Human Autonomy in Cross-Cultural Context: Perspectives on the Psychology of Agency, Freedom, and Well-Being: 1 (Cross-Cultural Advancements in Positive Psychology) by

Language: eng
Format: azw3
Publisher: Springer Netherlands
Published: 2010-12-01T16:00:00+00:00

Diabetes Self-Management

Diabetes is a common disease that lowers quality and length of life. Almost one-third of Americans will be diagnosed with diabetes that are born after the year 2000 (Narayan, Boyle, Thompson, Sorenson, & Williamson, 2003). Further, it is a disease that can be prevented (DPP, 2002) and if patients manage their glucose control tightly, measured on hemoglobin A1c (HbA1c), they will experience fewer complications (DCCT). Chronic conditions such as diabetes mellitus offer a unique opportunity to examine the process of internalization of personal autonomy (ID IN-TSRQ) and perceptions of competence. Motivation is particularly relevant for people with chronic diseases because humans need energy for the day-to-day effective management of their diseases. Internalization is expected to begin with diagnosis and is expected to differ as a function of the need supportiveness of the health care climate and important others in the diabetics life, as well as personality differences in causality orientation. Autonomous self-regulation is expected to be important in long-term adherence to lifestyle and persistent use of medications. Personal autonomy and perceived competence were predicted to energize diabetes self-management behaviors and reducing disease complications such as blindness, kidney failure, and numbness that affect quality of life. This is somewhat different than motivation to prevent onset of a disease in that symptoms of a disease that has set in are frequently experienced, and the complications can be monitored with feedback for the patient. Several studies of motivation regarding diabetes mellitus have been conducted.

In a 12-month longitudinal study of 128 patients with diabetes (Williams, Freedman, & Deci, 1998), personal autonomy (ID IN-TSRQ) was significantly correlated with HbA1c at baseline (r = −0.40), 4 months (r = −0.28) and 12 months (r = −0.30, all p’s < 0.001). In a second study of 159 patients with diabetes (Williams, McGregor, Zeldman, Freedman, & Deci, 2004), increase in personal autonomy (TSRQ) over the initial 6 months in the study predicted improvement in glycemic control (r = −0.24, p < 0.01). Life satisfaction was significantly correlated with personal autonomy (ID IN-TSRQ—beta = 0.34) even after controlling for dietary self-efficacy in a study of 638 French Canadian patients with diabetes (Senecal, Nouwen, & White, 2000). Personal autonomy (ID IN-TSRQ) for using medication to control diabetes and cholesterol was positively correlated with quality of life (r = 0.19, p < 0.01) measured on the Short-Form 12 Health Survey (SF-12v2; Ware, Kosinski, & Keller, 1996) in a study of approximately 2,000 patients with diabetes. In addition, personal autonomy (ID IN-TSRQ) predicted adherence to diabetes and cholesterol medications and diabetes control (r = −0.12, p < 0.01) and healthier cholesterol (r = −0.09, p < 0.01). Nearly 40% of this sample was non-white (36.5% African American, and 3.8% other), but when race was controlled for it didn’t significantly effect the findings.

In summary, personal autonomy, in the form of autonomous self-regulation (ID IN-TSRQ) for diabetes self-management behaviors, has been consistently associated with improved diabetes control, quality of life, and life satisfaction in Western cultures. Non-white subgroups have participated in these studies

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