What Motivates People With (Pre)Diabetes to Move? Testing Self-Determination Theory in Rural Uganda

Jeroen De Man; Edwin Wouters; Pilvikki Absetz; Meena Daivadanam; Gloria Naggayi; Francis Xavier Kasujja; Roy Remmen; David Guwatudde; Josefien Van Olmen

doi:10.3389/fpsyg.2020.00404

What Motivates People With (Pre)Diabetes to Move? Testing Self-Determination Theory in Rural Uganda

Front Psychol. 2020 Mar 24:11:404. doi: 10.3389/fpsyg.2020.00404. eCollection 2020.

Authors

Jeroen De Man¹, Edwin Wouters², Pilvikki Absetz^{3

4}, Meena Daivadanam^{5

6

7}, Gloria Naggayi⁸, Francis Xavier Kasujja⁸, Roy Remmen¹, David Guwatudde⁸, Josefien Van Olmen^{1

9}

Affiliations

¹ Centre for General Practice, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
² Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium.
³ Collaborative Care Systems Finland, Helsinki, Finland.
⁴ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
⁵ Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
⁶ Health Systems and Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁷ International Maternal and Child Health Division, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁸ Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁹ Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.

Abstract

Introduction: Sub-Saharan Africa is experiencing a rapid growth of type 2 diabetes (T2D) and its related burden. Regular physical activity (PA) is a successful prevention strategy but is challenging to maintain. Self-determination theory (SDT) posits that more autonomous forms of motivation are associated with more sustainable behavior change. Evidence to support this claim is lacking in sub-Saharan Africa. This study aims to explore the relationships between latent constructs of autonomous and controlled motivation, perceived competence, perceived relatedness, PA behavior, and glycemic biomarkers.

Methods: Structural equation modeling was applied to cross-sectional data from a rural Ugandan population (N = 712, pre-diabetes = 329, diabetes = 383). Outcome measures included self-reported moderate and vigorous PA, pedometer counts, and fasting plasma glucose (FPG) and glycated hemoglobin (HbA1C).

Results: Our findings support SDT, but also suggest that different types of motivation regulate different domains and intensities of PA. Higher frequency of vigorous PA - which was linked to a lower HbA1C and FPG - was predicted by autonomous motivation (β = 0.24) but not by controlled motivation (β = -0.05). However, we found no association with moderate PA frequency nor with pedometer counts. Perceived competence and perceived relatedness predicted autonomous motivation. Autonomous motivation functioned as a mediator between those needs and PA behavior.

Conclusion: This is the first study providing evidence for a SDT model explaining PA among people at risk of, or living with, T2D in a rural sub-Saharan African setting. Our findings suggest that individuals who experience genuine support from friends or family and who feel competent in doing vigorous PA can become motivated through identification of health benefits of PA as their own goals. This type of motivation resulted in a higher frequency of vigorous PA and better glycemic biomarkers. On the other hand, people who felt more motivated through pressure from others or through feelings of guilt or shame were not more engaged in PA.

Clinical trial registration: ISRCTN 11913581. Registered January 10, 2017.

Keywords: Uganda; autonomous motivation; controlled motivation; physical activity; psychological needs theory; self-determination theory; sub-saharan Africa; type 2 diabetes.