UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



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


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.


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

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© 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



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


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Link to Article in PubMed