The relationships among psychosocial variables, adherence with self-care behaviors, and glycemic control in 90 men with non-insulin dependent diabetes mellitus (NIDDM) were investigated. Patients completed the Basic Personality Inventory, Social Support Questionnaire, and Magnitude Estimation Inventory. Adherence scores were based on self-reports of adherence with six criteria congruent with satisfactory metabolic control. Glycemic control was measured by Glycosylated Hemoglobin (GHb) analyses. Results revealed no differences between diabetics and non-diabetic comparisons on dimensions of personality. There were differences between the non-adherent and self-reported adherent diabetics on three personality dimensions, ratings of satisfaction with social support, and items on the MEI. GHb was not systematically related to dimensions of personality, adherence, or social support. Implications for treatment were discussed and recommendations for the use of multiple measures for assessing adherence were made.

The development of Type 1 diabetes has a profound impact on many aspects of everyday life, health and well-being. In this thesis the literature relevant to different aspects coping with Type 1 diabetes is reviewed. The research described in the thesis includes (i) a prospective assessment of how psychosocial factors affect diabetes-related outcomes in adults following the onset of Type 1 diabetes, (ii) qualitative analysis of interviews that were conducted to explore the patient's perspective of what it means to cope with diabetes, and (iii) the development, pilot testing, and subsequent partial validation of a diabetes-specific questionnaire. The Edinburgh Prospective Diabetes Study examines the relationships between psychosocial variables recorded at diagnosis and diabetes related outcomes recorded at four months (n = 69), 12 months (n = 65), 24 months (n = 56) and 36 months (n = 40) after diagnosis. The results showed that individuals who had a lower socio-economic status had consistently poorer glycaemic control at 24 months (p < 0.001) and at 36 months (p < 0.01) after diagnosis. Diabetes knowledge at four months after diagnosis was a significant predictor of glycaemic control at 12 months (r= 0.35, p < 0.01) and at 36 months after diagnosis (r = 0.35, p < 0.05). In adults, self-reported outcomes were significantly predicted by longstanding psychological (e.g. personality traits) and social factors (e.g. quality of life). There was some evidence to suggest that coping strategies have an intermediate position between psychosocial factors and diabetes-related outcomes. The results and their implications for future research are discussed in terms of existing theories of coping. To date there are few psychometrically sound instruments capable of assessing how well a person is coping with their diabetes. With this in mind, the present research was undertaken to develop a new diabetes self-report measure termed the Diabetes Impact, Adjustment and Lifestyle Scales (DIALS). The development, pilot testing and partial validation of the DIALS are described. Semi-structured interviews (n = 1 0) were conducted to explore the patients' descriptions of their adjustment to diabetes and the impact that diabetes has on aspects of their daily life. A grounded theory approach (Strauss, 1987) was adopted to analyse the data. Several domains were established, from which items were generated. Two studies, a small pilot study (n =57), and a large cross-sectional validation study (n = 246) were carried out to establish the underlying structure, internal consistency, partial validity, and stability of the DIALS. Principal components analysis of the DIALS identified five dimensions: Impact, Adherence, Information-seeking, Fear of complications and Diabetes-related distress. Overall, the results suggest that the DIALS is a valid, reliable and stable indicator of coping in adults with Type 1 diabetes. A hierarchal model of causal relationships between psychological constructs (i.e. personality traits and illness-related coping constructs) and the DIALS was formulated and tested formally using Structural Equation Modelling. There was considerable overlap in the constructs, with evidence for two latent variables relating to 'emotionoriented' and 'task-oriented coping'. In summary, coping variables may be important mediators in the link between antecedent variables such as longstanding character traits (e.g. personality) and self-reported outcomes of diabetes.

A recent study, the Diabetes Complications and Control Trial (DCCT), demonstrated intensive therapy to manage blood glucose levels significantly reduced the incidence of some debilitating complications (DCCT, 1993). Self-care management is an integral part of any diabetic's care. Yet, research has demonstrated as many as 80% of known diabetics are noncompliant to a prescribed regimen.The purpose of this study was to examine self-efficacy in low-income insulin dependent diabetics. The framework for the study was the concept of self-efficacy as developed by Bandura (1977). The instruments used was the Insulin Management Diabetes Self-Efficacy Scale (IMDSES), (Hurley, 1990) and a researcher developed Demographics and Diabetes History Questionnaire. Data analysis included correlations between self-efficacy and ethnicity, educational level, years since diagnosis and years of experience with diabetes complications.Permission was received from the clinic administration to conduct this study at Matthew 25 Health and Dental Clinic in Northeast Indiana. This clinic serves the uninsured and the underinsured of the area. Procedures for the protection of human subjects were followed.A convenience sample of 82 ethnically mixed, low income individuals was surveyed. Relationships between total self-efficacy, diet self-efficacy, insulin self-efficacy and self-efficacy and the general ability to care for self were examined. These self-efficacy scales were also examined in relation to ethnicity, education, years of diagnosis and complication experiences. Result indicated Hispanics were significantly lower in insulin self-efficacy than African Americans.Correlations performed demonstrated that education correlated positively with insulin selfefficacy and the number of complications correlated negatively with insulin self-efficacy. Hispanics have a lower mean level of education and a greater number of complications. This could possibly explain why Hispanics have lower insulin self-efficacy than African Americans.The findings of this study evidenced a relationship between insulin self-efficacy, education, and experiences with complications. / School of Nursing

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The purpose of this study is to determine, "Is there a relationship between a diabetic individual's perception of stress and the onset of illness?" Thirty-seven diabetics who were patients in a midwestern hospital in June, 1983 were subjects of this study.Previous non-nursing research has correlated both the onset of diabetes and the exacerbation of illnesses with stress. This study has replicated the work of other biopsychosocial researchers and has particular implications for nursing and its role in prevention of illness.The instrument used to measure stress was the Schedule of Recent Experiences. Stress perception was measured by asking each subject to rate on a Likert scale the amount of stress associated with life events experienced in the past year. The instruments used to measure illness onset were the Signs and Symptoms of Stress Checklist and the Lab Indicators of Stress Checklist. Regression analysis and Pearson Product Moment correlations were used to analyze the data. The hypothesis was accepted with the subjective parameter (p•= <.001) and rejected with the objective parameter.Ball State UniversityMuncie, IN 47306

Diet recommendations to achieve target metabolic control for prevention of micro and macrovascular complications have been outlined. Although previous studies in individuals with type 2 diabetes have identified certain factors associated with adherence to diet recommendations, adherence is multi-factorial in nature and includes demographic, biological and psychosocial variables. Our main objective was to identify factors associated With dietary behaviour among individuals with type 2 diabetes attending an out-patient clinic. Furthermore, we attempted to identify factors associated with frequency of seeing the dietitian and stages of change far lower fat intake. Principal hypothesis: those who are younger, female, lower in body mass index (BMI), higher in education level, exposed to a dietitian in the past year, higher in stage of change, having greater nutrition knowledge, greater perception of risk and benefits as well as fewer perceived barriers, would consume less total and saturated fat. (Abstract shortened by UMI.)

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Studies investigating the use of behavioral techniques in the treatment of health-related problems have recently received considerable emphasis. Problems such as enuresis (Atthowe, 1972; Nordquist, 1971), obesity (Stuart, 19137), alcoholism (Miller, 1972; Sobell and Sobell, 1973), chronic pain (Fordyce, Fowler, Lehman, and DeLateur, 1975·), and asthma (Neisworth, 1972; Renne and Creer. 1976) have been treated by the use of behavioral techniques. Katz and Zlutnick (1975) mention two critical areas in which behavior analysis is particularly applicable to health care: a) rehabilitation, and b) patient management. Rehabilitation involves learning behaviors related to specific physical disabilities, for example stroke patients relearning walking skills, and amputees learning various self-care and vocational skills. Patient management involves increasing or decreasing specific patient behaviors to ensure they follow prescribed treatment plans. Patients with chronic dieases such as diabetes or multiple sclerosis must often be placed on stringent medical regimens. Thus, compliance with physicians 1 requests to take medication, follow diets, or engage in exercise is a vital component of patient management and must be maintained if a patient is to sustain optimal health. In view of these considerations, knowledge of the conditions under which

Thesis (M.A. (Psychology)) -- University of Limpopo, 2000 / Refer to document