfully implemented SDT-based strategies, fostering autonomy, competence, and relatedness. However, occasional directive advice highlighted opportunities to strengthen autonomy support. Ongoing training and feedback may enhance fidelity and sustainability of SDT-based interventions in community settings.