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Autonomy support from informal health supporters: links with self-care activities, healthcare engagement, metabolic outcomes, and cardiac risk among Veterans with type 2 diabetes

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Abstract

This study examined the role of autonomy support from adults’ informal health supporters (family or friends) in diabetes-specific health behaviors and health outcomes. Using baseline data from 239 Veterans with type 2 diabetes at risk of complications enrolled in behavioral trial, we examined associations between autonomy support from a support person and that support person’s co-residence with the participant’s diabetes self-care activities, patient activation, cardiometabolic measures, and predicted risk of a cardiac event. Autonomy support from supporters was associated with significantly increased adherence to healthy lifestyle behaviors (diet, p < .001 and exercise, p = .003); higher patient activation (p < .001); greater patient efficacy in interacting with healthcare providers, and lower 5-year (p = .044) and 10-year (p = .027) predicted cardiac risk. Autonomy support was not significantly associated with diabetes-specific behaviors (checking blood glucose, foot care, or medication taking); or hemoglobin A1c, systolic blood pressure, or non-HDL cholesterol. There was a significant interaction of autonomy support and supporter residence in one model such that lack of autonomy support was associated with lower patient activation only among individuals with in-home supporters. No other interactions were significant. Findings suggest that autonomy support from family and friends may play a role in patient self-management, patient activation, and lower cardiac risk.

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Funding

This work was supported by the Veterans Administration Health Services Research and Development IIR 14–074-1, the Michigan Center for Diabetes Translational Research (National Institutes of Health (NIH) Grant 5P60- DK09292), and the Michigan Claude D. Pepper Older Americans Independence Center (NIH Grant AG-024824). The funder did not and will not have any role in the study design; collection, management, analysis, and interpretation of data; writing of this report; or decision to submit this report for publication.

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Authors and Affiliations

  1. Department of Psychology, University of Mississippi, 310C Peabody Hall, University, MS, 38677, USA

    Aaron A. Lee & Patric Leukel

  2. VA Center for Clinical Management Research, Ann Arbor, MI, USA

    Michele Heisler

  3. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Michele Heisler

  4. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Michele Heisler

  5. VA Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Ranak Trivedi

  6. Division of Population Sciences and Public Mental Health, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    Ranak Trivedi

  7. VA Center for Health Equity Research and Promotion, Pittsburgh, PA, USA

    Maria K. Mor & Ann-Marie Rosland

  8. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    Maria K. Mor

  9. Department of Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, PA, USA

    Ann-Marie Rosland

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  1. Aaron A. Lee
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Correspondence to Aaron A. Lee.

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Aaron A. Lee declare that he has no conflict of interest, Michele Heisler declare that she has no conflict of interest, Ranak Trivedi declare that she has no conflict of interest, Patric Leukel declare that he has no conflict of interest, Maria K. Mor declare that she has no conflict of interest, and Ann-Marie Rosland declare that she has no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Lee, A.A., Heisler, M., Trivedi, R. et al. Autonomy support from informal health supporters: links with self-care activities, healthcare engagement, metabolic outcomes, and cardiac risk among Veterans with type 2 diabetes. J Behav Med 44, 241–252 (2021). https://doi.org/10.1007/s10865-020-00196-5

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