Date of Award

Spring 5-15-2017

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Genevieve Pinto-Zipp, Ed.D

Committee Member

Deborah A. DeLuca, JD

Committee Member

Ning Jackie Zhang, Ph.D


Autonomy Support, Shared Decision Making, Patient Activation, Diabetes Self-care Behaviors



Chronic disease places a different set of demands on an individual and family. Self-care behaviors and daily decision making is an integral part of diabetes management. According to the CDC (2014), the prevalence of Diabetes is estimated at 29.1 million and an alarming 86 million Americans have Pre-diabetes. Despite a plethora of evidence on the importance of diabetes self-care behaviors on clinical outcomes, studies have highlighted the current disconnect of patients not able to follow self-care behavior recommendations and not asking for help from their health care providers. There is no literature on the impact of an autonomy supported healthcare environment in shared decision making and patient activation levels of diabetes self-care behaviors.

Methods: This non-experimental, observational study investigated the relationship between the patient’s perceived autonomy support in a shared decision making encounter and their patient activation levels of diabetes self-care behaviors. The study design included both quantitative and qualitative methodology for exploratory, descriptive, and correlational research. Patients at Geisinger Health System Endocrinology clinic and Community Practice Service Line Clinics (CPSL) who met the eligibility criteria were sent the electronic survey per protocol email distribution requirements. A sample of 101 patients participated in this study.

Results: Mean duration of diabetes was 13 years with a range of 1-40 years living with diabetes. Gender was reported as 40% male and 60% female for those completing the survey. Only 22% of responders did not receive and previous diabetes education sessions.

Perceived autonomy support explained about 23% of the shared variance with Patient activation. There was no relationship between the number of diabetes education session and patient activation levels. The relationship between gender and patient activation levels and duration of diabetes and patient activation levels was weak. In the linear multiple regression model including four predictor variables on patient activation, the amount of variance explained increased to 27%. The only two variables of significance in the model were duration of diabetes and perceived autonomy support.

Qualitative findings revealed responses analogous with perceive autonomy support and feeling comfortable in the healthcare encounter. This included 33% of the patient responding in themes related to “feeling valued, understood and respected with caring professionals”. In comparison, another 33% of patients described their visits around the time limitations of the visit. The second question which queried the patient on the most important factors to them in their diabetes healthcare visit, three factors aligned (71%) with the importance of autonomy supported environment.

Conclusion: This study increases our understanding of perceived autonomy support in shared decision making and patient activation levels for diabetes self-care behaviors. Helping patients to initiate and maintain these self-care behaviors must remain a priority now and in the future. Greater than 25 % of patients suggest that perceived autonomy support in shard decision making does enhance patient activation levels. Multiple themes including feeling valued, supported, and encouraged in the healthcare interaction were dominant areas of importance based on qualitative analysis of survey responders. These themes are analogous with an autonomy supported environment. In healthcare practices, we can increase patients perceived autonomy support and thus increase patient activation levels in patients with diabetes.