Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support.
OBJECTIVE
To determine if a patient-centered, computer-assisted diabetes care intervention increased perceived autonomy support, perceived competence (from self-determination theory), and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes.


METHODS
A randomized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care settings in Colorado.


METHODS
Perceived autonomy support, perceived competence, patient satisfaction, glycemic control (HbA1c), ratio of total to HDL cholesterol, diabetes distress, and depressive symptoms.


RESULTS
The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05). Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids, diabetes distress, and depressive symptoms. The construct of autonomy support was found to be separate from that of patient satisfaction.


CONCLUSIONS
A patient-centered, computer-assisted intervention was effective in improving diabetes self-management outcomes, in part, because it increased patients' perception that their autonomy was supported which changed perceived competence. These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes.
Williams
Geoffrey C
GC
Department of Medicine.
Lynch
Martin
M
Department of Psychology.
Glasgow
Russell E
RE
Clinical Research Unit.
D000328:Adult; D003120:Colorado; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods; D026684:Personal Autonomy; D012044:Regression Analysis; D012648:Self Care / Q000523:psychology; D012944:Social Support; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome