UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date

2020-05-21

Document Type

Article

Disciplines

Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Epidemiology | Health Communication | Health Services Administration | Health Services Research | Nutritional and Metabolic Diseases | Telemedicine

Abstract

BACKGROUND: Diabetes is a complex, chronic disease that requires patients' effective self-management between clinical visits; this in turn relies on patient self-efficacy. The support of patient autonomy from healthcare providers is associated with better self-management and greater diabetes self-efficacy. Effective provider-patient secure messaging (SM) through patient portals may improve disease self-management and self-efficacy. SM that supports patients' sense of autonomy may mediate this effect by providing patients ready access to their health information and better communication with their clinical teams.

OBJECTIVE: We examined the association between healthcare team-initiated SM and diabetes self-management and self-efficacy, and whether this association was mediated by patients' perceptions of autonomy support from their healthcare teams.

DESIGN: We surveyed and analyzed content of messages sent to a sample of patients living with diabetes who use the SM feature on the VA's My HealtheVet patient portal.

PARTICIPANTS: Four hundred forty-six veterans with type 2 diabetes who were sustained users of SM.

MAIN MEASURES: Proactive (healthcare team-initiated) SM (0 or > /= 1 messages); perceived autonomy support; diabetes self-management; diabetes self-efficacy.

KEY RESULTS: Patients who received at least one proactive SM from their clinical team were significantly more likely to engage in better diabetes self-management and report a higher sense of diabetes self-efficacy. This relationship was mediated by the patient's perception of autonomy support. The majority of proactive SM discussed scheduling, referrals, or other administrative content. Patients' responses to team-initiated communication promoted patient engagement in diabetes self-management behaviors.

CONCLUSIONS: Perceived autonomy support is important for diabetes self-management and self-efficacy. Proactive communication from clinical teams to patients can help to foster a patient's sense of autonomy and encourage better diabetes self-management and self-efficacy.

Keywords

diabetes, mediation, patient autonomy, patient portal, patient-provider communication, qualitative, veterans

Rights and Permissions

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S. ; foreign copyright protection may apply) 2020.

DOI of Published Version

10.1007/s11606-020-05834-x

Source

Robinson SA, Zocchi MS, Netherton D, Ash A, Purington CM, Connolly SL, Vimalananda VG, Hogan TP, Shimada SL. Secure Messaging, Diabetes Self-management, and the Importance of Patient Autonomy: a Mixed Methods Study. J Gen Intern Med. 2020 May 21. doi: 10.1007/s11606-020-05834-x. Epub ahead of print. PMID: 32440998. Link to article on publisher's site

Journal/Book/Conference Title

Journal of general internal medicine

PubMed ID

32440998

Related Resources

Link to Article in PubMed

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