Thesis (M.Nurs.)--Washington State University, December 2008. / Title from PDF title page (viewed on Mar. 4, 2009). "Intercollegiate College of Nursing." Includes bibliographical references (p. 71-87).

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Background: Despite growing utilization of mobile phones and websites for consumers seeking health care advice, the area is largely understudied. A niche market for these applications is in diabetes care. Since diabetes is a chronic condition requiring daily monitoring it is a good candidate for consumer health informatics and especially interactive websites and mobile phone applications. As the obesity epidemic continues, so too the prevalence of type 2 diabetes continues to rise. This chronic condition can lead to major complications and high medical cost. It is on the rise in countries all over the world, and beginning to impact people at younger ages. Low cost interventions are being explored to mitigate these complications and cost. Objective: To examine the effectiveness of consumer health informatics, such as websites, personal digital assistants, and mobile phone applications that claim to help people with diabetes self-monitor diet and exercise behaviours to lose weight. Methods: A search for relevant literature was conducted using PUBMED, Cochrane, and IEEE Xplore, with the search terms: (mhealth OR mobile health OR phone OR web* OR ehealth OR internet OR ICT) AND diabetes AND (diet* OR exercise OR physical activity). Also, a bibliographic search was done to identify any studies that were missed in the initial search. The search was not limited to any date range, but articles were identified from the time period of September 2000 through April 2012. Only articles in English were included. Studies were included if the program included an interactive logging feature for diet and/or physical activity. Studies that looked at type 1 disbetes were excluded. Results: A total of 10 original studies were found that met the inclusion criteria. Including 2 qualitative design, 1 randomized trial, and 7 randomized control trials. There was a great deal of heterogeneity among the studies. Delivery methods varies, studies including the following are: *  Mobile device only: 3 *  Website only: 6 *  Website plus mobile device: 1 Many different outcome measures were used across the studies including: behavioural, physiological, psychosocial, as well as usability and satisfaction. Overall, adherence and follow up were low. Dietary tracking generally appears not to be as effective as broad goals such as, “each more fruits and vegetables”. Exercise tracking was more effective at increasing physical activity. Message boards and peer support did not show an increase in effectiveness, but personal online coaches and personalized emails showed promising results. Usability and satisfaction was high in those that reported it, but the large number of dropouts are not considered in this. Conclusions: At this time, consumer health informatics does not seem to be an effective solution in facilitating significant behavior change for people who have type 2 diabetes. Future programs should look at ways to increase adherence and usage of the programs because the people who did use the programs daily benefited more than sporadic users. Components that showed promising results are access to a personal online coach, personalized weekly emails, integration with a pedometer that automatically uploads to a tracking program, and broader food related goals. Further testing is necessary to determine if this type of intervention is effective. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Akron, School of Family and Consumer Science-Nutrition and Dietetics , 2007. / "May, 2007." Title from electronic thesis title page (viewed 4/26/2009) Advisor, Deborah Marino; Faculty readers, Richard Steiner, Evelyn Taylor, Cinda Chima; School Director, Richard Glotzer; Interim Dean of the College, James Lynn; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective To develop and test a marketable, Continuing Professional Development (CPD) accredited training manual focused on the role of medical nutrition therapy (MNT) for healthcare professionals (HCP) of the multidisciplinary Type 1 and Type 2 Diabetes Mellitus (DM) management team. Methods The study consisted of two components: (a) development of the MNT manual and (b) testing of the MNT manual. The development of the MNT manual consisted of seven steps: (1) needs assessment and problem definition; (2) literature search; (3) draft one of the MNT manual; (4) peer review; (5) draft two of the MNT manual; (6) evaluation by means of a survey; and (7) the final MNT manual. The testing of the MNT manual’s impact on knowledge had a test-retest design which consisted of seven steps: (1) DM knowledge questionnaire development; (2) participant recruitment; (3) questionnaire pilot; (4) initial knowledge testing; (5) self-study of MNT manual; (6) retesting of knowledge; (7) statistical analysis. Results From the literature a total of 132 published documents were selected for inclusion in the MNT manual after grading of the information. The first draft was compiled and sent for peer review and language editing. Recommended changes were made and the second draft was developed and sent to 79 registered dietitians (RDs) who volunteered to complete a survey after reading the MNT manual. The survey indicated that the majority were satisfied with the content, which in turn led to the final MNT manual.The questionnaire was compiled using the content of the MNT manual and creating 10 questions per section of the manual. The pilot was conducted using 10% (n = 7) of the total sample. Minor changes were made. For knowledge testing, participants included RDs between the ages of 23 and 60 years, registered with the Health Professions Council of South Africa. A test-retest design was used. Participants scored a mean of 57.5% on the initial knowledge questionnaire (KQ1), ranging between 33.6% and 79.8%. They lacked knowledge on: management of the hospitalised patient; diabetes and exercise; diabetes and religion; gestational diabetes; supplements commonly used by diabetics; diabetes in prisons; diabetes in children; the function, side-effects and contra-indications of metformin. The mean score on the second knowledge questionnaire (KQ2) increased to 90.5%, with the lowest score 50.4% and the highest 99.2%.There were two questions where participants scored < 50% (mean of n = 79) which related to the type of insulin regime most suitable during Ramadan and risk factors for Type 2 DM in children. Data were also analyzed according to various socio-demographic variables, but only one significant difference was found between groups. Conclusions and implications There is adequate research available to develop a comprehensive guide for HCP on the nutritional management of DM. Such an MNT manual should be marketed for CPD purposes to encourage HCP to improve their DM management skills, as seen by the dramatic improvement in DM management knowledge of the RDs participating in this research. Future studies may include knowledge testing of other HCP, as well as testing to determine if the newly acquired information is put into practice to the benefit of DM patients. / AFRIKAANSE OPSOMMING: Objektiewe Die ontwikkeling en toets van 'n bemarkbare, Voortgesette Professionele Ontwikkeling (VPO) geakkrediteerde handleiding oor die rol van mediese voedings terapie (MVT) vir mediese personeel van die multi-dissiplinêre Tipe 1- en Tipe 2 Diabetes Mellitus (DM) behandelings span. Metodes Die studie het bestaan uit 2 komponente: (a) die ontwikkeling van die MVT handleiding en (b) die toets van die MVT handleiding. Die ontwikkeling van die MVT handleiding het bestaan uit sewe stappe: (1) assesering van benodighede en probleem definisie, (2) literatuursoektog; (3) aanvanklike konsep van die MVT handleiding; (4) eweknie evaluasie; (5) volgende konsep weergawe van die MVT handleiding; (6) evaluering deur ‘n meningsopname; en (7) die finale MVT handleiding. Die toets van die MVT handleiding se impak op die kennis het 'n toets-hertoets ontwerp gehad wat bestaan het uit sewe stappe: (1) DM kennis vraelys ontwikkeling; (2) deelnemer werwing; (3) toets van vraelys; (4) toets van aanvanklike kennis; (5) selfstudie van die MVT handleiding; (6) hertoetsing van kennis; en (7) statistiese analise. Resultate Uit die literatuur is 132 gepubliseerde dokumente gekies vir insluiting in die MVT handleiding na gradering van die kwaliteit van die inligting. Die aanvanklike konsep is ontwikkel, taalversorg en eweknie geevalueer. Aanbevole veranderinge is gemaak en die tweede konsep is ontwikkel en gestuur aan 79 dieetkundiges wat vrywillig die MVT handleiding gelees het en aan ‘n meningsopname deelgeneem het. Uit die meningsopname was dit duidelik dat die meerderheid tevrede was met die inhoud, wat gelei het tot die finale MVT handleiding.Die vraelys is opgestel met 10 vrae per afdeling van die MVT handleiding, en getoets deur 10% (n = 7) van die totale aantal deelnemers, waarna geringe veranderinge gemaak is. Vir kennis toetsing, is dieetkundiges tussen die ouderdomme van 23 en 60 jaar, wat geregistreer is by die Raad vir Gesondheidsberoepe van Suid-Afrika, ingesluit. Deelnemers het 'n gemiddeld behaal van 57.5 % op die aanvanklike kennis vraelys, met kennis wat gewissel het tussen 33.6% en 79.8%. Hulle het aanvanklik gebrekkige kennis gehad oor: die behandeling van die hospitaal pasiënt; diabetes en oefening; diabetes en godsdiens; swangerskaps diabetes; aanvullings gebruik deur diabete; diabetes in gevangenisse; pediatriese diabetes; asook die funksie, newe-effekte en kontra-indikasies van metformien. Die gemiddelde telling op die tweede kennis vraelys het toegeneem tot 90.5%, met ‘n laagste telling van 50.4% en hoogste van 99.2%. Daar was 2 vrae waar deelnemers < 50% (gemiddelde % van n = 79) behaal het. Hierdie vrae het verband gehou met die mees geskikte insulien behandeling tydens Ramadan en risikofaktore vir Tipe 2 DM in kinders. Data is ontleed volgens verskeie sosio-demografiese veranderlikes, maar slegs een beduidende verskil is tussen groepe gevind. Gevolgtrekkings en implikasies Daar is voldoende navorsing beskikbaar om ‘n omvattende handleiding vir mediese personeel oor die rol van voeding in die behandeling van DM te ontwikkel. So 'n MVT handleiding moet bemark word vir VPO doeleindes om mediese personeel aan te moedig om hul DM bestuursvaardighede te verbeter, soos gesien deur die dramatiese verbetering in DM bestuur kennis van die huidige deelnemers. Toekomstige navorsing kan die bepaling van kennis verbetering van ander mediese professies insluit, en of die verbeterde kennis in die praktyk DM pasiënte bevoordeel.

Previous studies reported that noncompliance to diabetes treatment may result in a series of health complications. To further understand patients’ noncompliance to meal plans, a study on meal planning strategy was developed. Through a survey Certified Diabetes Educators determined which meal planning strategies were the most effective in encouraging patients’ compliance to meal plan according to age groups (18 and under, 19 to 49, 50 to 70, and 71 and above) and recency of diagnosis (newly- and non-newly diagnosed) with Type 2 diabetes. Results identified that nutrition labels had the greatest mean rating for effectiveness in age groups 18 and under, 19 to 49, and 50 to 70; and healthy food choices had the greatest mean rating for effectiveness with age group 71 and above. / Department of Family and Consumer Sciences

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective: The objective of the study was to assess and compare the level of knowledge of South African health professionals) treating patients with Type 1 and Type 2 Diabetes Mellitus (T1 and T2 DM) with regard to nutrition and Diabetes Self-management (DSM). To achieve this objective, two questionnaires (one for T1 DM and one for T2 DM) was developed and validated. In addition the study identifies the areas in need for further education as well as to assess if socio-demographic factors influence the level of knowledge. Methods: The questionnaires were developed by: i) planning and developing constructs on nutrition and DSM by experts (n = 2) in the field of nutrition and diabetes care, ii) compilation and evaluation of a pool of 60 questions for face and content validity by an expert panel comprising six Registered Nurses / Diabetes Educators (RN / DE) and registered dieticians (RD) and iii) testing the questionnaires for criterion validity and reliability by a pilot group (n = 34 RN / DE and RD). Chronbach’s alpha values were calculated to determine validity and questions were disregarded or changed depending on this outcome. These questionnaires were then sent via electronic and hard mail to a randomised sample of RD (n = 1200) and RN / DE (n = 498). Data of 70 questionnaires on T1 DM and 105 on T2 DM was coded and analysed. The cut off value of 70% was considered as adequate knowledge. Results: With regard to questionnaire development, constructs were eliminated by the expert panel and this resulted in the acceptance of 60 constructs for the final questionnaires. Five constructs were replaced to improve content validity and an additional three constructs were adjusted to improve face validity. Recommended amendments were made to improve the criterion validity of the questionnaires. Internal consistency was shown with an overall Cronbach’s alpha value of 0.73 for the T1 DM questionnaire and 0.71 for the T2 DM questionnaire. In terms of the assessment of knowledge for T1 DM, the RD (75.4%) but not the RN/DE (67.2%) had adequate knowledge of nutrition. This was not statistically significant different from the RN / DE (p = 0.07). Both groups scored equally with regard to their knowledge of DSM with scores indicating inadequate knowledge (64.7% and 64.9% respectively) (p = 0.27). For T2 DM, the RD (74.6%) but not the RN / DE (61.6%) showed their knowledge of nutrition to be adequate, and statistically significantly better than the RN / DE (p = 0.0005). Both groups showed inadequate knowledge of DSM (56.0% and 61.9% respectively) (p = 0.31). The main areas of knowledge for diabetes mellitus (DM) identified in need for further education were the glycaemic index (GI) values of food, carbohydrate counting, the use of sugars / sweeteners, timing of meals and snacks with regard to activity, medication used, treatment of hypo- and hyperglycaemia and the use of alcohol. Age affected knowledge (for both nutrition and DSM) with regard to T1 DM, as the age group 30 - 49 years scored significantly better than the rest (nutrition p = 0.005, DSM p = 0.006 respectively). Health professionals in the private sector achieved higher scores compared to those working in the public sector (nutrition p = 0.011, DSM p = 0.016 respectively). Conclusion: Two valid and reliable quantitative questionnaires comprising 4 sections and 30 questions were developed to assess the level of knowledge of health professionals (RN / DE and RD) on nutrition and DSM treating patients with T1 and T2 DM in South Africa. RN / DE required further education towards key nutrition concepts and RN / DE and RD required further education on key concepts regarding DSM for both T1 and T2 DM. / AFRIKAANSE OPSOMMING: Doel: Die doel van die studie was om die hoeveelheid van kennis van verpleeg en dieetkunde personeel wat persone met Tipe 1 en Tipe 2 Diabetes Mellitus (T1DM en T2DM) in Suid – Afrika behandel, te bepaal en te vergelyk. Die studie het gefokus op kennis t.o.v. voeding en diabetiese self-sorg. Om die doel te bereik was twee vrae lyste, een vir T1 DM en een vir T 2 DM ontwikkel. Die verskillende aspekte van kennis wat verdere opleiding benodig is geidentifiseer asook of enige demografiese faktore wat kennis kon beinvloed. Metode: Die volgende stappe was geneem om voldoende geldigheid en betroubaarhied te bereik: 1. Twee kenners het verskeie belangrike aspekte van voeding en diabetiese self-sorg geidentifiseer en ontwikkel. 2. ‘n Paneel van 34 geregistreerde dieetkundiges en verpleeg personeel wat in Diabetes Mellitus spesialiseer , het die inhoud van ‘n totaal van 60 vrae ge- evalueer vir geldigheid en toepaslikheid. 3. Die paneel het die vraelyste verder ge- evalueer vir ‘n aanvaarbare standard van betroubaarheid. Chronbach-alfa waardes was gebruik vir die aanvaarbaarheid van alle vrae. 4. Die finale weergawe van 30 aanvaarbare vrae in elke vraelys was gestuur via elektroniese en normale pos na 1200 RD en 489 verpleegpersoneel wat spesialiseer in T1 en T2 DM. 5. Inligting van onderskeidelik 70 T1DM en 105 T2 DM vraelyste was gekodeer en ge-analiseer. Resultate: Tydens die ontwikkeling van die vraelyste, was sekere aspekte van kennis deur die twee kenners ge-elimineer. Die evaluering van die groep van dieetkundiges en verpleeg personeel het verder bygedra tot die vervanging en aanpassing van sekere aspekte van kennis. Dit het bygedra tot die vlak van voldoende geldigheid en toepaslikheid. Vir voldoende betroubaarheid was die Chronbach- alfa waardes van 0.73 vir T1DM and 0.71 vir T2 DM onderskeidelik aanvaar. Die studie het getoon dat die dieetkundiges voldoende kennis besit t.o.v. voeding vir T1 DM (75.4%). Dit was egter nie statisties betekenisvol meer in vergelyking met die kennis soos behaal deur die verpleegpersoneel (62.2%) (p = 0.07). Beide groepe se kennis t.o.v diabetiese self sorg was bepaal as onvoldoende met onderskeidelik 64.7% en 64.9%. In terme van T2 DM, het die dieetkundiges statisties betekenisvol beter kennis getoon vir voeding (74.6%) in vergelyking met die vlak van kennis soos behaal deur die verpleeg personeel (61.6%) (p = 0.0005). Soos in die geval van T1 DM het beide groepe onvoldoede kennis getoon vir diabetiese self sorg met onderskeidelike waardes van 56.0% en 61.9%. (p = 0.31). Die areas van kennis wat geidentifiseer was vir verdere opleidig, was die glisemiese indeks van voedsel, bepaling van die hoeveelheid koolhidrate in voedsel, die gebruik van suiker en versoeters, die neem van maaltye en versnapperinge, oefening, medikasie, voorkoming van lae en hoe blood glukose vlakke asook die gebruik vam alkoholiese drankies. Die ouderdoms groep tussen 30-49 jaar het statisties ‘n hoer vlak van kennis getoon vir beide voeding (p = 0.005) en diabetiese self sorg (p = 0.006) vir T 1 DM in vergelyking met die ander ouderdoms groepe. Personeel wat in die private sektor werk het ‘n beter vlak van kennis getoon in vergelyking met personeel wat in die openbare sektor werk (p = 0.011 en p = 0.016 vir voeding en diabetiese self sorg onderskeidelik. Samevatting: Twee geldige en betroubare vrae lyste met 30 vrae in totaal was ontwikkel om die vlak van kennis van dieetkundiges en verpleeg personeel te bepaal in terme van voeding en diabetiese self sorg vir beide T1 en T2 DM. Die verpleegpersoneel benodig verder opleiding t.o.v sekere aspekte van voeding en diabetiese self -sorg en die dieetkundiges t.o.v. diabetiese self -sorg vir beide T1 en T2 DM.

Type 2 diabetes mellitus (DM) is a progressive disease characterised by hyperglycaemia caused by defects in insulin secretion and insulin action. In early stages of type 2 DM, dietary and lifestyle changes are often sufficient to control blood glucose levels. However, over time, many patients experience β cell dysfunction and require insulin therapy, either alone or in combination with oral agents. There are guidelines available to structure the management of this disease state, including both the use of oral hypoglycaemic agents and or insulin. Besides health complications, there are economic burdens associated with the management of type 2 diabetes mellitus. The aim of this study was to determine the management of type 2 DM in a South African sample group of patients drawn from a large medical aid database. The objectives of the study were: to establish the prevalence of type 2 DM relative to age, examine the nature of chronic comorbid disease states, establish trends in the prescribing of insulin relative to other oral hypoglycaemic agents, investigate cost implications, and determine trends in the use of blood and urine monitoring materials by patients. The study was quantitative and retrospective and descriptive statistics were used in the analysis. DM was found to be most prevalent amongst patients between 50 and 59 years old. Results also demonstrated that 83% of DM patients also suffered from other chronic comorbid diseases, with cardiovascular diseases, especially hypertension and hypercholesterolaemia being the most prominent. This study also revealed that DM is predominantly managed with oral hypoglycaemic agents. Changes in drug prescribing, for chronic disease states such as DM may have medical, social and economic implications both for individual patients and for society and it is envisaged that the results of this study can be used to influence future management of DM. Keywords: Pharmacoepidemiology, management, type 2 diabetes mellitus

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