Empowering people to regulate their lifestyle, adopt healthy behaviors and to abstain from or change high risk behaviors might pose a significant impact on prevention of serious chronic illnesses, their induced complications, disabilities and mortality (1-2). However, in realm many more individuals end up with an unhealthy lifestyle and high-risk behaviors that put them in danger of contracting serious or fatal illnesses. This is partly due to lack of self-motivation and failure in autonomous regulation of the behavioral pattern to sustain a healthy and vivid life (3-4).
The self-determination theory (SDT) developed by Deci & Ryan (5-6) introduces the autonomous regulation as a proxy to achieve a long-term change in behaviors (1). Autonomous regulation with the gradual substitution of internal controls for external controls; help individuals to stay on track in a goal-setting process, in comparing their achievements with the goals, and eventually being able to overcome challenges of behavior change (7).
According to the SDT, intrinsic and extrinsic motives can drive people to act or not to act when action is needed on a daily basis. Amotivation which is the absence of both intrinsic and extrinsic motivation in a person may invoke a state of unwillingness in an individual to do a task or practice.
Distinct variation is observable in peoples’ general source of motivation hence; they can be categorized on a spectrum of low and high self-motivation. Highly self-determined individuals are classified with highest levels of intrinsic motivation and in consequence autonomous regulation. People with low level of self-determination are generally dependent on extrinsic motivation therefore; are categorized with low level of autonomous self-regulation. The four controlling pathways through which extrinsic motives shed influence on our behaviors include:
- External regulation (to get a prize, avoid punishment, or to follow social pressures),
- Introjected regulation (to avoid sin or shame, presence of a need to prove something),
- Identified regulation (giving value and importance to a healthy lifestyle)
- Integrated regulation (individuals’ internalized value to have a healthy lifestyle and its addition to their value system).
The two first regulatory paths are within the controlled regulation area but identified and integrated regulation paths are within the autonomous regulation area (Figure 1) that generally lead to a change in behavior based on an internal motive (2,4,8-12).
The philosophical assumptions of SDT posits that individuals naturally act proactively and has an inherent tendency to growth therefore; management of internal and external motives instead of being a product of social learning (13). It is based on autonomous regulating pathway that people emotionally feel commitment to a behavior and considers it as a duty and adjusts their behavior in order to receive positive feedback (2,14).
Type 2 diabetes if uncontrolled could cause many life-threatening complications, is very prevalent and it is expected that by 2030, diabetes management costs and its complications will account for 12 percent of the world's health budget. Different complications of type 2 diabetes are occurring due to absence or low level of motivation in patients to adhere to the prescribed therapeutic regimen. Type 2 diabetes successful management is based on a complex set of effective, evolving and non-stop self-management processes as prerequisite elements of interventional strategies to prevent both long-term and immediate risks of the disease-induced complications including hypoglycemia, hyperglycemia, nephropathy, neuropathy and retinopathy (8-9, 15).
Based upon unquestionable importance of self-management competencies of type 2 diabetes patients in controlling the illness and prevention of its debilitating complications the Treatment Self-Regulation Questionnaire (TSRQ) was introduced by Ryan & Cannell (16-17) as a generic tool to assess independency of patients in autonomous self-regulation of healthy behaviors, changing high-risk behaviors, and identifying and adhering to therapeutic recommendations (2, 18-21).
Different versions of the TSRQ have been adapted in various studies (22-25) to examine the effect of autonomous regulation on distinct behaviors e.g. lifestyle changes in patients with chest pain (26), physical activity in patients with rheumatoid arthritis (27-28), dietary habits (1, 15, 22-23), physical activity (1, 29), drinking behavior (30), smoking (1, 31-32) and weight loss practices (12, 33). Consistent with these studies’ importance of autonomous regulation on diabetes control, care and self-management, positive lifestyle changes, therapeutic adherence and regular physical activity, diet change, blood glucose control and stress control were studied (3-4, 8, 12-13, 17, 33-43).
The TSRQ have been tested psychometrically in various studies for use in self-regulation appraisal of the patients or healthy subjects (1, 6-7, 10, 44-45) but not validated for application in Persian-speaking populations. This study was aimed to culturally adapt and psychometrically evaluate the Persian version of TSRQ (TSRQ-P) properties on a group of Iranian type 2 diabetes patients.