The Influence of Support Groups and Identity on Goal Setting and Achievement in Persons with Type 2 Diabetes.

Abstract

This cross-sectional self-administered online survey examined the influence of illness identity, social identity and online support group identity on the setting and achievement of both lifestyle and medication goals in persons with type 2 diabetes. The aims of the study were: to determine the relationship between illness identity and social identity on goal setting and achievement; to determine the influence of support group identity on the relationship between social identity and goal setting; to determine the influence of support group identity on the relationship between goal setting and goal achievement; and to characterize the interactions that occur within the support group network. Structural equation modeling found social identity influenced lifestyle goal setting. Lifestyle goal self-efficacy mediated the relationship between goal setting and achievement in support group members (n=133) and non-support group members (n=253). Illness identity directly influenced lifestyle goal self-efficacy for both groups. For non-support group members, illness identity also influenced medication goal behaviors. Moderated mediation regression demonstrated significant interaction between support group identity and medication goal self-efficacy on goal achievement (t= -1.91 p=0.05) in persons in an online support group. Bootstrap estimates for confidence intervals around the mean (2.46) were -.135 to -.649 and Sobel test statistic= 2.4799 SE=0.2909 p=0.01reveal significant indirect effects. Other regression analyses found that for behaviors related to self-monitoring blood glucose and avoiding certain foods, there was a direct relationship between goal setting and achievement (t=2.68 p=0.008). For behaviors including eating healthy, exercising and conducting foot exams, goal setting and goal achievement were related (t=3.35 p=0.001). Setting medication goals significantly predicts medication goal achievement (t=5.10 p<0.001).

Control of diabetes was significantly associated with social identity, the belief that diabetes is controlled by medication, self-monitoring blood glucose levels, goal self-efficacy and lifestyle goal. Support group membership did improve goal behaviors, particularly medication goals. Social identity also influenced goal setting for lifestyle goals. Illness identity impacted lifestyle goal self-efficacy and medication taking goal behaviors. These findings have implications for the assessment of identity in the provision of healthcare services and the use of support groups in the goal setting process for the self-management of type 2 diabetes.