The aim of this study was to explore and describe the experiences of diabetes mellitus patients at the Piggs Peak Hospital in Swaziland, from the time of diabetes diagnosis to living with diabetes, adherence to treatment and implementing diabetes self-care. A descriptive, exploratory, contextual qualitative research was conducted. Data was gathered through semi-structured interviews with 26 participants purposively selected on diabetes days at the hospital. Data was analysed qualitatively. Results revealed that patients present late for diagnosis. Being diagnosed causes psychological distress of varying intensity and duration. Hospital visits are burdensome due to financial and transport challenges, as well as service shortcomings. Self-care activities are difficult due to financial challenges and nonconducive social circumstances at home. Social support is lacking. Diabetes patients fear insulin use and prefer oral tablets. It is concluded that diabetes self-care is burdensome for most patients of the PPH in Swaziland. The service providers, stakeholders, and government need to explore strategies for mitigating effects of various barriers to self-care as revealed in this study. / Health Studies / M.A. (Public Health)

Indiana University-Purdue University Indianapolis (IUPUI) / Physical activity monitoring using wearable sensors give valuable information about patient's neuro activities. Fall among ages of 60 and older in US is a leading cause for injury-related health issues and present serious concern in the public health care sector. If the emergency treatments are not on time, these injuries may result in disability, paralysis, or even death. In this work, we present an approach that early detect fall occurrences. Low power capacitive accelerometers incorporated with microcontroller processing units were utilized to early detect accurate information about fall events. Decision tree algorithms were implemented to set thresholds for data acquired from accelerometers. Data is then verified against their thresholds and the data acquisition decision unit makes the decision to save patients from fall occurrences. Daily activities are logged on an onboard memory chip with Bluetooth option to transfer the data wirelessly to mobile devices. In this work, a system prototype based on neurosignal activities was built and tested against seven different daily human activities for the sake of differentiating between fall and non-fall detection. The developed system features low power, high speed, and high reliability. Eventually, this study will lead to wearable fall detection system that serves important need within the health care sector. In this work Inter-Integrated Circuit (I2C) protocol is used to communicate between the accelerometers and the embedded control system. The data transfer from the Microcontroller unit to the mobile device or laptop is done using Bluetooth technology.

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose: Patient-provider communication has been studied extensively in the last two decades, and many researchers have confirmed the importance of communication between patient and provider in medical contexts. In spite of increased research in patient-provider communication in dentistry, dental care providers still report that patients often do not accurately follow oral health recommendations. Thus, there is the need for additional study on how patients make sense of the oral health information they receive and how they translate that information into action. This study aimed to obtain insight into how dental care patients perceive and make sense of the information they receive from their dentist and how they translate that information into action. Methods: 16 patients and 8 dentists from Indiana School of Dentistry’s (IUSD) Graduate Prosthodontic Clinic in Indianapolis, Indiana were included. Two in-depth interviews, one immediately following the dental visit and one 7-10 days later, were conducted with the patients, and one short interview was conducted with each patient’s dental care provider. Interviews were audio taped and transcribed. Results: The results show both patients and providers perceived the interaction during consultation positively. The majority of patients were able to accurately recall information they received from their dentists and made sense of new information through the lens of their previous experiences. Four additional factors that explain patients’ adherence with health advice were also found in addition to the previous studies. Conclusions: Successful dentist-patient interaction could be thought of as a match between what dentists think patients need to know, what patients think they want/need to know, and what patients actually know. Thus, some barriers that can keep dentists and patients from reaching information equilibrium are discussed. The study concludes by offering practical and theoretical implications.

Indiana University-Purdue University Indianapolis (IUPUI) / African American adolescents have inadequate self-management behaviors, particularly during middle adolescence (14-16 years of age). Inaccurate beliefs, degree of asthma impairment (well controlled or not well controlled), and gender could influence asthma self-management (symptom management, medication management, and environmental control). The researcher used the illness representations concept from the common sense self-regulation model as the framework for this study. The descriptive correlational study explored (1) differences in illness representations (cognitive and emotional) and self-management behaviors by gender, asthma impairment, and gender by asthma impairment of African American adolescents with asthma; and (2) relationships between illness representations and asthma self-management behaviors, gender, and asthma impairment in 133 African American adolescents with asthma. Data were collected using the Asthma Control Test, the Illness Perceptions Questionnaire-Revised, and the Asthma Self-Care Practice Instrument. Data were analyzed using ANOVA, MANOVA, Pearson correlations, and multiple regressions. Findings indicated that females whose asthma was not well controlled had more beliefs about the chronicity of their asthma than those who were well controlled. However, there were no differences in such beliefs among males whose asthma was not well controlled from those who were well controlled. Well controlled adolescents differed from not well controlled adolescents for cognitive representations of cyclic timeline, treatment control, psychological attributes, and consequences as well as for emotional representations. There were no significant differences in the means of the self-management behaviors by gender, by asthma impairment, or by gender by asthma impairment. A significant bivariate relationship was found between representations of identity, consequences, treatment control, and symptom management. In the multiple regression model, representations of treatment control and consequences contributed to variances in symptom management; however, no other representations, gender, or asthma impairment variables were statistically significant. The representations, gender, and asthma impairment variables did not contribute to variances in medication management or environmental control. Limited studies have been conducted with African American adolescents with asthma; therefore, the findings will contribute information to the literature on their illness representations and self-management behaviors. The findings also contribute to the literature information based on adolescents' genders and levels of asthma impairment.

Indiana University-Purdue University Indianapolis (IUPUI) / Given the numerous benefits of a healthy diet and exercise for cancer survivors, there has been an increase in the number of lifestyle intervention trials for this population in recent years. However, the extent to which adherence to a diet and exercise intervention predicts health-related outcomes among cancer survivors is currently unknown. To address this question, data from the Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW) diet and exercise intervention trial were analyzed. RENEW was a yearlong telephone and mailed print intervention for 641 older (>65 years of age), overweight (body mass index: 25.0-39.9), long-term (>5 years post-diagnosis) survivors of colorectal, breast, and prostate cancer. Participants were randomized to the diet and exercise intervention or a delayed-intervention control condition. The RENEW telephone counseling sessions were based on determinants of behavior derived from Social Cognitive Theory (SCT) (e.g., building social support, enhancing self-efficacy). These factors have been hypothesized to improve health behaviors, which in turn should improve health outcomes. Thus, drawing on SCT and prior diet and exercise research with cancer survivors, I hypothesized that telephone counseling session attendance would be indirectly related to health-related outcomes (i.e., physical function, basic and advanced lower extremity function, mental health, and body mass index) through intervention-period strength and endurance exercise and dietary behavior (i.e., fruit and vegetable intake, saturated fat intake). The proposed model showed good fit to the data; however, not all of the hypothesized relationships were supported. Specifically, increased telephone counseling session attendance was related to engagement in all of the health behaviors over the intervention period. In turn, (a) increased endurance exercise was related to improvement in all of the health-related outcomes with the exception of mental health; (b) increased strength exercise was solely related to improved mental health; (c) increased fruit and vegetable intake was only related to improved basic lower extremity function; and (d) saturated fat intake was not related to any of the health-related outcomes. Taken together, these findings suggest that SCT determinants of behavior and the importance of session attendance should continue to be emphasized in diet and exercise interventions. Continued exploration of the relationship between adherence to a diet and exercise intervention and health-related outcomes will inform the development of more cost-effective and efficacious interventions for cancer and other medical populations.

Indiana University-Purdue University Indianapolis (IUPUI) / The PeerSpirit Circle is a non-hierarchical, intentional, and relationship-centered practice of collaboration. There is a lack of scientific knowledge about the phenomenon of the PeerSpirit Circle in nursing or its potential impact on nursing practice, education, research, and the evolution of the profession and health care. The health care milieu is often entrenched in ways of being that do not support sustained change. For vitality to prosper and creativity to abound, paradigmatic shifts and new models of practice that emphasize collaboration are being called for. The purpose and aims of this phenomenological research study are to explore and give voice to the experiences of nurses who have participated in the PeerSpirit Circle model of practice with other nurses. The study includes interviews from five registered nurses from Canada and the United States conducted from 2009–2010 and interpreted from a Gadamerian philosophical hermeneutic perspective. The research findings reveal three themes: (1) experiencing the Circle container” where participants begin to understand the value of intentional preparation of the interpersonal space for safe human interaction and stronger collaboration—there are experiences of gathering, protecting, appreciating ritual, and sharing stories; (2) Experiencing space where protected space seems to be the essential element to inspire the presencing of participants with self and other, which in turn engenders genuine dialogue, a sense of sacred space, and freedom to be authentic; and (3) Experiencing our humanity, an unfolding theme, where participants experience reconnection with and understanding of their deeper humanity, stronger congruence with their core values, deeper experiences of caring and courage, personal and professional growth, and a profound appreciation for belonging to a lineage of nurses. The findings inspire a deeper understanding of barriers to congruence between values and action in nursing and nurses’ need to acknowledge, honor, support, and protect each other’s vulnerability. The implications for nursing practice, education, and research show that the PeerSpirit Circle model is a beneficial for use in all settings.

Social Work / MA(SS)(MENTAL HEALTH)

Social Work / MA(SS)(MENTAL HEALTH)