published_or_final_version / Nursing Studies / Master / Master of Nursing

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

Background Telehealth is a communication technology that allows exchange of data between patients and health care providers. Disease management is a structured multifaceted intervention to patient care that promotes self-management skills and improves patient-doctor communication. This systematic review aims to determine the effectiveness of “telehealth diabetes management programmes” for patients with type-2 diabetes (T2DM) in improving outcomes such as glycaemic control, diabetes related mortality, hospital admissions and overall cost-effectiveness of programme. Its applicability to Hong Kong will be reviewed. Methods A literature search of electronic bibliographic databases was performed to identify relevant articles. Both randomised control trials and observational studies on patients with T2DM published up to March 2013 were included in the analysis. Results A total of 14 articles were eligible (n=9708 subjects). Eight were randomised controlled trials and six observational studies. Ten studies reported on mean change in HbA1c level, three on health care utilization and three on cost-effectiveness of telehealth management programme. No studies had diabetes related mortality as their outcome measure. Across these trials, telehealth diabetes management programme resulted in an improvement in glycaemic control, likely reduction in health service utilization and a probable cost-effective programme. Discussions The current Hong Kong’s health care system faces challenges from long wait-list for medical consultations and rising health care costs. The applicability of the results from this review to the setting in Hong Kong, and feasibility of implementation will be discussed. Conclusion Telehealth disease management programmes had clinically modest but significant improvement in HbA1c among adults with T2DM and likely to be cost-effective. The results of this review have potential important implications for policy makers in the allocation of health care resources. / published_or_final_version / Public Health / Master / Master of Public Health

This study will be focussing on the experiences of Xhosa-speaking patients with DM utilising the NMMM public hospitals complex. In the OPD patients are assessed and treated for all chronic conditions including DM, and patients are seen at monthly intervals or when necessary. The OPD serves the neighbouring black population from the surrounding townships as well as the informal settlements. The effects of urbanisation have resulted in this area having a semi–rural, semi-urban population that is mostly Xhosa speaking. The bulk of the population is unemployed, while others are living on a minimal income. Unemployment in the Eastern Cape ranges from 40% in rural areas, rising to 50 - 60% in the urban areas (Proposed aluminium Pechiney smelter within the Coega IDZ, 2002:4-8). In some homes there is no or little money to buy food, and even less to make use of a health service. Some people live on either a social grant for the elderly, a grant for young children or a disability grant and most people in this area have an income below the level at which payment of taxes for contribution to the economy is possible.

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