Secure Messaging, Diabetes Self-management, and the Importance of Patient Autonomy: a Mixed Methods Study
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Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; 2Boston University School of Medicine, Boston, MA, USA; 3The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; 4 University of Massachusetts Medical School, Worcester, MA, USA; 5Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; 6Department of Psychiatry, Harvard Medical School, Boston, MA, USA; 7School of Medicine, Boston University, Boston, MA, USA; 8Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; 9School of Public Health, Boston University, Boston, MA, USA.
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 selfmanagement 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
Received September 2, 2019 Accepted April 1, 2020
help to foster a patient’s sense of autonomy and encourage better diabetes self-management and self-efficacy. KEY WORDS: patient portal; veterans; patient-provider communication; diabetes; qualitative; mediation; patient autonomy. J Gen Intern Med DOI: 10.1007/s11606-020-05834-x © Society of General Internal Med
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