Hindawi
Journal of Diabetes Research
Volume 2023, Article ID 5341656, 12 pages
https://doi.org/10.1155/2023/5341656
Review Article
Self-Determination Theory and Quality of Life of Adults with
Diabetes: A Scoping Review
Jacob Owusu Sarfo ,1 Paul Obeng,1 Henneh Kwaku Kyereh ,1 Edward Wilson Ansah ,1
and Priscilla Yeye Adumoah Attafuah 2
1Department of Health, Physical Education and Recreation, University of Cape Coast, Ghana
2Public Health Nursing Department, School of Nursing and Midwifery, University of Ghana, Ghana
Correspondence should be addressed to Priscilla Yeye Adumoah Attafuah; pyaattafuah@ug.edu.gh
Received 16 September 2022; Revised 21 March 2023; Accepted 28 March 2023; Published 12 April 2023
Academic Editor: Akira Sugawara
Copyright © 2023 Jacob Owusu Sarfo et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. Diabetes is one of the leading causes of sickness, death, and decreased quality of life globally. The prevalence of
diabetes keeps rising globally due to lifestyle changes and urbanization. Therefore, improved quality of life (QoL) and
appropriate diabetes self-management practices, including treatment adherence, are crucial to improving and sustaining the
health of diabetic patients. Some studies have adopted the self-determination theory (SDT) to study diabetes interventions, but
less is known about its effectiveness in improving QoL, treatment adherence, and diabetes self-management. Aim/Objective.
This review assessed the effectiveness of SDT in improving self-management practices, treatment adherence, and QoL among
adult diabetic patients. Method. We followed the six-stage framework by Arksey and O’Malley in conducting the review.
PubMed, JSTOR, Central, and ScienceDirect databases were searched for published articles from January 2011 to October 2021
using keywords and Boolean logic. Furthermore, we screened a reference list of related articles. Also, Google Scholar, Z-library,
and web-based searches were carried out to retrieve other relevant evidence that applied SDT in improving QoL, diabetes self-
management, and treatment adherence. Findings. Fifteen studies met the inclusion criteria, from which data were extracted as
findings. SDT effectively improved QoL, diabetes treatment adherence, and diabetes self-management among diabetic patients.
Of these studies, 11 provided data on SDT and diabetes self-management and affirmed the effectiveness of the theory in
improving appropriate diabetes self-management practices. Two studies confirmed the effectiveness of SDT in improving
treatment adherence. SDT and QoL were assessed in 4 of the studies, which demonstrated the effectiveness of SDT in
enhancing the QoL of diabetic patients. Conclusion. SDT effectively improved QoL, diabetes treatment adherence, and diabetes
self-management. The application of SDT in diabetes management will improve the health and QoL of diabetic patients.
Hence, diabetes management interventions could adopt SDT to guide treatment.
1. Introduction were about 476 million diabetes cases, of which the inci-
dence was about 22.9 million in 2017 [6]. Accordingly, over
Diabetes is one of the leading causes of sickness, decreased 1.37 million people died from the disease and its complica-
quality of life (QoL), and deaths worldwide [1]. It is also tions, with over 67.9 million disability-adjusted life years
among the top 10 causes of death globally [2, 3]. Besides, (DALYs) in 2017 [6]. The presence of diabetes exposes an
diabetes is a chronic noncommunicable disease (NCD) that individual to a 2-3-fold risk of all causes of death among
occurs when the pancreas produces insufficient insulin (the adults [4]. Moreover, diabetes and cardiovascular diseases
hormone that regulates the body’s blood sugar level) or the (CVD), respiratory diseases, and cancers account for over
body cannot effectively utilize the insulin produced [4]. 80% of premature deaths from NCDs globally [7, 8]. Unfor-
Thus, diabetic patients usually take insulin daily to help tunately, research shows that the condition will rise to over
absorb food nutrients into their system [5]. Globally, there 693 million cases by 2045 if adequate measures, including
2 Journal of Diabetes Research
efforts to ensure adequate self-management practices and In the first stage, we identified and drafted the research
medication adherence, are not implemented [9]. questions to guide the study: (1) How effective is SDT in
Patients with diabetes experience worse QoL than those improving diabetes self-management? (2) How effective is
without chronic diseases [10–12]. The QoL (physical and SDT in improving treatment adherence? and (3) How effec-
social functioning and perceived physical and mental well- tive is SDT in improving the QoL of adult diabetic patients?
being) of diabetic patients are mostly affected due to the
management process and the need to adjust to diabetes 3. Identification and Selection of Studies
management demands [7, 13, 14]. Thus, diabetic patients
must consciously balance insulin intake and other manage- 3.1. Search Strategy. Two authors (PO and HKK) conducted
ment interventions [15]. Moreover, the psychosocial burden a preliminary literature search on the topic to set the inclu-
of living with diabetes usually affects the self-care behaviour, sion and exclusion criteria. Furthermore, we expanded and
medication adherence, and QoL of diabetic patients [16]. refined our search strategy with expert help (an academic
The main target in diabetes care is maintaining blood glu- librarian at the University of Cape Coast). In addition, we
cose levels in a healthy range to avoid long-term diabetes conducted a vigorous literature review of published articles
complications through adhering to medications and appro- in four electronic databases (PubMed, JSTOR, Central, and
priate self-management [17]. However, studies show low ScienceDirect). We expanded the search via hand search to
levels of medication adherence [18], poor self-management include other unpublished sources. The search strategy
practices [19], and poor quality of life among diabetic included literature from January 2011 to October 2021 using
patients [20]. Moreover, it seems there is a dearth of infor- key search words and Boolean logic. Also, a free web-based
mation on the most effective method of improving medica- search was conducted to retrieve other relevant materials.
tion adherence, appropriate self-management practices, Also, Google Scholar and Z-library were searched for addi-
and QoL among diabetes patients [16]. tional records. Furthermore, reference lists of eligible records
Studies employed self-determination theory- (SDT-) were checked for other relevant articles.
based interventions to improve medication adherence, self- The final search was completed on October 28, 2021.
management practices, and QoL of diabetic patients Titles and abstracts of studies retrieved were read, and only
[21–24]. The theory consists of three psychological needs, studies relevant to the study were considered. Six keywords
relatedness, competence, and autonomy, for optimal function- were used in the search strategy: (“Self-determination Theory”
ing [25]. Autonomy consists of diabetic patients’ experiences OR “diabetes”OR “Application of Self-determination Theory”
and perceptions of control and self-initiation in line with their OR “QoL” OR “Diabetes self-management” OR “Diabetes
idea of self [26]. Additionally, competence develops from the medication adherence) AND (“Adults” OR “grownups” OR
need to be effective in diabetes management practices and “people aged 18-75 years” OR “grown people”).
the praise or appreciation of such excellence. Also, relatedness
3.2. Eligibility Criteria. Studies were included if conducted
involves the need to “experience love and care as well as to
among adult diabetic patients (type 1, type 2, and gestational
express love and care towards others” [27].
diabetes), aged 18-75 years, measured at least one SDT-
Besides, the SDT improved the quality of life of diabetes
based motivational construct, and published online between
patients in Norway [28]. Also, Raaijmakers et al. [29] found
January 2011 and October 2021 (with no limit concerning
that self-determination regarding type 2 diabetes care con-
the start date). Also, the authors must have explicitly men-
tributed to improved QoL. Moreover, the SDT improved
tioned SDT as the framework for a study to be included.
physical activities among diabetic patients in France [30]
and Uganda [31]. Although studies have linked some con- 3.3. Exclusion Criteria. We excluded studies that did not
structs of the SDT and QoL of adults with diabetes, the effec- specify the study population and those that were not pub-
tiveness of SDT in improving the QoL and self-management lished in English. Additionally, nonprimary studies (system-
practices of adult diabetic patients is not pronounced in the atic reviews and scoping reviews) and studies that used
literature. This scoping review examined available evidence SDT-based measures but employed motivational interview-
on the link between SDT and QoL of adults with diabetes. ing as their guiding framework with no reference to SDT
were excluded.
2. Methods 3.4. Procedure. We used the eligibility criteria of the current
study to scan the titles and appraise the abstracts of the iden-
This scoping review was conducted following the six-stage tified literature for full-text review. We further scanned and
framework by Arksey and O’Malley [32]. The framework manually screened the references of all included literature to
was adopted because it helps to assess the literature to exam- add relevant studies to our review. Two of the current
ine what has been done and identify the gaps in knowledge study’s authors (PO and HKK) did the full-text review inde-
that need attention [33]. Arksey and O’Malley [32] suggest pendently. The authors later met, reconciled the differences,
that the following stages should be followed in conducting and agreed on the included studies. We then developed a
a scoping review: (1) identifying and stating the research data extraction sheet with the following categories: author,
questions; (2) identifying relevant studies; (3) study selec- year of publication, study title, country, population, study
tion; (4) data collection; (5) data summary and synthesis of design, sample size, sampling strategy, and summary of find-
results; and (6) consultation. ings (see Table 1 in the Appendix). Three of the study’s
Journal of Diabetes Research 3
Table 1: Effectiveness of SDT in diabetes self-management among adults.
Author Year Study title Country Population Study design Sample size Sampling strategy Summary findings
Patients experience multiple
impediments to effective self-
management of diabetes and
behaviour change, including poor
health literacy, a lack of self-
efficacy, and perceived social
A qualitative study of the Qualitative study A criterion
support. Most patients reported not
experiences of care and motivation comprising sampling
having received adequate
for effective self-management Hypertensive and individual, in- procedure was
Murphy South information, counselling, or
2015 among diabetic and hypertensive diabetic patients 18 depth interviews 22 used to select
et al. Africa autonomy support from their
patients attending public sector years and above. with hypertensive patients who had
healthcare providers. Their
primary health care services in and diabetic diabetes and/or
experiences suggest that the current
South Africa patients hypertension
approach to chronic care largely
fails to meet patients’ motivation
needs, leaving many of them feeling
anxious about their state of health
and frustrated with the quality of
their care.
Their findings suggest that different
types of motivation regulate
different domains and intensities of
PA. A higher frequency of vigorous
PA—which was linked to a lower
The study was a
Adults aged 30-75 HbA1C and FPG—was predicted
What motivates people with cluster-randomized
De Man years in two rural Cluster sampling by autonomous motivation but not
2020 (pre)diabetes to move? Testing SDT Uganda adaptive 794
et al. districts in eastern technique by controlled motivation. Perceived
in rural Uganda implementation
Uganda competence and perceived
trial
relatedness predicted autonomous
motivation. Autonomous
motivation functioned as a
mediator between those needs and
PA behaviour.
The findings indicate that the
participants experienced new life
possibilities after participating in
New possibilities in life with type 2 the SDT program, which positively
Descriptive and Purposive and
diabetes: experiences from influenced their motivation for self-
Karlsen Adults with type 2 explorative convenient
2018 participating in a guided self- Norway 16 management. Through reflections
et al. diabetes mellitus qualitative sampling
determination program in general on how to live with diabetes, the
approach technique
practice participants reinterpreted their life
with diabetes by gradually
developing a closer relationship
with the disease and moving
4 Journal of Diabetes Research
Table 1: Continued.
Author Year Study title Country Population Study design Sample size Sampling strategy Summary findings
towards acceptance. Dialogue with
nurses was seen to have helped
support the participants to become
more self-determined.
The HbA1c and self-management
scores increased higher in the
autonomy support group than in
the other two groups. After the
intervention, the control rate in the
autonomy support group was
Adult diabetic
higher than in the other two
Effectiveness of self-management patients in 3
Pretest posttest 3 Convenient groups. The value in the autonomy
Liu et al. 2018 behaviour intervention on type 2 China selected
intervention study communities sampling method support group was higher than in
diabetes based on SDT communities in
the routine intervention group.
Beijing
Baseline self-management
behaviour, self-efficacy, knowledge,
skill, family support, autonomy
support, peer support, and age were
positively correlated with the
change in behaviour.
Participants with “high combined”
and “self-determined” profiles
reported higher perceived
Adult type 2 competence and longer leisure-
Motivational profiles for physical diabetics patients in time PA practice in comparison to
Gourlan Cross-sectional
2016 activity practice in adults with type France a diabetes care 350 — those with a “moderate” profile.
et al. design
2 diabetes: an SDT perspective Centre in a French This study highlights the necessity
hospital of adopting a person-centred
approach better to understand
motivation towards PA among type
2 diabetes patients.
Applying SDT, it was found that
many participants reported
relatively dominant controlled
“I’ve made this my lifestyle now”: a motivation to comply with lifestyle
Newly diagnosed
prospective qualitative study of recommendations, avoid their non-
adults with type 2
Sebire motivation for lifestyle change Randomized Purposive compliance being “found out” or
2018 England diabetes and were 593
et al. among people with newly control trial sampling suppress guilt following lapses in
participants in the
diagnosed type two diabetes behaviour change attempts. Such
early ACTID trial
mellitus narratives were accompanied by
experiences of frustrating slow
behaviour change progress. More
autonomous motivation was
Journal of Diabetes Research 5
Table 1: Continued.
Author Year Study title Country Population Study design Sample size Sampling strategy Summary findings
expressed as something often
achieved over time and reflected
goals to improve health, QoL, or
family time.
The findings suggested that the
patient’s intrinsic motivation was
Barriers to initiation of insulin Patients with type 2 less than their extrinsic motivation.
Rajab therapy in poorly controlled type 2 diabetes who had Descriptive cross- It was observed that patients do not
2020 Iran 151 Random sampling
et al. diabetes based on self- indications for sectional study properly understand their illness
determination theory insulin therapy due to the low score of relatedness
representative of patients’ and care
providers’ relationships.
The data supported the SDT
process model, in which the effect
of the intervention significantly
predicted indirect changes in
behaviour and health through
Physical activity and motivational Adult patients with
motivation variables. Considering
Halvari predictors of changes in health both type 2 diabetes Purposive
2017 Norway Clinical trial 108 the moderate to large effects on
et al. behavior and health among DM2 and coronary artery sampling
increases in motivation, behaviour,
and CAD patients disease (CAD)
and health, promoting organized
physical activity programs that are
perceived as need-supportive may
have important health implications
for patients with DM2 and CAD.
Patients in an autonomous support
group (ASP) achieved better
HbA1c reduction at the end of
intervention than those in the usual
care group (UCG) and successfully
maintained it for up to 6 months.
However, patients in a social
Can autonomy support have an support group (SSG) did not
Cluster Purposive and
effect on type 2 diabetes glycemic Patients with type 2 experience a significant change in
Yun et al. 2020 China randomized 364 convenient
control? Results of a cluster diabetes HbA1c at 3 or 6 months when
controlled trial sampling
randomized controlled trial compared with patients in UCG.
Besides, patients in both the SSG
and ASG experienced an
improvement in exercise at 3
months. Patients in ASG sustained
improvement in exercise for up to 6
months but those in the SSG did
not. Autonomy support for patients
6 Journal of Diabetes Research
Table 1: Continued.
Author Year Study title Country Population Study design Sample size Sampling strategy Summary findings
with type 2 diabetes could help
achieve glycaemic control at the
end of the intervention and
successfully maintain it for up to 6
months.
Dietary self-care was longitudinally
associated with self-efficacy, self-
Longitudinal motivational evaluation, autonomy support, and
predictors of dietary self-care and People newly autonomous motivation. The
Nouwen Longitudinal study Purposive
2011 diabetes control in adults with Netherlands diagnosed with type 237 results indicate that autonomy
et al. design sampling
newly diagnosed type 2 diabetes 2 diabetes support, self-efficacy, and self-
mellitus evaluation are key targets for
interventions to improve dietary
self-care.
The findings of this study
supported SDT by showing that
autonomous motivation was the
Success in increasing physical strongest predictor of success in
Koponen activity (PA) among patients with Patients with type 2 Cross-sectional increasing PA among people with
2018 Finland 1256 —
et al. type 2 diabetes: a self-determination diabetes survey type 2 diabetes. The autonomous
theory perspective motivation was associated with
success in increasing PA even after
the effect of other important life-
context factors was controlled for.
Of all measured explanatory
factors, autonomous motivation
was most strongly associated with
engagement in PA. Autonomous
motivation mediated the effect of
perceived autonomy support on
Determinants of physical activity patients’ PA. Thus, perceived
among patients with type 2 autonomy support was associated
Koponen diabetes: the role of perceived Patients with type 2 Cross-sectional Purposive with the patient’s PA through
2017a Finland 5167
et al. autonomy support, autonomous diabetes survey sampling autonomous motivation.
motivation, and self-care Interventions for improved
competence diabetes care should concentrate on
supporting patients’ autonomous
motivation for PA. Internalizing
the importance of good self-care
seems to give sufficient energy to
maintain a physically active
lifestyle.
Journal of Diabetes Research 7
Table 1: Continued.
Author Year Study title Country Population Study design Sample size Sampling strategy Summary findings
Autonomy support from one’s
physician was most strongly
Quality of primary health care and
associated with autonomous
Koponen autonomous motivation for Patients with type 2 Cross-sectional Purposive
2017b Finland 2866 motivation (self-regulation) for
et al. effective diabetes self-management diabetes survey sampling
effective diabetes self-management
among patients with type 2 diabetes
among patients with type 2
diabetes.
Participants in the guided self-
The effect of guided self- Adults (all determination group training
determination on self-management Caucasian) aged (GSD-GT) group exhibited a
Prospective
Mohn in persons with type 1 diabetes Western 18–55 with type 1 Random significant reduction in diabetes-
2017 ≥ randomize control 178et al. mellitus and HbA1c 64mmol/ Norway DM for at least 1 assignment related distress relative to the
trial
Mol: a group-based randomized year and HbA1c control group (CG) the GSD-GT
controlled trial ≥64mmol/Mol group showed an increase in self-
esteem relative to the CG.
Two dietary patterns (healthy and
unhealthy) were identified. The
competence construct was most
strongly associated with a healthy
Can self-determination explain Adults at risk of
diet. Autonomous motivation and
dietary patterns among adults at and with type 2
Güil competence mediated the effect of
risk of or with type 2 diabetes? A diabetes from two Quantitative cross- Purposive
Oumrait 2020 Sweden 147 relatedness on diet behaviour. In
cross-sectional study in socioeconomically sectional design sampling
et al. conclusion, social surroundings can
socioeconomically disadvantaged disadvantaged
promote adults at high risk of or
areas in Stockholm Stockholm areas
with type 2 diabetes to sustain
healthy diets by supporting their
autonomous motivation and
competence.
8 Journal of Diabetes Research
28,909 records identifed through Additional records identifed
database search (JSTOR = 30, PubMed = 83, through other sources
central = 7,031, ScienceDirect = 4,353, (n = 16)
Z-library = 12, Google Scholar = 17,400)
Records afer duplicates removed 14,873 records were excluded
(n = 15,058) because:
(i) 13,873 of the articles were
not relevant to the research
question.
(ii) 105 relevant articles were
Records screened written in a language the
(n = 15,058) researcher could not read.
(iii) 775 of them were conducted
among adolescents.
(iv) 95 were systematic reviews
(v) 25 of them were conference
presentations.
170 Full-text articles were excluded
Full-text articles assessed because:
for eligibility
(  = 185) (i) 62 of them did not specifyn
the population involved
in their study
(ii) 40 did not establish the
relationship between SDT
and diabetes.
(iii) 68 of studies used SDT-based
measures but employed 
Studies included in motivational interviewing
qualitative synthesis
(n = 15)
Figure 1: PRISMA flow diagram of records and screening process.
authors (PO, HKK, and JOS) extracted the data indepen- ysis for eligibility. We finally used 15 full-text studies in our
dently. They later settled the differences to obtain a final thematic analysis and synthesis (Figure 1 details the screen-
result for the study. We involved third (EWA) and fourth ing process).
(PYAA) reviewers to settle differences where there was dis-
agreement in the findings of the three authors. One of the 4.1. Characteristics of Included Studies. The included litera-
authors (PO) drafted the final extracted table (Results). All ture includes studies conducted among diabetic patients
the authors read through the final draft results and ensured 18-75 years old using SDT to determine or improve QoL,
the findings reflected the agreed results. We finally carried diabetes self-management practices, and diabetes medica-
out a thematic analysis and synthesis and presented the tion adherence. Out of the 15 included studies, five were
results. Additional consultations were made with subject experimental studies, one was a descriptive explorative qual-
experts to enhance the review. We used the PRISMA flow itative study, five were cross-sectional studies, and one was a
diagram to keep records and also screen the identified longitudinal study (Table 1 in the Appendix). Four studies
records (see Figure 1). addressed SDT and QoL among patients with diabetes, two
explored SDT and treatment adherence, and 11 focused on
4. Results SDT and diabetes self-management practices. Based on the
research questions, three main themes were derived from the
The initial search in JSTOR, PubMed, Central, ScienceDir- reviewed studies: (1) SDT and diabetes self-management; (2)
ect, Google Scholar, Google, and Z-library produced 28,909 SDT and diabetes treatment adherence; and (3) SDT and
records (JSTOR = 30, PubMed = 83, Central = 7,031, QoL among diabetic patients.
ScienceDirect = 4,353, Z − library = 12, and Google Scholar
= 17,400). Additional 16 records were identified through 4.2. SDT and Diabetes Self-Management. Eleven [34] studies
other sources. After removing duplicates using the Mendeley applied SDT to improving diabetes self-management. Lack
software, 15,058 records were available for screening. Fur- of autonomy hindered diabetes self-management [35].
thermore, 185 pieces of literature qualified for full-text anal- Also, autonomous motivation, perceived competence, and
Included Eligibility Screening Identifcation
Journal of Diabetes Research 9
relatedness influenced the higher frequency of vigorous PA tively managing themselves than those who received auton-
among people [31]. The application of SDT was effective omy support. However, there was an increase in diabetes
in improving PA among diabetic patients in five studies self-management scores among autonomous support groups
([11, 30, 36–38]). Besides, SDT was also influential in in the Chinese study. The similarities could be that when
improving dietary self-care among diabetic patients [39] diabetes patients feel more autonomous (are willing to initi-
(see Table 1 [Appendix]). ate an action without being forced to do so) in their manage-
ment process, they tend to take control of their management
4.3. SDT and Treatment Adherence. The adoption of an process [38]. Typically, diabetes patients are challenged with
SDT-based intervention effectively motivated diabetic the high cost of healthy foods, difficulty in giving up on
patients to comply with lifestyle recommendations and unhealthy lifestyles, busy work schedules, side effects of
avoided noncompliance behaviours in one study [40]. Also, medications, and accessibility of diabetic management
SDT-based intervention predicted that patients with less services [43]. Perhaps autonomy support increases their
intrinsic motivation and a low relatedness score report a willingness to continue appropriate management practices
higher rate of nonadherence to diabetes treatment [41]. despite their challenges. The current findings imply that dia-
4.4. SDT and QoL of Patients with Diabetes.We summarized betic patients need a sense of desire to comply with diabetes
the ndings on the e ectiveness of SDT in determining or self-management protocols to improve their health. How-fi ff
improving the QoL of diabetic patients. A study revealed ever, contrary to the present results, Liu et al. [34] found
that diabetic patients who did not receive autonomy support autonomy support insufficient to promote appropriate self-
from their healthcare providers experienced anxiety about management practices among diabetic patients, but other
their health status and frustration with the care quality factors such as self-efficacy, knowledge, skill, family, and
[35]. Also, patients who engaged in SDT interventions expe- peer support.
rienced new life possibilities and accepted their condition Also, the current finding where autonomy supports
[28]. Further, diabetic patients who participated in the improved PA is similar to that of other studies [31, 37, 38,
SDT intervention reported relatively dominant control 44] which reported higher PA among people with autonomy
motivation to comply with lifestyle recommendations and support and low PA among those with no or less autonomy
experienced improved health and QoL [40]. Also, diabetic support. Perhaps people who receive autonomy support
patients who participated in the SDT intervention developed engage in PAs willingly to satisfy their desires [45]. This
increased self-esteem. and vice versa [42] (see Table 1 in the finding may imply that diabetes self-management interven-
Appendix). tions that fail to provide autonomy support to their patients
could experience a decrease in appropriate self-management
5. Discussion practices among their participants.Furthermore, we found that SDT (competence, related-
This scoping review determined the effectiveness of SDT in ness, and autonomy) effectively increased appropriate die-
improving the QoL of diabetic patients. Our paper also tary self-care practices among diabetic patients. Nouwen
explored the effectiveness of SDT in improving treatment et al.’s [39] findings affirm those of the current study. They
adherence and appropriate self-management practices found diabetes patients in SDT intervention adopt healthy
among diabetic patients. We highlighted several findings. dietary practices. Perhaps SDT-guided diabetes management
Firstly, we found that a lack of autonomy support impedes interventions promote patients’ autonomy and help develop
diabetes self-management, whereas the autonomy support skills for healthy dietary patterns.
component of the SDT effectively improved PA among
them. Secondly, SDT effectively increased appropriate die- 5.2. SDT and Medication Adherence. We found that SDT
tary self-care practices among diabetic patients. Thirdly, interventions effectively guided diabetic patients to develop
SDT interventions effectively guided diabetic patients to willingness, mastery, and connection to comply with pre-
develop the willingness, mastery, and connection to comply scribed medication and treatment methods. Our findings
with prescribed medication and treatment methods. are similar to those of other studies [40, 46]. This finding
Fourthly, diabetic patients in SDT interventions developed could be because SDT-based interventions equip diabetic
the dominant controlled motivation to comply with their patients to own their management interventions, feel sup-
recommended medications. Lastly, SDT was effective in ported, and help them develop competence in their manage-
improving the QoL of diabetic patients. ment programs [44, 47]. However, Rajab et al. [41] found
otherwise in their study. They found that patients with low
5.1. SDT and Diabetes Self-Management. We found that a autonomy and relatedness scores did not comply with their
lack of autonomy support impedes diabetes self- medication due to poor intrinsic motivation and relatedness
management and that the autonomy support component [41]. Probably, when diabetic patients satisfy autonomy (free
of the SDT is more effective in improving PA and appropri- will), develop mastery (competence), and feel love and care
ate dietary self-care practices in diabetic patients. Our find- from family and healthcare providers, they are more likely
ings agree with studies conducted in South Africa [35] and to comply with their medications and treatment routine that
China [34]. The diabetic patients in the South African study could improve their health and QoL. Also, contrary to our
who received no adequate autonomy support from findings, Aloudah et al. [46] found higher treatment adher-
healthcare providers experienced more difficulty in effec- ence among diabetic patients who observed others adhering
10 Journal of Diabetes Research
to their treatment routines than those in SDT intervention. Disclosure
The divergent views call for a combination of therapies, such
as SDT and imitation, to achieve treatment adherence and The research was performed as part of the employment of
attendant health-improved outcomes in patients. the authors at the University of Cape Coast, Ghana, and
University of Ghana, Ghana.
5.3. SDT and QoL among Diabetic Patients. We found that Conflicts of Interest
SDT effectively improves the QoL of diabetic patients. This
finding could be because the theory improves patients’ compe- The authors declare no competing interests.
tencies, guides them to take voluntary actions, and makes
them feel loved and supported [42]. Our finding implies dia- Authors’ Contributions
betic patients could develop a high QoL if SDT guides diabetes
management interventions. Our finding aligns with other JOS conceived the idea of the study. All authors (JOS, PO,
studies [12, 35, 40, 42, 48]. These studies reported that diabetic HKK, EWA, and PYAA) participated in the synthesis and
patients in SDT interventions developed new life possibilities data charting. All authors wrote, read, and approved the
and exercised control over their new lives. final version of the manuscript.
Acknowledgments
6. Limitations
We appreciate all authors whose papers were used in this
This scoping review has provided insight into the effective- study.
ness of SDT in improving QoL, diabetes treatment adher-
ence, and diabetes self-management. However, there are a References
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