Investigating the role of perceived autonomy support in moderating the association between diabetes stigma and psychological and diabetes self-management outcomes among adults with type 2 diabetes in Ghana

Abstract

Studies on diabetes-related stigma rarely focus on identifying or examining protective factors (e.g., social support and healthcare environment) that can mitigate the adverse effect of this social phenomenon. In this cross-sectional study, we examined perceived autonomy support, a concept from the self-determination theory, as a moderator of the association between diabetes-related stigma and its adverse behavioral and psychological (depression, diabetes distress, and anxiety) correlates. We recruited 190 adults with type 2 diabetes (T2D) from a tertiary hospital in Ghana. We assessed diabetes-related stigma, depression, anxiety, diabetes distress, diabetes self-management, and perceived autonomy support using psychometric instruments. Hierarchical multivariable linear regressions were used to evaluate moderation effects of perceived autonomy support. Participants had an average age of 59.44 (standard deviation [SD] = 10.7) years, were mostly female (70.5%, n = 134), and had had T2D diagnosis for a median of 14.5 years. Autonomy support was directly associated with lower anxiety and depression and better diabetes self-management behaviors. Greater perceived autonomy support reduced the negative association between diabetes-related stigma and diabetes self-management (β = 0.20, 95% confidence interval [CI]: 0.01 to 0.39; p = 0.041). Perceived autonomy support buffered the negative effects of diabetes stigma on self-management. These findings highlight autonomy-supportive care as a promising strategy to address the adverse effects of diabetes-related stigma in Ghana.

Fig 1. Scatter plot showing the association among study variables.

We observe that perceived autonomy support is associated with lower depressive and anxiety symptoms and better self-management behaviors. The red trend line indicates direction of the correlation.

Fig 2. Spotlight analysis of the effect of T2D stigma on diabetes self-management behaviors at three levels of perceived autonomy support (mean, mean + SD, and mean -SD).

At lower levels of perceived autonomy support (mean - SD), the negative effect of T2D stigma on self-management behaviors is steep compared to the mean autonomy support.

Fig 3. Johnson-Neyman plot showing ranges of autonomy support for which the association between diabetes stigma and self-management behaviors is significant.

We observe that as autonomy support increases, the effect of diabetes stigma on self-management behaviors approaches zero.