Predictors of motivation for type 2 diabetes mellitus self management of patients in primary care in Singapore

Background: Diabetes is among the top 10 causes of death in Singapore, which has the second-highest proportion of diabetics among all developed nations. Diabetic patients’ self-management is often driven by their perceptions about their own chronic condition. This study explored specific aspects of patients’ (1) cognitive appraisal, (2) emotional distress and (3) a motivational measure in relation to their diabetic condition and attitude toward self-management. Methods: Seventy adult participants (41 female and 29 male) with type-2 diabetes were recruited in this cross-sectional study from patients who sought psychological consultation at polyclinics. The questionnaires administered were (1) Brief Illness Perception Questionnaire, (2) Diabetes Distress Scale, (3) Generalised Anxiety Disorder-7, (4) Insomnia Severity Index, (5) Patient Health Questionnaire-9, (6) Readiness-to-Change Ruler and (7) Sheehan Disability Scale. Results: Multiple regression analysis showed that severity of insomnia symptoms (β = -.26 , p < .05), emotional distress of diabetes (β = -.48 , p < .05), interpersonal distress of diabetes (β = -.35 , p < .05), total distress of diabetes (β = .58 , p < .05), and perception of personal control over diabetes (β = .-.30, p < .05) were significantly associated with reported motivation for engaging in diabetes self-management (R2 = .26, F(5, 62) = 4.26, p < 0.01). Conclusion: Insomnia, emotional distress and perception of personal control over diabetes significantly predicted patients’ reported motivation for diabetes self-management. It may be more productive for clinicians to focus their interventions on these particular aspects of diabetic patients’ experience in promoting self-management behaviour. Future studies may involve (1) the measurement of actual self-management behaviour beyond participants’ report of their motivation to engage in such desirable behavior and (2) qualitative approaches for understanding subjective dimensions of “insomnia,” “distress” and “personal control” in relation to diabetes self-management