# 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

## TL;DR

This study explores how feeling supported in making health decisions can reduce the negative effects of diabetes stigma on mental health and self-care in Ghana.

## Contribution

The study introduces perceived autonomy support as a novel moderator of diabetes stigma effects in a Ghanaian context.

## Key findings

- Perceived autonomy support is linked to lower anxiety and depression and better diabetes self-management.
- Higher autonomy support reduces the negative impact of diabetes stigma on self-management behaviors.
- Autonomy-supportive care is suggested as a strategy to mitigate diabetes-related stigma effects.

## 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.