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Determinants of glycaemic control among patients with type 2 diabetes: testing a process model based on self-determination theory.

ABSTRACT: Aims:To investigate a hypothesised process model based on self-determination theory (SDT) in a population of people with type 2 diabetes. The model suggests that autonomy support from healthcare professionals is an important determinant of autonomous motivation and perceived competence in diabetes, which correlate positively in turn with wellbeing and negatively with HbA1c. Methods:This cross-sectional study used baseline questionnaire data and HbA1c levels from a randomised controlled trial investigating the effects of a person-centred consultation program. The questionnaire used validated scales and items assessing autonomy support, wellbeing, motivation, self-care activities, diabetes distress and perceived competence. Pearson correlations were calculated, and mediation analysis was conducted by multivariate linear regression analysis. Results:116 participants completed the questionnaire. Autonomy support was significantly correlated with perceived competence and controlled motivation. Perceived competence correlated negatively with diabetes distress and positively with self-care activities. Diabetes distress correlated negatively with wellbeing. Controlled motivation correlated positively with autonomous motivation, which correlated positively with both wellbeing and self-care activities. Self-care activities correlated negatively with HbA1c. Conclusion:As suggested by the hypothesised SDT process model, autonomy support, autonomous motivation and perceived competence are associated with better wellbeing and improved HbA1c.

SUBMITTER: Gronnegaard C

PROVIDER: S-EPMC7553979 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Determinants of glycaemic control among patients with type 2 diabetes: testing a process model based on self-determination theory.

Grønnegaard Cecilia C Varming Annemarie A Skinner Timothy T Olesen Kasper K Willaing Ingrid I

Heliyon 20201007 10

<h4>Aims</h4>To investigate a hypothesised process model based on self-determination theory (SDT) in a population of people with type 2 diabetes. The model suggests that autonomy support from healthcare professionals is an important determinant of autonomous motivation and perceived competence in diabetes, which correlate positively in turn with wellbeing and negatively with HbA1c.<h4>Methods</h4>This cross-sectional study used baseline questionnaire data and HbA1c levels from a randomised contr ...[more]

PMID: 33083586

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Project description:IntroductionSub-Saharan Africa is experiencing a rapid growth of type 2 diabetes (T2D) and its related burden. Regular physical activity (PA) is a successful prevention strategy but is challenging to maintain. Self-determination theory (SDT) posits that more autonomous forms of motivation are associated with more sustainable behavior change. Evidence to support this claim is lacking in sub-Saharan Africa. This study aims to explore the relationships between latent constructs of autonomous and controlled motivation, perceived competence, perceived relatedness, PA behavior, and glycemic biomarkers.MethodsStructural equation modeling was applied to cross-sectional data from a rural Ugandan population (N = 712, pre-diabetes = 329, diabetes = 383). Outcome measures included self-reported moderate and vigorous PA, pedometer counts, and fasting plasma glucose (FPG) and glycated hemoglobin (HbA1C).ResultsOur findings support SDT, but also suggest that different types of motivation regulate different domains and intensities of PA. Higher frequency of vigorous PA - which was linked to a lower HbA1C and FPG - was predicted by autonomous motivation (β = 0.24) but not by controlled motivation (β = -0.05). However, we found no association with moderate PA frequency nor with pedometer counts. Perceived competence and perceived relatedness predicted autonomous motivation. Autonomous motivation functioned as a mediator between those needs and PA behavior.ConclusionThis is the first study providing evidence for a SDT model explaining PA among people at risk of, or living with, T2D in a rural sub-Saharan African setting. Our findings suggest that individuals who experience genuine support from friends or family and who feel competent in doing vigorous PA can become motivated through identification of health benefits of PA as their own goals. This type of motivation resulted in a higher frequency of vigorous PA and better glycemic biomarkers. On the other hand, people who felt more motivated through pressure from others or through feelings of guilt or shame were not more engaged in PA.Clinical trial registrationISRCTN 11913581. Registered January 10, 2017.

Project description:Treatment recommendations for prevention of type 2 diabetes complications often require radical and life-long health behaviour changes. Observational studies based on Self-determination theory (SDT) propose substantial factors for the maintenance of behaviour changes and concomitant well-being, but experimental research is needed to develop and evaluate SDT-based interventions. The aims of this paper were to describe 1) the design of a trial assessing the effectiveness of a training course for practice-nurses in autonomy support on patient-perceived motivation, HbA1, cholesterol, and well-being among a diabetes population, 2) the actual intervention to a level of detail that allows its replication, and 3) the connection between SDT recommendations for health care-provider behaviour and the content of the training course.The study is a cluster-randomised pragmatic trial including 40 Danish general practices with nurse-led diabetes consultations, and the associated diabetes population. The diabetes population was identified by registers (n = 4034).The intervention was a 16-hour course with interactive training for practice nurses. The course was delivered over 4 afternoons at Aarhus University and one 1/2 hour visit to the practice by one of the course-teachers over a period of 10 months (0, 2, 5, 10 mths.). The intervention is depicted by a PaT Plot showing the timeline and the characteristics of the intervention components.Effectiveness of the intervention will be assessed on the diabetes populations with regard to well-being (PAID, SF-12), HbA1c- and cholesterol-levels, perceived autonomy support (HCCQ), type of motivation (TSRQ), and perceived competence for diabetes care (PCD) 15-21 months after the core course; the completion of the second course afternoon. Data will be retrieved from registers and by questionnaires.Challenges and advantages of the pragmatic design are discussed. In a real-world setting, this study will determine the impact on motivation, HbA1c, cholesterol, and well-being for people with diabetes by offering a training course in autonomy support to practice-nurses from general practices with nurse-led consultations.ClinicalTrials.gov: NCT01187069.

Project description:IntroductionThe burden of type 2 diabetes is growing rapidly in sub-Saharan Africa. Healthy eating has been shown to prevent the disease but is challenging to maintain. Self-determination theory offers a motivational framework for maintaining a healthy diet based on evidence from western settings. This study aims to assess whether self-determination theory can explain healthy diet behavior in a disadvantaged urban South African population.MethodsCross-sectional data from a South African township population (N = 585; pre-diabetes = 292, diabetes = 293, age 30-75) were analyzed using structural equation modeling, while controlling for socio-demographic factors. Measures included self-reported autonomous and controlled motivation, perceived competence (measured through barrier self-efficacy), perceived relatedness (measured through perceived participation of significant others) and, as indicator for healthy diet, frequency of fruit, vegetable, and non-refined starch intake.ResultsHealthy eating was positively associated (β = 0.26) with autonomous motivation, and negatively associated (β = -0.09) with controlled motivation. Perceived competence and relatedness were positively associated with healthy eating (β = 0.49 and 0.37) and autonomous motivation (β = 0.65 and 0.35), and negatively associated with controlled motivation (β = -0.26 and -0.15). Autonomous motivation mediated the effect of perceived competence and relatedness on healthy eating. The model supported a negative association between controlled and autonomous motivation.ConclusionThis is the first study providing evidence for self-determination theory explaining healthy eating in a disadvantaged sub-Saharan African setting among people at risk of or with diabetes type two. Our findings suggest that individuals who experience support from friends or family and who feel competent in adopting a healthy diet are more likely to become more motivated through identifying the health benefits of healthy eating as their goal. This type of autonomous motivation was associated with a healthier diet compared to individuals whose motivation originated in pressure from others or feelings of guilt or shame. Our recommendations for public health interventions include: focus on the promotion of diet-related health benefits people can identify with; encourage social support by friends or family; reinforce people's sense of competence and skills; and avoid triggering perceived social pressure or feelings of guilt.

Project description:BACKGROUND:Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control. METHODS:This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c. RESULTS: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P <?0.001). Higher self-efficacy score was shown to be correlated with lower HbA1c (r -?0.41, P <?0.001). Multiple linear regression analysis demonstrated that higher self-efficacy scores (b -?0.398; 95% CI: -0.024, -?0.014; P <?0.001), shorter duration of diabetes (b 0.177; 95% CI: 0.002, 0.007; P <?0.001) and smaller waist circumference (b 0.135; 95% CI: 0.006, 0.035; P =?0.006), were significantly associated with good glycaemic control. CONCLUSION:This study demonstrated that higher self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care.

Project description:BackgroundUnderstanding children's physical activity motivation, its antecedents and associations with behavior is important and can be advanced by using self-determination theory. However, research among youth is largely restricted to adolescents and studies of motivation within certain contexts (e.g., physical education). There are no measures of self-determination theory constructs (physical activity motivation or psychological need satisfaction) for use among children and no previous studies have tested a self-determination theory-based model of children's physical activity motivation. The purpose of this study was to test the reliability and validity of scores derived from scales adapted to measure self-determination theory constructs among children and test a motivational model predicting accelerometer-derived physical activity.MethodsCross-sectional data from 462 children aged 7 to 11 years from 20 primary schools in Bristol, UK were analysed. Confirmatory factor analysis was used to examine the construct validity of adapted behavioral regulation and psychological need satisfaction scales. Structural equation modelling was used to test cross-sectional associations between psychological need satisfaction, motivation types and physical activity assessed by accelerometer.ResultsThe construct validity and reliability of the motivation and psychological need satisfaction measures were supported. Structural equation modelling provided evidence for a motivational model in which psychological need satisfaction was positively associated with intrinsic and identified motivation types and intrinsic motivation was positively associated with children's minutes in moderate-to-vigorous physical activity.ConclusionsThe study provides evidence for the psychometric properties of measures of motivation aligned with self-determination theory among children. Children's motivation that is based on enjoyment and inherent satisfaction of physical activity is associated with their objectively-assessed physical activity and such motivation is positively associated with perceptions of psychological need satisfaction. These psychological factors represent potential malleable targets for interventions to increase children's physical activity.

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Determinants of glycaemic control among patients with type 2 diabetes: testing a process model based on self-determination theory.

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Determinants of glycaemic control among patients with type 2 diabetes: testing a process model based on self-determination theory.

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