This study was funded by the MU Department of Family & Community Medicine

1. Motivation and diabetes self-management*Cheryl L. Shigaki, PhD, ABPP, **Robin L. Kruse, PhD, MSPH, **David Mehr, MD, MS, †Kennon M. Sheldon, PhD, ‡Bin Ge, MD, MA, **Cherith Moore, PhD, **Joseph LeMaster, MD, MPH*Dept Health Psychology, **Dept Family & Community Medicine, †Dept. Psychological Sciences, ‡ Dept Biostatistics School of Health Professions Interdisciplinary Center on Aging University of Missouri - Columbia Abstract Measures This study examined the relationship between autonomous motivation and diabetes self-care activities (maintaining diet, exercising and testing blood glucose) among adults with diabetes plus other chronic conditions, recruited from outpatient primary care clinics. Participants reported their self-care activities, motivation, social support and self-efficacy. Health literacy measures also were obtained. Participants had difficulty maintaining self-care activities, especially exercise. Meeting recommended levels of self-care activity was challenging, even for patients with adequate levels of health literacy. Regression analyses showed that autonomous motivation was the only variable significantly associated with performing diet and blood glucose testing. No variables had a statistically significant relationship with exercise; age approached statistical significance, with older individuals being less likely to have exercised in the past week. Findings support the utility of Self-Determination Theory in promoting diabetes self-care. • Dependent Variables: • Diet, Testing blood glucose, exercise (Summary Diabetes Self-Care Activities-R)10 • Potential Predictors: • Demographics: age, gender, education, race income • Health related: diabetes duration, comorbid conditions (FCI),11 general & mental health (SF-36v2)12 • Person attributes: Motivation (autonomous and controlled; Treatment Self-Regulation Questionnaire – Diabetes),7,13 Social Support (MOS Social Support Scale),14 Self-efficacy (Perceived Competence-D)7 • Health literacy: Rapid Estimate of Adult Literacy in Medicine (REALM),15 Newest Vital Sign (NVS)16 Results Background Participants: female (64%), Caucasian (77%), at least high school education (87%), diabetes duration 10+ y (46%), mean age 63y, mean number comorbidities 4.6. Effective management of diabetes requires that patients both initiate and maintain activities relating to diet, exercise and use of medications. Self-Determination Theory (SDT), a general theory of motivation, describes individuals as being motivated autonomously when they feel a sense of choice, volition and congruence of their behavior with their personal values.1,2 In clinical settings, autonomous motivation has been associated with greater successes in programs promoting health behaviors.3-5Among patients with diabetes, having higher levels of autonomous motivation for self-care has been associated with more desirable A1c levels.6 Studies of the relationship between autonomous motivation and specific self-care behaviors, however, are limited.7,8The current study investigated the influence of motivation on performance of commonly recommended diabetes self-care activities. Our a priori hypothesis was that higher levels of autonomous motivation would be associated with frequency of self-care behaviors. Accomplishing self-care activities on a daily basis was challenging. Autonomous motivation was the only predictor identified for self-care. Methods Conclusions • Potential participants identified from primary care clinic registries • Adults with diabetes and at least one other chronic condition (N=77) • Screened for cognitive impairment using Six-item Screener9 • Self-report surveys; health literacy tests administered by research assistant. • Variables related to an outcome (p<.10) in bivariate screening were entered in multivariate models. Variables were retained in multivariate models when p<.05. We found that individuals with diabetes have difficulty maintaining self-care demands, especially exercise. Results suggest potential utility for clinical interventions that support autonomy; i.e. patients feel they are initiators of behavior that is congruent with personal beliefs about health and well-being. Our sample had a high level of education relative to national norms. A larger or more “typical” sample might reveal additional predictors; it is unlikely, however, that a more representative sample would demonstrate decreased influence of autonomous motivation on the frequency of self-care behaviors. While the literature suggests more positive health and behavioral outcomes among individuals with higher levels of health literacy, our data does not support this conclusion. This study was funded by the MU Department of Family & Community Medicine