Abstrakt Bakgrund: Typ 2 diabetes är en livsstilssjukdom som ökar både i Sverige och globalt. Egenvården är en viktig del i behandlingen av sjukdomen och är en livslång uppgift. Sjuksköterskan har en viktig roll i att, genom stöd, undervisning och vägledning, motivera och stärka personens egenvårdskapacitet. För att bättre förstå personens behov i egenvården är det betydelsefullt att sjuksköterskan får ta del av personers erfarenheter av egenvård vid typ 2 diabetes. Syfte: Syftet med denna litteraturstudie var att belysa personers erfarenheter av egenvård vid typ 2 diabetes. Metod: Litteraturstudie baserad på tolv kvalitativa artiklar. Artiklarna söktes i databaserna Cinahl och PubMed. Artiklarna kvalitetsgranskades och analyserades och kategorier och underkategorier identifierades.  Resultat: Resultatet kategoriserades i fyra kategorier och elva underkategorier. Dagligt liv med underkategorier kost, fysisk aktivitet, läkemedelsbehandling och blodsockerkontroll. Stöd; socialt stöd, stöd i samband med sociala sammankomster, familjen som stöd och tron som stöd. Psykiska aspekter; motivationens betydelse för egenvård och känslor i samband med egenvård. Kunskap/information; kunskap och förståelse och behov av diabetesutbildning. Konklusion: Erfarenheter av egenvård varierar från person till person. Att kunna stödja och motivera personen till egenvård ställer stora krav på sjuksköterskans omvårdnadskapacitet. Mycket talar för att Orems egenvårdsteori är användbar i sjuksköterskans arbete med detta.  Nyckelord: Typ 2 diabetes, egenvård, Orem, patientperspektiv, omvårdnad.

Osteoarthritis (OA), the most common form of arthritis in older adults, often results in pain, disability and poor psychological well-being. Compared to White adults, Black adults consistently report more pain, more activity limitations, and have different perceptions about OA. Racial disparities also exist in treatments, and prevalence of arthritis. It is imperative to have effective interventions and treatment options for older Blacks. Yet, few arthritis interventions have included Black participants in their samples, and nearly all of those have failed to report separate analyses indicating the effectiveness for Black adults, thus leaving a gap in the literature. The purpose of this study is to begin to identify factors needed to design arthritis interventions that will reduce barriers and increase appeal to Blacks. The present dissertation consists of one study with two related parts. The first part consists of a needs assessment that examined intervention preferences, barriers to healthcare, knowledge about interventions and care, utilization, and health beliefs among Black and White adults with self-reported physician-diagnosed OA. The second part evaluated materials used in an existing arthritis intervention for acceptability. The study was based on the Arthritis Self Management Program (ASMP). Frequencies were examined to determine needs related to arthritis healthcare of Blacks and Whites recruited from the community. Independent samples t-tests and Pearson’s Chi-square analyses were examined to determine group differences between Blacks and Whites. Blacks were more likely to report cost, lack of trust, fear of being the only person of their race, lack of recommendation from their doctor, and lack of recommendation of a family or friends as barriers to participating in arthritis interventions. In addition, Blacks were more likely to prefer the intervention content, structure and delivery, and arthritis resources presented in the needs assessment in comparison to Whites. As for the evaluation of the intervention materials, Blacks and Whites were similar on most sections. Based on our findings we suggest that practical adaptations (e.g., cost) be made to existing arthritis interventions to increase cultural sensitivity. Such adaptations have the potential to minimize barriers and offer a program that would be appealing to Blacks with OA.

Academic researchers and marketing practitioners are exploring methods to improve salesperson training. Recently, self-directed learning projects were proposed as a new paradigm for learning to take place in the sales domain (Artis & Harris, 2007). Current conceptual work provides a strong foundation for understanding salesperson self-directed learning; however, prior to quantitatively testing proposed models, scales must be created and modified to address salesperson specific learning endeavors. The purpose of this dissertation is: 1) to develop scales to measure salesperson willingness to use self-directed learning projects (SDLP's), 2) to develop a conceptual model of salesperson self-directed learning, 3) to modify current scales to specifically examine salesperson self-directed learning, and 4) to test this model empirically. To accomplish this, the relevant theories and literature were analyzed to create a theoretical model that would test the following research questions: 1.What factors contribute to salesperson willingness to use SDLP's? 2.What is the relationship between salesperson willingness to use SDLP's and salesperson use of SDLP's? 3.What is the relationship between salesperson use of SDLP's and salesperson performance? Two conceptual models were created to account for two categories of learning projects, induced and synergistic SDLP's. The following variables reflect the conceptual models: willingness to use induced/synergistic SDLP's, use of induced/ synergistic SDLP's, perceived supervisor/organizational support for induced/synergistic SDLP's, and self-regulation training and performance. Data from 392 salespeople within the financial services industry fit the measurement model and suggest that use of synergistic (non-mandatory) SDLP's positively impacts performance (.396) and use of induced (mandatory) SDLP's does not impact performance. Willingness to use synergistic SDLP's positively impacts use of synergistic SDLP's. Support from the organization and supervisor positively impact willingness to use induced and synergistic SDLP's. Surprisingly, training in self-regulation did not positively impact salesperson willingness to use induced or synergistic SDLP's. The new measures for all constructs exhibit Cronbach's alpha reliability statistics over .7 and acceptable confirmatory factor analysis results. The study provides reliable measurement scales and empirical support for the future study of self-directed learning in a sales context.

This waitlist-controlled study aimed to evaluate the effects of the “Development Of Executive Skills (DOES)” program (Education Bureau, HKSAR, 2010) on the executive functions of children with Attention-Deficit/Hyperactivity Disorder symptoms. Sixteen participants (15 boys, 1 girl), aged 7 to 8 years (M = 7.95, SD = 0.59), were recruited voluntarily from a local service center. Half of them, the DOES group, received the 7 weekly training sessions after the pre-tests; the other half, the Waitlist group, joined the same program after the post-tests. Their demographic characteristics, medical conditions and nonverbal intelligence were comparable. Cognitive measures and parent observations assessing their executive skills and social behavioral functions were taken before the study, after the training for the DOES group and that for the Waitlist group. No statistically significant intervention effect was found. Effect size analyses, however, suggested potential social benefits of the program. Recommendations on improving the program effectiveness were discussed. / published_or_final_version / Educational Psychology / Master / Master of Social Sciences

Diabetes is increasing globally and nationally. Diabetes complications and costs can be reduced through modification of lifestyle risks and diabetes self-management education (DSME). The Cooperative Extension System (CES) is uniquely positioned to implement DSME. This study assessed the role and impact of the Cooperative Extension System (CES) in DSME. A survey was sent to CES professionals throughout the U.S. a total of 43 participants provided information on 73 DSME programs. Most participants were from the South (n=22, 51.16%) and Midwest (n=12, 27.91%) and most programs targeted adults with and at risk for type 2 diabetes. Most programs were developed and taught by registered dietitians and family and consumer science agents and were focused on healthy eating and cooking techniques. Few programs addressed medications, mental and physical health, influenza and pneumococcal vaccinations. Implementation challenges were related to recruitment, attrition, and funding and most suggestions for the future of CES in DSME were related to funding. CES has a wide reach in terms of DSME with over 29 states. Future CES efforts should target children with type 2 diabetes and should form/continue partnerships with health care professionals.

Bakgrund:Diabetes typ 2 är en livslång sjukdom där egenvård har en stor betydelse för att undvika komplikationer. Sjuksköterskan har en betydande roll i egenvården och sjuksköterskan ska ha förmågan att vägleda samt ge stöd. Därför är det viktigt att sjuksköterskan får en djupare förståelse av upplevelsen av egenvård vid diabetes typ 2. Syfte:Syftet var att beskriva upplevelser av egenvård hos individer med diabetes typ 2. Metod:En litteraturöversikt baserad på nio vetenskapliga artiklar varav åtta kvalitativa samt en kvantitativ. Artiklarna har hämtats från databaserna CINAHL, Pub Med samt SWE pub. Resultat:I resultatet framkommer tre huvudteman. Temat ”Upplevelsen av egenvård vid nydiagnostiserad diabetes typ 2” beskriver individens upplevelse av att få diagnosen diabetes typ 2. I temat ”Att integrera sjukdom och egenvård i vardagen” beskrivs hur individen integrerar sjukdom samt egenvård i sitt liv. I det tredje temat ”Vårdgivarens inflytande på egenvården” berörs sjukvårdspersonalens betydelse för egenvård. Två subteman har även tillkommit ”Upplevelser av socialt stöd i egenvården” som tillhör temat ”Upplevelsen av egenvård vid nydiagnostiserad diabetes typ 2” samt ”Vändpunkter i upplevelsen av egenvård” som tillhör temat ”Att integrera sjukdom och egenvård i vardagen”. Diskussion:Under metoddiskussionen diskuteras litteraturöversiktens styrkor samt svagheter. De flesta artiklarna är utförda i Norden vilket kan ses som en styrka, att författaren skrivit ensam och själv fått bestämma utformningen av arbetet är ytterligare en styrka. Samtidigt var det en svaghet att skriva ensam då författaren saknat någon att diskutera med. Resultatdiskussionen utgår ifrån den teoretiska utgångspunkten Orems egenvårdsteori. / Background:Diabetes type 2 is a lifelong disease in which self-care is of great importance to avoid complications. The nurse has a significant role in the individuals ' self-care and will be there to guide and be able to provide support. Therefore it is important that the nurse gets a deeper understanding of the experience of self-care in diabetes type 2.  Aim: The aim of this study was to describe the experience of self-care in adults with diabetes type 2. Method:A literature review based on nine studies. The articles were sought in CINAHL, Pub Med and SWE pub. Results:The results are presented in three themes. The theme ”Experiences of self-care in newly diagnosed diabetes type 2" describes how it is experienced to get the diagnosis diabetes type 2.  ”Integrating illness and self-care in everyday life” describes how the individual integrate disease and self-care in their lives.  The theme ”The caregivers influence on self-care” describes the nurses role in the individuals self-care.  Two subthemes have also resided ”Experiences of social support in self-care” and ”Turning points in the experience of self-care”. Discussions:Under the method discussion it was discussed about the strengths and weaknesses in the literature review. The result discussion has Dorothea Orems theory of self-care as a basis.

Cognition and Self-Management in Type 2 diabetes in the older person was studied using neuropsychological evaluation and self-management assessments. Type 2 diabetes is increasing in prevalence, erodes quality of life, and places significant burden on healthcare services. The condition is largely self-managed, requiring daily performance of a variety of tasks. Impaired cognition has been associated with Type 2 diabetes, particularly in those who have had diabetes for longer or are older. It is unknown whether such changes in cognition seen in Type 2 diabetes affect the ability to self-manage the condition; the few studies that have been conducted in this area have shown little consensus in focus, methodology, or results. This thesis aimed to investigate any links between cognitive impairment and diabetes self management skills in an older population with Type 2 diabetes, by determining assessment schedules for both selfmanagement and cognition in this population and searching for associations between the two. Literature review, questionnaire and focus group studies pointed towards four main components of diabetes selfmanagement; diabetes knowledge, self-efficacy, motivation, and diabetesspecific problem solving abilities. A theoretical framework emerged from this analysis; Bandura’s Social Cognitive Theory provides a context for the interaction of environment, society and cognitions in health behaviours. A systematic review found several associations between self-management skills and abilities, and global and individual areas of cognition, including links between executive function and memory, and diabetes knowledge, insulin skills, adherence to medications, missed appointments, and decreased frequency of self-care activities. A further clinical study identified several associations including visual and working memory, and reaction times, with diabetes knowledge. Future studies with larger sample sizes might revisit these associations. Clinical implications include the need for routine cognitive assessment in an older population with Type 2 diabetes; interventions might include checking medication adherence, diabetes knowledge, and referral to support groups.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Diabetes has reached epidemic levels, to the currently estimated 29 million individuals who are living with diabetes. Those with diabetes must manage their disease through a combination of medication, physical activity recommendations, and nutritional guidelines. The consequences of non-adherence to recommendations include cardiovascular disease, kidney failure, vision loss, or ultimately, death. Despite the risks of non-adherence, individuals often do not adhere to recommended treatment. Researchers have attempted to identify strategies to promote diabetes self-management adherence, thereby decreasing complications related to the disease. Specific Aims: describe the factors that prohibit individuals from adhering from diabetes self-management behaviors as well as the factors that promote self-management adherence, compare adherence rates of individuals participating in an enhanced diabetes education program with the adherence rates of individuals that participated in enhanced diabetes education and also attended group social support sessions, evaluate the adherence to self-management behaviors of individuals participating in a diabetes care coordination program. Results: A review of research articles from 2009 through 2013 identified barriers to diabetes self-management adherence as complexity of self-management, low health literacy, the financial burden of adherence, availability of resources, and lack of knowledge. Factors that promote diabetes self-management adherence include diabetes self-management education, self-efficacy, social support, and goal setting. A retrospective chart review of participants in an employer-sponsored health program was performed to examine the effectiveness of a social support intervention administered through the health program to promote adherence to recommended diabetes treatment. Results of the study revealed that individuals who participated in the social support intervention, in addition to the employer-sponsored health program, demonstrated increased adherence to recommended diabetes treatment from baseline to 12 months, in comparison to those who participated in only the health program (p = .048). Additional chart review compared participants’ self-management behaviors at baseline with their self-management behaviors at 12 months after entry into the program. There was a significant improvement in adherence to self-management behaviors of receiving an influenza vaccination (p = .036), decreased reported use of alcohol (p = .002) and tobacco (p = .043), and fewer reports of skipped meals (p = .009).