Method

Data was collected from two regions in the UK between 2010 and 2012. Initially all nursing homes within three adjoining districts in the south of England were contacted (69 in total), asking for participation from managers and care assistants, and requesting a minimum of ten responses from care assistants in each nursing home. Thirty-three nursing homes agreed to participate. Managers from 21 homes responded, of which three were excluded as no care assistants responded from their nursing home. Ninety-one care assistants responded from 25 homes, of which 13 schedules were excluded as the manager from their home had not responded (seven homes).

Subsequently, all nursing homes within two adjoining districts in the Midlands were contacted (41 in total), of which 23 agreed to take part. Responses were obtained from 20 managers and 115 care assistants, of which no responses were excluded.

The final sample comprised 38 managers and 193 care assistants. The managers (37 women) had an average age of 51.25 years (SD = 6.44), ranging from 37 to 65 years old. They had been managers for an average of 12.00 years (SD = 8.35) and had been in their current role for an average of 6.72 years (SD = 6.38). The majority (95%) of managers were white, 2.5% were black and 2.5% of other ethnicities. All of the managers were British. The majority (58%) had university level qualifications, 18.5% had at least one A-level, 10.5% had NVQ level qualifications, and 13% had GCSE or O-level qualifications.

The care assistants (170 women, 7 gender not disclosed), had an average age of 39.92 years (SD = 13.01), ranging from 18 to 66 years old. Respondents had been care assistants for an average of 9.00 years (SD = 8.36), and working in their current role for an average of 5.50 years (SD = 5.74). The care assistants were mainly white (77.2%) or

Asian (16.1%) and 2% were of other ethnicities (4.7% of participants did not disclose their ethnicity). Most care assistants were British (78.2%), 11.5% were from Indonesia, 2.6% from Europe, 1% from China, and 1% from Africa (5.7% of the sample did not disclose their nationality). The majority of care assistants had NVQ-level qualifications (52.8%), 14% had university level qualifications, 10.9% had at least one A-level or BTEC qualification, 10.4% had GCSEs, and 6.7% had no qualifications (5.2% did not disclose their level of education).

Manager Measures

Managerial autonomy support. The Problems at Work (PAW - Deci, Connell, & Ryan, 1989) questionnaire assesses the extent to which managers are more

controlling versus autonomy supportive of their employees. The measures are composed of eight vignettes describing situations that managers might encounter with employees. Each vignette is followed by four items which describe respectively a highly autonomy supportive, a moderately autonomy supportive, a moderately controlling, and a highly controlling way a manager could deal with the problem. The highly autonomy

supportive items reflect a manager listening, acknowledging feelings, providing non- judgmental, supportive feedback if necessary, and encouraging employees to find their own solutions to problems. The moderately autonomy supportive items reflect a manager encouraging individuals to resolve their problems by observing how others have dealt with similar situations. Thus some autonomy support is provided because individuals are given freedom to seek their own solutions, but the response is not highly autonomy supportive because individuals are being guided to comply with norms rather than seeking creative and individualized solutions. The moderately controlling items show a manager telling employees what solution to use for a problem and implying that

it is in their best interests to adhere to this solution. The highly controlling items describe a manager that prescribes a solution and demands that it is followed, often accompanied by the promise of a reward or the threat of a punishment.

The response to each item falls upon a continuum that ranges from highly autonomy supportive to highly controlling. Managers rated the degree of

appropriateness of each item based on their own managerial style on a seven-point scale from 1 (Very inappropriate) to 7 (Very appropriate). Ratings for each response style were summed across the eight vignettes and the four subscale scores were combined using weightings of +2, +1, -1, and -2 for highly autonomy supportive, moderately autonomy supportive, moderately controlling, and highly controlling scores

respectively. A single overall score of managerial autonomy support was created, with higher scores reflecting higher levels of autonomy support. Scores could potentially range from -18 to +18. The alphas for the four subscales derived as described above were: highly autonomy supportive = .88, moderately autonomy supportive = .70, moderately controlling = .83, and highly controlling =.86. A full copy of this, and all subsequent measures in the thesis, can be found in the Appendices.

Relatedness towards care assistants. A 12-item scale was designed specifically for this study to measure the extent to which managers/matrons fostered closeness and connection with their staff. Two items reflecting feeling understood were adapted from a relatedness support scale developed by Parfyonova (2009). The

remaining items were written to reflect three different determinants of relatedness as reported by Reis et al. (2000): talking about something meaningful, feeling appreciated and understood, and engaging in pleasant and interesting activities. Example items include ‘I encourage care assistants to talk about things that are important to them,’ ‘I make sure care assistants know that they are appreciated,’ and ‘I don’t spend much time

thinking about whether care assistants are taking part in activities that they might find especially pleasant’ (reverse item). Items were assessed on a 7 point scale from 1 (Not at all true of me) to 7 (Very true of me). A reliability analysis showed that these items were internally consistent (α = .76) therefore the items were averaged to form a single index of relatedness towards care assistants

Care Assistant Measures

Aspirations. The Aspirations Index (T. Kasser & Ryan, 1996) was developed to assess the importance of, likelihood of attaining, and current level of attainment of extrinsic and intrinsic life goals or aspirations. For the purposes of this study

participants were asked to rate how important two intrinsic aspirations were to them on a scale of 1 (Not at all important) to 7 (Very important). Community and affiliation aspirations were each reflected by five items. Examples of items include ‘To have good friends that I can count on’ (affiliation, α = .86) and ‘To help people in need’

(community, α = .80).

Basic need satisfaction at work scale (BNS-W). The BNS-W (Baard et al., 2004; Ilardi et al., 1993) is a 21-item measure intended to rate satisfaction of the basic psychological needs for autonomy, competence, and relatedness at work. The self- report measure consists of three subscales. Seven items measure autonomy at work (e.g., ‘I feel like I can make a lot of inputs to deciding how my job gets done). Six items measure competence at work (e.g., ‘I do not feel very competent when I am at work’; reversed item). Eight items measure relatedness at work (e.g., ‘I get along with people at work’). All items were rated on a seven-point scale from 1 (Not at all true) to 7 (Very true). Alphas for the autonomy, competence, and relatedness subscales were .65, .57, and .77 respectively.

Work self-regulation questionnaire. Self-regulation questionnaires assess the degree to which people have autonomous versus controlled motivations to carry out activities such as learning, prosocial behaviour, and health behaviours (Ryan & Connell, 1989; Williams et al., 1996). A well-validated self-regulation at work scale does not currently exist. Therefore a scale was developed adapting items from the self-regulation questionnaire for students with learning difficulties (Deci, Hodges, Pierson, &

Tomassone, 1992). This simplistic scale was chosen in preference to more complex scales in order to minimise the cognitive load on care assistants following feedback from previous studies.

The original scale had four subscales: external and introjected regulation, reflecting controlled motivation, and identified and intrinsic regulation, which reflected autonomous motivation. Six items were developed in total to represent identified (‘I do my work because I want to give the best care that I can’) and intrinsic (‘I do my work because I enjoy it’) regulation. Care assistants chose from four options: Always, Most of the Time, Sometimes and Never, which were then converted into numerical scores of 4, 3, 2, and 1 respectively. Exploratory factor analysis revealed that the intrinsic and identified items loaded onto a single factor. In alignment with previous studies that have combined intrinsic and identified self-regulation items to form a single score for autonomous motivation (Ntoumanis & Standage, 2009; Vansteenkiste, Lens, De Witte, De Witte, & Deci, 2004) and the distinction made between autonomous and controlled motivation in SDT (Deci & Ryan, 2000; Gagné & Deci, 2005), the items from both subscales were used to indicate autonomous motivation (α = .83).

Relatedness towards residents. This 12-item scale was adapted from the ‘relatedness towards care assistants’ measure described above to reflect the extent to which care assistants fostered a sense of closeness or connection with residents.

Example items include ‘I encourage residents to talk about things that are important to them’ and ‘I often spend time looking for activities that I think residents will find beneficial’. Items were assessed on a 7 point scale from 1 (Not at all true of me) to 7 (Very true of me). Reverse items were removed from the scale because of low inter- item correlations with positively worded items and associated reductions in Cronbach’s alpha. Assessment of reliability of the remaining nine, positively worded, items showed that the items were internally consistent (α = .85)

Autonomy towards residents. This scale was developed by adapting items from the autonomy subscale of the basic need satisfaction at work scale (described above) to measure the extent to which care assistants support the autonomy of residents. The scale consisted of seven items, for example, ‘I make sure that residents are free to decide for themselves how to live their lives’ and ‘In day to day care, I frequently tell residents what to do without giving them any choices’ (reverse item). Items were assessed on a 7 point scale from 1 (Not at all true of me) to 7 (Very true of me). A reliability analysis showed that these items were internally consistent (α = .77). This short and simple scale was used in preference to an adaptation of the Problems at Work Scale in order to reduce cognitive load and participant fatigue among care assistants.

2.4 Results