Secure Messaging, Diabetes Self-management, and the Importance of Patient Autonomy: a Mixed Methods Study

Stephanie A. Robinson, Mark S. Zocchi, Dane Netherton, Arlene Ash, Carolyn M. Purington, Samantha L. Connolly, Varsha G. Vimalananda, Timothy P. Hogan, Stephanie L. Shimada

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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 self-management 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 help to foster a patient’s sense of autonomy and encourage better diabetes self-management and self-efficacy.

Original languageEnglish (US)
Pages (from-to)2955-2962
Number of pages8
JournalJournal of general internal medicine
Issue number10
StatePublished - Oct 1 2020


  • diabetes
  • mediation
  • patient autonomy
  • patient portal
  • patient-provider communication
  • qualitative
  • veterans

ASJC Scopus subject areas

  • Internal Medicine


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