Diabetes is a chronic condition affecting more than 30 million adults living in the United States. Diabetes self-management (DSM) can prevent or delay the complications of diabetes and improve clinical outcomes; however, data show that low-income, food insecurity, female gender, and race contribute to challenges performing effective DSM. The health belief model was the theoretical framework for this cross-sectional study, which examined how food insecurity, low-income, and race affect DSM activities in women with diabetes. The sample population from the 2017 Behavioral Risk Factor Surveillance System survey consisted of 1,842 women with diabetes who were 18 years of age or older, had an annual income of less than $50,000, and were food insecure. Results of the chi square analyses indicated a significant association between food insecurity and DSM activities (χ2 = 48.99, p < 0.0001); however, results showed no significant association between low-income or race (p > 0.05). Results of a binary logistic regression model revealed that food secure and younger women had 1.618 and .584 times the odds of having effective DSM activities than food-insecure and older women (OR=1.618, 95% CI=1.282 - 2.041, p < 0.001; OR=.584, 95% CI=.465 - .733, p < 0.001, respectively). These results might provide researchers with guidance regarding food insecure and younger women with diabetes who might require additional support for their diabetes management. Tailored public health interventions might lead to positive social change by increasing food stability and nutrition knowledge, potentiating improvements in hemoglobin A1C, a 90-day measure of glucose control, which could reduce risk of diabetes-related morbidity and mortality.

Numerous scholars have examined multiprocessors and techniques to decrease the heart failure readmission rate and to improve heart failure patient self-management. This project examined a new teaching method to create the experts' awareness of possible solutions to improve heart failure education in a small community hospital. The purpose of this project was the assessment of a new iPad heart failure patient pre-discharge education program video HFPDEV). Pender's health care model (PHM) served as a framework for this project. Five local nursing educator experts (master prepared) were asked to view a new iPad HFPDEV. After reviewing the 15-minute iPad HFPDEV, the local experts were asked to evaluate the video by completing a Likert-type survey, which evaluated the content, process, design, time, and functionality of the iPad HFPDEV along with a section for comments and recommendations. Descriptive analysis was used to analyze the survey results. Four of the experts defined the content, process, design, and functionality of the iPad HFPDEV as 'excellent.' One defined the content, process, design, and functionality of the iPad HFPDEV as 'adequate.' All experts expressed recommendations to improve the IPad HFPDEV by doubling the iPad size with an enlargement of print for easy reading and erecting all teaching iPads on mobile stands. A future pilot project will evaluate the relationship of HF readmission rate to the iPad HFPDEV. Social change will occur when the organization provides HF patients with iPad HFPDEV that will increase HF self-management skills and decrease HF readmissions.

African Americans diagnosed with diabetes are less likely to self-manage diabetes-specific modifiable risk factors. As a result, utilization of healthcare services occurs at a greater rate than other racial groups, and thereby incurs higher than expected healthcare costs. This ethnographic study explored the elements of diabetes educational material African Americans in a large city in the southern part of the United States found most useful to facilitate self-management of their disease. Bandura's self-efficacy theory provided the theoretical framework. Research questions addressed the preferred educational content, layout of material, and methods for educational delivery and caregiver support. A purposive sample of 30 African Americans with diabetes who had engaged in diabetes education classes participated in this study. Data were collected through in-depth personal interviews, which were inductively coded and then categorized around emergent themes. A key finding of this study is that participants preferred group learning formats, but perceived educational material to be confusing and difficult to understand. They also expressed some preferences for the use of color, pictures, and presentation of graphical information that may provide the basis for a revision of educational materials. Interestingly, participants indicated a tendency to seek out church members rather than family for support. The positive social change implications of this study include recommendations to healthcare professionals to adopt educational curricula that reflect cultural nuances and needs of target populations in order to support better health outcomes for at-risk populations and cost efficiency improvements.

Type 2 diabetes disproportionately affects low-income African American women, age 50 years and older: 30% to 40% of this population has this chronic disease. Two significant factors affecting poor diabetes practice adherence are food insecurity and depression; another is obesity. The purpose of this quantitative correlational study was to determine if either food insecurity or depression significantly affect Type 2 diabetes self-management practices; and/or if food insecurity significantly influences practice adherence indirectly, through the mediator of depression, while controlling for obesity. The research questions were aligned with the theoretical pathways posited in Matthews's reserve capacity model (RCM) and used the most current national data from the 2015 BRFSS dataset. The results of the linear regression models indicated that as hypothesized, depression was significantly associated with poor practice adherence; contrary to hypotheses, food insecurity and obesity were not. The lack of significance between food insecurity and depression eliminated the need to test for mediation. While correlational analyses revealed a significant association between obesity and depression, this relationship was no longer detected in linear regression analyses. An unanticipated finding was the significant relationship between education and Type 2 depression self-management practices, a relationship that maintained significance even with the entry of depression. These findings have implications for positive social change in the form of preventative interventions aimed at weight-loss and/or reducing depression among African American women at risk for developing Type 2 diabetes.

Diabetes has quickly become an epidemic in the United States and affects all genders and races. Some ethnic groups are at greater risk for being diagnosed and face devastating health consequences due to poor diabetes self-management. Diabetes self-management education (DSME) is considered to be a positive step toward patient self-efficacy and diabetes management. The benefits of diabetes self-management education can only be realized if patients diagnosed with diabetes not only enroll, but complete the program. The purpose of this research study was to investigate the association between race and gender and dropout rates among participants enrolled in a DSME program. Archival data from a DSME were collected for 352 participants enrolled in the program. A multiple logistic regression was used to analyze whether independent variables of race and gender were predictors of dropout rates. Chi-square was used to explore if there was an association between race and gender and drop-out rates. Results revealed that there was no statistically significant association between race and gender and dropout rates from participants in a DSME program. Positive implications for social change include exploring the reasons participants choose to drop-out of a DSME program and potentially identify those at risk for droppoing out due to challenges and barriers.

Background: Chinese immigrants (CIs) with non-insulin dependent diabetes mellitus (NIDDM) generally have poor control in their diet regimen. Due to the variation in body mass, physiology, and cultural differences as compare with the general American population, special attention must be conducted in treating diabetes in Cis, emphasizing culturally sensitive care and nutrition therapy that acknowledge the differences. Purpose: The purpose of this project was to assess cultural challenges in self-management for CIs living with non-insulin dependent diabetes mellitus and evaluate the effectiveness of a diabetic nutritional self-management guide tailored to this population. Theoretical Framework: Havelock’s theory of change is a model emphasized for understanding and intervening of the possibility that people might be resistant to behavior changes. Methods: Thirty-five foreign-born CIs were selected. The project was comprised of two phases to include pretest and posttest self-assessment questionnaires in addition to pretest and posttest A1C levels to evaluate the effectiveness of a custom meal plan. Results: Result findings were non-significant. However, female CIs were noted to have superiority for diet management as compared with male CIs. The two groups had no significant difference in age and cultural characteristics. Conclusion: The goal of the implementation of this project was to improve self-care for Chinese diabetic patients through behavior training and change in policy making. Social and cultural norms were identified that had great influence on an individual’s overall health knowledge. Increasing health care providers’ overall cultural competency was expected to promote better health outcome and ease the complexity of the acculturation process. However, the management of the diet did not have a significant change for the improvement of A1c. Future recommendations include the exploration of the immensity of change in cultural diet and acculturation.

Bakgrund: Diabetes mellitus typ-2 är en kronisk folksjukdom som fortsätter öka över hela världen. Sjukdomen innebär en minskad insulinproduktion tillsammans med en ökad insulinkänslighet. Behandling av sjukdomen ställer krav på en strikt egenvård tillsammans med livsstilsförändringar, som dieter och motion. Kunskap och information om sjukdomen samt stöd från vårdpersonal och närstående beskrivs som viktiga komponenter för att främja egenvård. Syfte: Syftet var att beskriva personers upplevelser av egenvård vid diabetes typ-2. Metod: En strukturerad litteraturöversikt som baseras på en sammanställning av resultat från tio vetenskapliga artiklar. Samtliga artiklar är publicerade i databaserna CINAHL Complete och Pubmed. Valda artiklar analyserades och tematiserades utifrån Fribergs metodbeskrivning. Resultat: Resultatet beskriver både positiva men främst negativa upplevelser av egenvård vid diabetes typ-2, vilka presenteras under fyra huvudteman;Egenvård i vardagen, Kunskap och information, Behov av stöd och Läkemedelsbehandling. Sammanfattning: Det är vanligt att personer med diabetes typ-2 upplever svårigheter i vardagen då egenvårdshanteringen kräver tid, kunskap och anpassning. Svårigheterna kopplas främst till de livsstilsförändringar som krävs samt integreringen av nya vanor och rutiner. Många personer upplever en bristande motivation, där stödet från närstående och vårdpersonal har en avgörande roll. / Background: Type-2 diabetes mellitus is a public health chronic disease that continues to increase worldwide. The disease results from a lack of insulin production in combination with an increased insulin sensitivity. The treatment of the disease requires a strict self-care management along with lifestyle changes, such as diets and physical activity. The knowledge and information about the disease together with the support from healthcare professionals and relatives are considered as important components for promoting self-management. Aim: The purpose was to describe people´s experiences with self-management of type-2 diabetes. Method: A structured literature review based on a compilation of results from ten scholarly articles. The articles are all published in the databases CINAHL Complete and Pubmed. The content was analyzed and thematized based on the description of Friberg's analysis method. Results: The results describes both positive but mainly negative experiences in managing self-care with type-2 diabetes which was presented as four main themes; Self-management in everyday life, Knowledge and information, Need for support and Medical treatment. Conclusion: It is common for people with type-2 diabetes to experience difficulties in their everyday life because maintaining self-care management requires time, knowledge and adaptation. The difficulties are mainly linked to the required lifestyle changes together with a integration of new habits and routines. Many people experience a lack of motivation, where the support of relatives and healthcare professionals play a crucial role.

Indiana University-Purdue University Indianapolis (IUPUI) / Epilepsy is the most common chronic neurological condition in the United States, and it is incurable. Those who suffer from it must engage in both collaborative and independent management of their condition for the remainder of their lives. The treatment and care of those with epilepsy must therefore include not only medical interventions, which alone cannot cure the disorder or prevent the disability associated with it, but must also prepare persons for and facilitate their independent management—self-management—of the disorder. Self-management is a process that affects important outcomes including resource utilization, mortality, and quality of life. In the United States, those age 60 years and older have the highest incidence of new-onset epilepsy. Despite the high incidence of epilepsy in this population, coupled with the knowledge that self-management affects important outcomes, a thorough search of the literature suggests that self-management experiences of older adults diagnosed with epilepsy late in life have not been investigated. The purpose of the study was to examine, using a qualitative descriptive design, the self-management experiences of older adults diagnosed with epilepsy at or after age 60. Semi-structured interviews were used to generate data. A total of 20 older adults participated. Major findings indicate that older adults in the sample, and particularly the women, experienced a delay in receiving an epilepsy diagnosis. These older adults experienced multiple problems and life changes since diagnosis—some of which are unique to this population and many of which are amenable to intervention. These older adults devise and execute a variety of management strategies, within a system, that are classified as disease/treatment-focused and problem/life changes-focused. These strategies further are categorized as proactive or reactive, with proactive strategies being pre-planned and effective, and reactive strategies being unplanned and less effective. Knowledge generated from this study reveals the problems experienced by older adults with epilepsy, as well as their management needs. These findings will inform future studies, the aim of which will be to investigate more thoroughly these problems and needs and, ultimately, to inform interventions aimed at resolving this population’s problems and concerns while also improving outcomes.

Indiana University-Purdue University Indianapolis (IUPUI) / Poor long-term kidney transplant outcomes are a significant problem in the U.S. Interventions must focus on preserving allograft function by managing modifiable risk factors. An instrument capable of identifying problems with post-kidney transplant self-management behaviors may enable the design and testing of self-management interventions. This study’s purpose was to test the psychometric properties of the new Kidney Transplant Self-Management Scale (KT–SM). The Zimmerman framework adapted for kidney transplant self-management guided the cross-sectional study. A total of 153 kidney recipients recruited from Facebook® completed the Self-Efficacy for Managing Chronic Disease (SEMCD), Patient Activation Measure (PAM), Kidney Transplant Questionnaire (KTQ), and KT–SM Scale instruments via a REDCap® survey. Most participants were female (65%), White (81.7%), and middle-aged (M = 46.7; SD = 12.4 years) with a history of dialysis (73%) and received a kidney transplant an average of 6.58 years previous (SD = 6.7). Exploratory factor analysis results supported the 16-item KT–SM Scale as a multidimensional scale with five domains with loadings ranging between .39 and .89: medication adherence, protecting kidney, cardiovascular risk reduction, ownership, and skin cancer prevention. Internal consistency reliability for the total scale (Cronbach’s α = .84) and five domains ranged from .71 to .83. The total and domains were positively correlated, ranging from r = .51 to .76, p = .01. Criterion-related validity was evidenced by significant correlations of KT–SM and domains with SEMCD (r =.22 to .53, p = .01), PAM (r = .31 to .52, p = .01), and the overall KTQ (r = .20 to .32, p = .01) except for one KT–SM domain: protecting kidney. Construct validity was evaluated using multivariate regression analysis. The linear combination of age, patient activation, and self-efficacy explained 45% of the variance in KT–SM behaviors; 47% of the variance in KTQ (measuring quality of life) was predicted by age, comorbidity, and self-efficacy. These findings provide beginning evidence of reliability and validity for the newly developed KT–SM scale. Instruments like this may provide a means to capture the self-management behaviors of the kidney transplant population, which is critical for future work on interventions.

Indiana University-Purdue University Indianapolis (IUPUI) / Adolescents with a type of conversion disorder called psychogenic nonepileptic seizures (PNES) experience many school, relationship, and health care struggles as they attempt to manage their mental health condition with PNES events that strikingly resemble epileptic seizures. Considered one of the top three neuropsychiatric problems, health care providers and school personnel remain ill-informed regarding how to care for adolescents with PNES. Because of the unique multidisciplinary approach needed to address adolescent PNES, school nurses are uniquely positioned to bridge health care and education systems. A review of literature examined the concept of school nurse selfmanagement support for PNES, existing school nurse-led mental health interventions, and the relationships between concepts for a conceptual framework guiding adolescent PNES research. This review of literature reveals an absence of adolescents’ perspective and school emphasis in PNES research. This study was designed to investigate adolescents’ experience attending school and self-managing PNES. This was accomplished through a qualitative content analysis of data generated from semi-structured interviews and magnitude coding of select quantifiable data. Data were obtained from 10 adolescents, 12 to 19 years of age, with current or recent in-person school attendance. The results indicate adolescents from the sample had school experiences that involved stress, bullying, accusations of faking seizures, and feelings of isolation or exclusion. Their mostly effective proactive selfmanagement activities included seeking protection, persevering in life despite PNES struggles, and progress monitoring through seizure tracking. Reactive activities of mixed effectiveness included coping responses to seizure warnings. School nurses, school personnel, family members, and peers served as both facilitators and barriers for PNES self-management. Adolescents also contributed information for three emerging themes— family-management, school-management, and illness representation. These findings reveal the difficulties of attending school and self-managing PNES and inform future PNES interventions to improve academic, mental health, and quality of life outcomes.