Koponen Anne M, Simonsen Nina, Suominen Sakari
Folkhälsan Research Center, and Department of Public Health, University of Helsinki, Finland.
School of Health and Education, University of Skövde, Skövde, Sweden.
Health Psychol Behav Med. 2018 Apr 25;6(1):104-119. doi: 10.1080/21642850.2018.1462707.
Increased physical activity (PA) is crucial for achieving and maintaining glycemic control and is beneficial for overall well-being of patients with type 2 diabetes as well. Despite that, many patients fail to make changes in their exercise behavior. Self-determination theory (SDT) addresses this problem and suggests that perceived autonomy support, autonomous motivation and self-care competence play a key role in the process of health behavior change. This study investigated the impact of these three factors on success in increasing PA among patients with type 2 diabetes but considered also the role of other important life-context factors, such as mental health, stress and social support. The effect of these other factors may outweigh the effect of SDT constructs; however, previous studies based on SDT have largely overlooked them.
This cross-sectional mail survey was carried out in 2011. Out of 2866 respondents, those who had been over 2 years in care in their present and principal primary care health center and had during the past two years tried to increase PA either with or without success ( = 1256, mean age 63 years, 52% men), were included in this study. Logistic regression and mediation analyses were the main methods used in the data analysis.
Autonomous motivation predicted success in increasing PA even after controlling for the effect of other important life-context factors. Other predictors of success were felt energy, good perceived health, younger age and less social support. Autonomous motivation mediated the effect of perceived autonomy support from a doctor on success in increasing PA.
The results were in line with SDT showing the importance of autonomous motivation for success in increasing PA. Doctor-patient relationships and lifestyle interventions should focus on promoting self-motivated reasons for health behavior change.
增加身体活动（PA）对于实现和维持血糖控制至关重要，对2型糖尿病患者的整体健康也有益。尽管如此，许多患者未能改变其运动行为。自我决定理论（SDT）解决了这一问题，并表明感知到的自主支持、自主动机和自我护理能力在健康行为改变过程中起关键作用。本研究调查了这三个因素对2型糖尿病患者增加PA成功与否的影响，但也考虑了其他重要生活背景因素的作用，如心理健康、压力和社会支持。这些其他因素的影响可能超过SDT结构的影响；然而，以往基于SDT的研究在很大程度上忽略了它们。
这项横断面邮件调查于2011年进行。在2866名受访者中，那些在其当前主要的初级保健健康中心接受治疗超过2年且在过去两年中试图增加PA，无论成功与否的患者（n = 1256，平均年龄63岁，52%为男性）被纳入本研究。逻辑回归和中介分析是数据分析中使用的主要方法。
即使在控制了其他重要生活背景因素的影响后，自主动机仍能预测增加PA的成功。成功的其他预测因素包括感觉精力充沛、良好的健康感知、较年轻的年龄和较少的社会支持。自主动机介导了医生给予的感知自主支持对增加PA成功的影响。
结果与SDT一致，表明自主动机对增加PA成功的重要性。医患关系和生活方式干预应侧重于促进健康行为改变的自我激励原因。
