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).

The current study investigated the mediating role of motivational self-regulation (MSR) strategies (i.e., mastery self-talk, performance/extrinsic self-talk, performance/relative ability self-talk, interest enhancement, relevance enhancement, efficacy enhancement) in the relationships between achievement goals and cognitive and behavioral engagement (i.e., involved engagement, withdrawal in the face of difficulties, avoidance of challenges, rehearsal and elaboration) among 1096 Chinese gifted high school students (43% male). Structural equation modeling supported the mediating role of MSR strategies. Mastery goals positively predicted all six MSR strategies with medium to large effects whereas performance approach goals positively predicted five out of six MSR strategies with small to medium effects. While all six MSR strategies positively predicted involved engagement, rehearsal and elaboration, interest enhancement and efficacy enhancement showed additional benefits. Theoretical and practical implications are discussed. / Department of Educational Psychology

The present study examined the implementation of a self-management strategy, termed the calm carrel, as a potential means of bringing about behavioural improvement (as reflected, primarily, in global behavioural ratings, extent of isolation time-out assignments, and student and teacher feedback) among six classes of Grade 4 to 6 children with emotional and behavioural disorders, being educated in self-contained classroom settings. The intervention consisted of a carrel within the class which students could choose to visit for up to three, 5-minute periods per day. While at the carrel, students could select from a variety of audio-based strategies provided on a CD player, comprising soothing music selections, as well as progressive muscle relaxation exercises, and visualization narratives which the children could work through. The option of completing a simple problem-solving form, as a means of reflecting upon their behaviour, was also provided. During both the 20-day baseline and 20-day experimental phase of the study, teachers maintained daily behavioural ratings and time-out frequency counts (also indicating the precipitating factor in the case of each time-out). Students kept their own records of carrel usage, and also completed pre- and post-intervention surveys and feedback forms. At the conclusion of the study, teachers completed a feedback form and were interviewed by the researcher. T-tests, Wilcoxon-signed rank tests, and ANOVA tests on the quantitative data garnered from the study, did not reveal the presence of significant trends suggestive of behavioural changes, within the data. Both student and teacher feedback, however, was largely positive, and can be regarded as indicative of the calm carrels value as an intervention blending self-management and relaxation techniques to provide a non-punitive student-directed alternative to the predominantly teacher-mediated approaches often characteristic of EBD classrooms. The intervention, deemed worthy of further study as a result of the present thesis, is thought to represent a technique which might help to facilitate the transition of students with EBD from segregated to inclusive class settings, insofar as it should be equally feasible to implement in both environments. / Special Education

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.

Despite the fact that as many as 80-90% of patients with cancer pain can be effectively treated using pharmacological therapies and other advanced approaches, 31% to 85% of cancer patients in Taiwan still experience varying levels of pain. Pain is one of the symptoms that patients fear most; it overwhelms all aspects of patients' lives and creates a sense of uncertainly and hopelessness. Pain control is, therefore, a high priority in the treatment of cancer patients. Pharmacological therapy is the cornerstone of cancer pain management. With the current trend toward outpatient care, many patients are being required to assume greater responsibility for self-management of prescribed analgesics at home to deal with the variable and complex nature of cancer pain and side effects of opioids. Patients however, have misconceptions regarding analgesics and a series of difficulties when attempting to put a pain management regimen into practice. This research addressed the hypothesis that self-efficacy beliefs might play an important role in analgesic adherence and pain experience in Taiwanese outpatients with cancer. The purpose of this study was to develop a scale to measure the self-efficacy expectations relating to opioid-taking in Taiwanese outpatients with cancer. Another purpose was to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contribute to patients' analgesic adherence and pain experience in Taiwanese outpatients with cancer. In the first stage semi-structured interviews were conducted to collect data from a purposeful sample (n=10) of oncology outpatients from two teaching hospitals in the Taipei area of Taiwan. The purpose of this phase was to identify behaviours and situational impediments associated with analgesic taking. Findings from this phase were used to develop a scale to measure opioid-taking self-efficacy. In the second stage a pilot test with a convenience sample (n=30) was conducted to test the validity and reliability of the new scale and to identify the feasibility of using the scale in a cross-sectional survey. In the third stage a cross-sectional survey was undertaken (n=92) to describe pain experiences, analgesic adherence, beliefs about opioid analgesics, and opioid-taking self-efficacy in Taiwanese outpatients with cancer and to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contributed to analgesic adherence and pain experience. Results of this study highlight an important issue - under-treatment of cancer pain in this group of Taiwanese outpatients. As well, low adherence rates to opioid analgesics in cancer outpatients arose as an important issue in this study. A range of misconceptions about using opioids for pain was also common amongst the sample. Despite these misconceptions, patients reported being moderately confident in their ability to perform self-management behaviours related to their prescribed opioid-taking. Results of this research supported the notion that patients' self-efficacy in relation to taking their prescribed opioid regimen was a significant independent predictor of patients' adherence behaviour and pain relief, but not of pain severity. Beliefs about opioid analgesics were also an independent predictor of patients' adherence, but not of pain relief or pain severity. In addition, findings from this study provided support for the validity and reliability of the opioid-taking self-efficacy scale. Results suggested there is a need for systematic assessment of beliefs affecting patients' opioid adherence behaviours for cancer pain control, including perceived personal self-efficacy and beliefs about opioid analgesics. Educational programs that focus on overcoming patients' misconceptions (beliefs) about taking opioid analgesics may be particularly beneficial. In addition, this study advocates that conducting self-efficacy-enhancing interventions may improve medication adherence for patients and therefore pain relief. More research is needed to demonstrate the construct validity of the self-efficacy scale and to evaluate self-efficacy enhancing interventions in cancer pain management.