Striving for autonomy in everyday diabetes self-management—qualitative exploration via grounded theory approach

Abstract

ObjectivesThe rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap.DesignThis qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments.SettingParticipants were recruited from the outpatient ward of a university clinic in Hungary.ParticipantsThe study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment.ResultsThe study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness.ConclusionsThe results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor–patient relationship characterised by partnership. The tentative empirical model of pathways towards patients’ experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.

Modified e-Delphi Process for the Selection of Patient-Reported Outcome Measures for Children and Families With Type 1 Diabetes Using Continuous Glucose Monitors: Delphi Study

“…Autonomous motivation is important in adopting and maintaining DSM practices that improve glycemic control [ 34 , 35 ]. DSM requires continual improvement of disease-related knowledge in patients as well as maintaining engagement, skills, and self-efficacy [ 36 ]. DSM was identified as the principal construct to assess for this domain.…”

Self-Efficacy and Adherence to Self-Care Among Patients With Type 2 Diabetes: A Systematic Review

“…Psychosocial interventions targeting self-efficacy should be an inseparable component of diabetes control treatment regimens. Although several past and recent studies based on autonomy motivation and support have shown the importance of promoting self-efficacy for the long-term maintenance of diabetes management (Anderson et al, 2009;Chen et al, 2022;Funnell et al, 2007;Lee et al, 2019;Sallay et al, 2021;Tang et al, 2005), few studies have explored the nuances of phase-specific self-efficacy and their influence on self-care behaviors among the T2D population. Recently, Ranjbaran et al (2020) reported a significant association between task self-efficacy, maintenance self-efficacy, and medication adherence among individuals with T2D, reflecting the need for more studies to examine the various facets of self-efficacy and predict different self-care activities involved in diabetes management.…”

Social exclusion in people with diabetes: cross-sectional and longitudinal results from the German Ageing Survey (DEAS)

“…Therefore, it is well-suited to provide data about social and medical determinants of well-being and provides a multitude of variables relevant to the presented research questions. The DEAS is an ongoing survey with currently six waves (1996–2017) and several shorter surveys during the COVID-19 pandemic (2020–2022) 37 . In accordance with the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) and the Institute for Applied Social Science (INFAS), no ethics approval was needed for the study as data were collected under pseudonyms and voluntarily, and the study was deemed low-risk, as no work on patients was included.…”

“…In a second step, we aimed to understand the particular characteristics of social exclusion in people with diabetes. For this purpose, we determined how social exclusion in people with diabetes is associated with various medical and psychosocial cofactors that are known to be relevant for social exclusion 10 , 11 , 22 : sex, higher BMI/obesity 10 , 33 , 34 , socioeconomic status 35 , multimorbidity 36 , depression 10 , 22 , 23 , loneliness 28 , self-esteem and self-efficacy 22 , 23 , physical function 10 , and autonomy 37 . Finally, we used longitudinal data to explore the onset of social exclusion in people with diabetes, and whether diabetes itself can be considered a risk factor for social exclusion.…”