Assessment of Motivational Cognitions in Diabetes Self-Care: the Motivation Thought Frequency Scales for Glucose Testing, Physical Activity and Healthy Eating.

PURPOSE: There is a need for improved measurement of motivation for diabetes self-care. The Elaborated Intrusion Theory of Desire offers a coherent framework for understanding and identifying the cognitive-affective events that constitute the subjective experience of motivation and may therefore inform the development of such an instrument. Recent research has shown the resultant Motivation Thought Frequency scale (MTF) to have a stable factor structure (Intensity, Incentives Imagery, Self-Efficacy Imagery, Availability) when applied to physical activity, excessive snacking or alcohol use in the general population. The current study aimed to confirm the four-factor structure of the MTF for glucose testing, physical activity and healthy eating in people with type 2 diabetes. Associations with self-reports of concurrent diabetic self-care behaviours were also examined. METHOD: Confirmatory factor analyses tested the internal structure, and multiple regressions assessed the scale's relationship with concurrent self-care behaviours. The MTF was completed by 340 adults with type 2 diabetes, and 237 from that sample also reported self-care behaviours. Separate MTFs assessed motivation for glucose testing, physical activity and healthy eating. Self-care was assessed using questions from the Summary of Diabetes Self-Care Activities. RESULTS: The MTF for each goal achieved an acceptable fit on all indices after selected errors within factors were allowed to intercorrelate. Intensity and Self-Efficacy Imagery provided the strongest and most consistent correlations with relevant self-care behaviours. CONCLUSION: Results provide preliminary support for the MTF in a diabetes sample. Testing of its sensitivity to change and its predictive utility over time is needed.

Qualitative analysis of feedback on functional imagery training: A novel motivational intervention for type 2 diabetes.

OBJECTIVE: Effective motivational support is needed in chronic disease management. This study was undertaken to improve a novel type 2 diabetes motivational intervention, (functional imagery training, FIT) based on participant feedback and results from a self-management randomised controlled trial. DESIGN: Qualitative inductive thematic analysis of semi-structured interviews. MAIN OUTCOME MEASURES: Open-ended questions on participant experiences of the FIT intervention content, process, most/least helpful features, suggestions for improvement and general feedback. RESULTS: Eight themes emerged. Participants thought FIT promoted autonomy and self-awareness. They found the intervention interesting and helpful in keeping their health on track through accountability provided by regular phone calls. However, boredom with repetitive use of imagery, feeling inadequately equipped to manage unhealthy cravings, and difficulty with the time commitment was reported by some. Supplementary written material was recommended. CONCLUSION: Several well-received features of FIT overlapped with those from traditional motivational interviewing. FIT sessions should ensure content is regularly adapted to new health-enhancing goals. After self-management behaviour becomes habitual, imagery practice could be restricted to challenging contexts. Provision of a written rationale and use of mindfulness for cravings is recommended. With these improvements, the impact of FIT on diabetic control may be substantially enhanced.