Self-determination theory interventions versus usual care in people with diabetes: a protocol for a systematic review with meta-analysis and trial sequential analysis

Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory

AIMS

In type 2 diabetes control, self-management is an effective way to minimize the risk of developing complications and improve the quality of life. Self-determination theory (SDT) proposed a promising explanatory framework to predict self-regulated behavior which was particularly relevant for self-management. This study aimed to investigate whether SDT constructs can affect the self-management and controlling glycated hemoglobin A1c (HbA1c) levels in type 2 diabetic patients or not.

METHODS

This cross-sectional study was conducted from August to December 2022 at two diabetes clinics in Zahedan. The study included 300 patients with type 2 diabetes. Data collection was done using a researcher-administrated questionnaire that included demographic data, diabetes self-care activities, and self-determination constructs including autonomous support, autonomous motivation, and perceived competence.

RESULTS

The mean of the overall score of self-care activities was 34.62 ± 11.86 out of a maximum of 70. Patients in the fourth quarter (wealthiest) of the socioeconomic status had the highest mean self-care score (P = 0.003). There was a significant relationship between diet score with perceived competence (P = 0.009). Perceived competence (P<0.001) and controlled self-regulation (P<0.001) were the predictors of exercise score in diabetes patients. Independent self-regulation (P<0.001, r = 0.21) and overall self-regulation (P = 0.001, r = 0.19) were significantly related to blood-glucose testing score. There was a significant relationship between foot care score with perceived competence (P = 0.048, r = 0.11) and autonomous support (P = 0.013, r = 0.14). Multiple regression showed that exercise was the predictor of HbA1c (P = 0.014).

CONCLUSION

Exercise is crucial for achieving good individualized glycemic control and reducing the risk of diabetes complications. The findings provided valuable insights into the determinants of self-care activities in patients with type 2 diabetes and underscore the need for interventions that address socioeconomic disparities, enhance perceived competence, and provide autonomy support to improve diabetes self-care.

Self-determination theory interventions versus usual care in people with diabetes: a systematic review with meta-analysis and trial sequential analysis

BACKGROUND

Autonomy-supporting interventions, such as self-determination theory and guided self-determination interventions, may improve self-management and clinical and psychosocial outcomes in people with diabetes. Such interventions have never been systematically reviewed assessing both benefits and harms and concurrently controlling the risks of random errors using trial sequential analysis methodology. This systematic review investigates the benefits and harms of self-determination theory-based interventions compared to usual care in people with diabetes.

METHODS

We used the Cochrane methodology. Randomized clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory in any setting were eligible. A comprehensive search (latest search April 2022) was undertaken in CENTRAL, MEDLINE, Embase, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S, and CPCI-SSH to identify relevant trials. Two authors independently screened, extracted data, and performed risk-of-bias assessment of included trials using the Cochrane risk-of-bias tool 1.0. Our primary outcomes were quality of life, all-cause mortality, and serious adverse events. Our secondary outcomes were diabetes distress, depressive symptoms, and nonserious adverse events not considered serious. Exploratory outcomes were glycated hemoglobin and motivation (autonomy, controlled, amotivation). Outcomes were assessed at the end of the intervention (primary time point) and at maximum follow-up. The analyses were conducted using Review Manager 5.4 and Trial Sequential Analysis 0.9.5.10. Certainty of the evidence was assessed by GRADE.

RESULTS

Our search identified 5578 potentially eligible studies of which 11 randomized trials (6059 participants) were included. All trials were assessed at overall high risk of bias. We found no effect of self-determination theory-based interventions compared with usual care on quality of life (mean difference 0.00 points, 95% CI -4.85, 4.86, I2 = 0%; 225 participants, 3 trials, TSA-adjusted CI -11.83, 11.83), all-cause mortality, serious adverse events, diabetes distress, depressive symptoms, adverse events, glycated hemoglobulin A1c, or motivation (controlled). The certainty of the evidence was low to very low for all outcomes. We found beneficial effect on motivation (autonomous and amotivation; low certainty evidence).

CONCLUSIONS

We found no effect of self-determination-based interventions on our primary or secondary outcomes. The evidence was of very low certainty.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020181144.

Undergraduates' Negative Emotion and Academic Procrastination During COVID-19: Life Autonomy as a Mediator and Sense of School Belonging as a Moderator

Introduction

This study aims to investigate the impact of COVID-19 on undergraduate students' academic procrastination and negative emotions. It seeks to examine the relationship between negative affect and academic procrastination among university students, considering the mediating role of life autonomy and the moderating effect of a sense of school belonging.

Methods

The study sample consisted of 776 university students from the Guangxi Zhuang Autonomous Region, China. Data collection involved the use of the Negative Affect Scale, Academic Procrastination Scale, Life Autonomy Scale, and Sense of School Belonging Scale. SPSS version 26.0 and PROCESS V3.580 to conduct relationship analysis, test the mediation model (model 4) and the moderated mediating model (model 7).

Results

The findings revealed significant relationships among the variables. Negative emotions were negatively related with life autonomy and sense of school belonging, and positively related with academic procrastination. Academic procrastination showed a negative correlation with both life autonomy and sense of school belonging. Sense of school belonging exhibited a positive relationship with life autonomy. The study also identified life autonomy as a mediator in the relationship between negative emotions and academic procrastination. Additionally, the sense of school belonging moderated the initial segment of the negative emotion-life autonomy-academic procrastination pathway.

Discussion

This study contributes to a better understanding of the association between negative affect and academic procrastination. It highlights that negative emotions have a direct and indirect influence on academic procrastination through the mediating role of life autonomy. Moreover, the moderating role of sense of school belonging suggests that the relationship between negative affect and life autonomy is stronger when the sense of school belonging is weaker.

Effect of Self-Determination Theory on Knowledge, Treatment Adherence, and Self-Management of Patients with Maintenance Hemodialysis

Our aim of this study was to investigate the effect of self-determination theory on awareness of relevant knowledge, treatment compliance, and self-management level in maintenance hemodialysis (MHD) patients. A total of 90 patients who received MHD treatment in our hospital from April 2018 to June 2020 were selected and randomly divided into the intervention group and the routine group with 45 cases in each group. Both groups were given basic hemodialysis patient management measures, and the intervention group was given self-determination theory to manage patients on this basis. The awareness rate of hemodialysis patient-related knowledge, patient treatment compliance, patient self-management scores, and quality of life scores were compared between the two groups before intervention and 6 months after intervention. After intervention, the awareness rate of dialysis principle, reasonable diet, internal fistula protection, and complication prevention knowledge in the intervention group was higher t (P < 0.05); before intervention, there was no significant difference in the scores of all dimensions of compliance between the two groups (P > 0.05); after intervention, the dietary compliance, fluid intake compliance, dialysis regimen compliance, and total score of compliance in the intervention group were higher than those in the conventional group (P < 0.05). After intervention, the total scores of problem solving, partnership, emotional processing, self-care activities, and self-management in the intervention group were higher than those in the conventional group, (P < 0.05). After intervention, the physical domain, psychological domain, social relationship domain, and total scores of quality of life in the intervention group were higher than those in the conventional group (P < 0.05). Self-determination theory management is effective in improving the awareness of hemodialysis-related knowledge, treatment compliance, self-management level, and quality of life in MHD patients.

Relationship between Psychological Distress, Basic Psychological Needs, Anxiety, Mental Pressure, and Athletic Burnout of Chinese College Football Athletes during the COVID-19 Pandemic

The rapid spread of the COVID-19 pandemic in early 2020 poses a significant threat to mental health, which may lead to psychological stress in a number of individuals. Athlete burnout is a common psychological phenomenon that has a negative influence on their sports career. The main purpose of this study was to evaluate the relationship between psychological distress and athletic burnout among Chinese college football athletes during the COVID-19 pandemic, and the mediating role of basic psychological needs, anxiety and mental pressure. In an online cross-sectional survey conducted in February 2022, the team coaches sent an electronic questionnaire to college football athletes. Participants completed questionnaires on relevant variables. Pearson correlation analysis and mediation effect analysis were carried out by using SPSS software and its plug-in process V3.3. The study included 672 participants and the results showed that: (1) psychological distress, basic psychological needs, anxiety, mental pressure and athletic burnout were significantly pairwise correlated, (2) mental pressure, anxiety and basic psychological needs play a mediating role between psychological distress and athletic burnout respectively, and (3) basic psychological needs and anxiety, basic psychological needs and mental pressure, anxiety and mental pressure, as well as mental pressure, anxiety and basic psychological needs respectively play a chain mediating role between psychological distress and athletic burnout. In conclusion, psychological distress during the COVID-19 pandemic is an important factor leading to athletic burnout among Chinese college football athletes and may further affect the level of athletic burnout through basic psychological needs, anxiety and mental pressure. The government and schools should strengthen the recognition of these factors in order to improve the situation of athletic burnout among Chinese college football athletes.

Guided self-determination intervention versus attention control for people with type 2 diabetes in outpatient clinics: a protocol for a randomised clinical trial

INTRODUCTION

In the management of type 2 diabetes, autonomy-supporting interventions may be a prerequisite to achieving more long-term improvement. Preliminary evidence has shown that the guided self-determination (GSD) method might have an effect on haemoglobin A1c and diabetes distress in people with type 1 diabetes. Previous trials were at risk of uncertainty. Thus, the objective is to investigate the benefits and harms of a GSD intervention versus an attention control group intervention in adults with type 2 diabetes.

METHODS AND ANALYSIS

This trial protocol is guided by the The Standard Protocol Items: Recommendations for International Trials Statement. We describe the protocol for a pragmatic randomised, dual-centre, parallel-group, superiority clinical trial testing a GSD intervention versus an attention control for people with type 2 diabetes in outpatient clinics. The participants (n=224) will be recruited from two diverse regions of Denmark. The experimental stepped-care intervention will consist of three to five GSD sessions lasting up to 1 hour with a trained GSD facilitator. The sessions will be conducted face to face, by video conference or over the telephone. The attention controls will receive three to five sessions lasting up to an hour with a communication-trained healthcare professional provided face to-face, by video conference, or over the telephone. Participants will be included if they have type 2 diabetes,>18 years old, are not pregnant. Participants will be assessed before randomisation, at 5-month, and 12-month follow-up, the latter being the primary. The primary outcome is diabetes distress. Secondary outcomes are quality of life, depressive symptoms and non-serious adverse events. Exploratory outcomes are haemoglobin A1c, motivation and serious adverse events. Data will be collected using REDCap and analysed using Stata V.16.

ETHICS AND DISSEMINATION

The trial will be conducted in compliance with the protocol, the Helsinki Declaration in its latest form, International Harmonisation of Good Clinical Practice guidelines and the applicable regulatory requirement(s). The trial has been approved by the Danish Data Protection Agency (P-2020-864). The Ethics Committee of the Capital Region of Denmark reviewed the trial protocol, but exempted the trial protocol from full review (H-20003638). The results of the trial will be presented at the outpatient clinics treating people with type 2 diabetes, at national and international conferences as well as to associations for people with diabetes and their relatives.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov identifier: NCT04601311.