Longitudinal motivational predictors of dietary self-care and diabetes control in adults with newly diagnosed type 2 diabetes mellitus

Objective: This prospective study examined relationships between constructs from social–cognitive theory (Bandura, 1986) and self-determination theory (Deci & Ryan, 1985; Deci & Ryan, 1991) and the diabetes outcomes of dietary self-care and diabetes control. Method: Longitudinal data were collected from 237 people newly diagnosed with Type 2 diabetes who filled in questionnaires on dietary self-care, and motivational factors derived from social–cognitive theory and self-determination theory. Blood samples were taken to assess diabetes control (HbA1c). Repeated measurements were taken every 3–4 months for a total of five time points over 18 months. Predictor measures included autonomy support, autonomous and controlled motivation, amotivation, dietary self-efficacy, positive and negative outcome expectancies for dietary self-care and self-evaluation. Age, sex, BMI, and diabetes knowledge were included as control measures. Results: Using Generalized Estimating Equations (GEE) analyses two models were tested: a standard model reflecting longitudinal associations between absolute values of predicted and outcome variables; and a change model examining motivational predictors of changes over time in diabetes outcomes of dietary self-care and diabetes control (HbA1c). Dietary self-care was longitudinally associated with self-efficacy, self-evaluation (the strongest predictor) autonomy support and autonomous motivation, but not with controlled motivation or outcome expectancies. Changes in dietary self-care were predicted by changes in self-efficacy, self-evaluation, and controlled motivation but not by changes in autonomous motivation or autonomy support. Negative outcome expectancies regarding diet were longitudinally associated with HbA1c, and changes in negative outcome expectancies predicted changes in HbA1c. However, there were indications that dietary self-care predicted changes in HbA1c. Conclusions: The results indicate that autonomy support, self-efficacy and, in particular, self-evaluation are key targets for interventions to improve dietary self-care.