Thesis (doctoral)--Lund University, 1989. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1989. / Added t.p. with thesis statement inserted.

Thesis (M.N.)--University of Alberta, 1997. / In partial fulfillment of the requirements for the degree of Master of Nursing. Faculty of Nursing. Also available online.

Class of 2011 Abstract / OBJECTIVES: To assess the current perceptions of patients with type II diabetes regarding the impact of lifestyle changes (diet and exercise), in particular, their relative impact on their disease state as it compares to that of their medication. METHODS: This was a descriptive study using a survey questionnaire. The primary dependent variable were the rating of the importance of diet and exercise, and a descriptive variables include medication use, amount of exercise, importance of medications, beliefs related to lifestyle and demographic variables. Questionnaires were passed out to eligible participant at the Walmart Pharmacy located on 7150 E. Speedway Blvd., Tucson Arizona. RESULTS: 56 survey questionnaires were completed. 18 men (mean age = 55.6) and 31 women (mean age = 43.8). Seven of the survey questionnaire did not indicate sex. Overall, lifestyle modification was rated favorably by all participants. On a scale of 1 through 5 (1 being least important, 5 being most important), the mean ratings were 3.5 and 3.6 for diet and exercise respectively. Confidence in medication use was rated a mean of 2.15. Attitude of study population with regards to obesity and diabetes was highly skewed toward obesity contributing diabetes (mean = 4.5). Finally, only 26.7% of participant get more than three hours a week of regular exercise. CONCLUSION: Based on the result from this study, patients with type II diabetes have a stronger inclination towards a belief in lifestyle changes (diet and exercise) to improve their disease state than medication alone.

No description available.

published_or_final_version / abstract / toc / Psychiatry / Master / Master of Philosophy

The study was conducted for the purpose of designing and evaluating an educational program for undereducated diabetes mellitus patients. The program as designed integrated recommended emphases found in the literature for the development of educational programs for low literacy levels and accounted for cultural relevancy. Developed program components were the diabetic diet guide and an audiotape-slide presentation entitled, "How to Follow the Diabetic Diet Guide." Concentrated efforts were made to develop understandable and applicable dietary education materials. Educator and professional dietitian expertise were utilized in the formation and completion of the program design. Patients similar to potential study participants voluntarily served as trial learners provided input relative to realistic content transmission, application to the daily dietary regimen, and comprehensibility. The program components are clear, concise, colorful, visually-oriented, and interesting. The provision of an easy-to-follow guide for regular home use allows for repetitive application of required dietary principles. The content emphasis was on the necessary concepts for dietary control of the disease. Knowledge areas included nutritional knowledge basic to the disease, the foods in food groups, the measurement of serving sizes of foods using standard methods, unrestricted foods, restricted foods, the use of fat in food preparation, and the advocacy of an established eating routine throughout the day from day-to-day. In the diabetic diet guide, the aforementioned concepts were clearly and colorfully presented so that literacy was not required. The same concepts utilizing portions of the guide were reinforced by a unisex cartoon character explaining use of the guide. Evaluation instruments were designed to test program effectiveness with an undereducated diabetes mellitus patient population. The instruments (developed by the researcher) were a 70-item knowledge test, a 24-hour recall record, and a medical chart information sheet. A field test trial was conducted with 50 participants who are served on an outpatient basis. The site was the High Point Memorial Hospital Outpatient Clinic, funded by the health department. Fifty consenting participants were randomly assigned to experimental and control groups by a ratio of two to one by race and sex. Thirty-two experimental and 18 control subjects completed the study. All data collection was orally solicited initially, at two months, and at four months. The educational intervention was presented only to experimental subjects. Evaluation of increments in knowledge, decreases in weight, blood glucose values, and minimal acute complications indicated the newly designed program was successful. The data was subjected to statistical analysis using analysis of covariance. The initial scores or readings were used as covariates to control for initial variances. Knowledge scores improved significantly from the beginning to the end of the study (p ≤ 0.0001). Knowledge attainment must occur for subsequent application as reflected by clinical measurements. The desirable clinical measurements were generated during the four-month study as shown by statistically significant decreases in blood glucose values (p < 0.05) and a pronounced trend in weight loss. A further indication of success was that the experimental population had fewer acute complications than the control subjects. / Ph. D.

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

Memory performance was measured in 48 persons between the ages of 40 - 65 with Type II diabetes. Correlations between performance on the California Verbal Learning Test, tests of Working Memory, Priming Memory, and Prospective Memory and several predictor variables were examined. These variables included the Slosson Intelligence Test Scores, demographic variables, presence of diabetic complications, finger-stick and HbA1c measures. Subjects performed worse than the normative sample on the California Verbal Learning Test. Higher chronic and acute blood glucose tended to be associated with worse performance on the CVLT, Priming, and Working Memory. However, after the effects of intelligence, education, and sex were statistically controlled, glycemic status predicted performance on just a few memory measures. These were short-delay recall compared with recall on List A trial 5, and List B on the CVLT, and recall accuracy on digit forward of the Working Memory Test. Glucose status was unrelated to performance on a prospective memory test. Several other demographic and diabetic complication factors predicted performance beyond the contribution of intelligence. These results contrast with previous studies which found strong effects of glycemic control, but did not statistically control for the contribution of intelligence. Differential effects of diabetic status on different aspects of memory were discussed.

MMed, Community Health, Faculty of Health Sciences,University of the Witwatersrand / Introduction: The complications associated with diabetes usually occur over a long period of time and are mainly influenced by poor glycaemic control. Diabetic complications impact on the individual, the healthcare delivery system, and also have high cost implications. A number of studies have shown the management of diabetes to be sub-optimal in primary health care settings. Barriers that impair a patients’ ability to achieve good glycaemic control can be looked at from a patient, health facility and health professional perspectives. Good glycaemic control will not only benefit the individual patient but will also have a positive financial impact on South Africa’s already overstretched healthcare budget. Methods: In this cross sectional analytical study set in three Community Health Centres (CHCs) in the Johannesburg Metropolitan Health District, 418 diabetic patients were selected. An HbA1c test was conducted for every patient and was used to classify patients into a well controlled glycaemic group (HbA1c < 7%) or a poorly controlled group (HbA1c ≥ 7%). Differences between the two groups in terms of their risk factors for poor glycaemic control were investigated. Patient related risk factors studied included, basic demographic, treatment related, clinical, behavioural and lifestyle characteristics. Healthcare professionals and facility managers were interviewed and patient records were reviewed to describe health system challenges to providing optimal care. Univariate and multivariate logistic regression models were used to determine patient related factors influencing glycaemic control. Results: Of 394 patients with a measurable outcome (HbA1c), only 62 (15.7%) had well controlled diabetes. The mean HbA1c was similar across the three CHCs studied (p=0.464). Good glycaemic control was significantly associated with unemployment, shorter duration since diabetes diagnosis, treatment with oral medication alone and normal LDL-cholesterol levels (p<0.05). On multivariate analysis significant predictors of good glycaemic control were found to be a shorter duration since diabetes diagnosis, treatment with oral medication alone, being male, and those who were unemployed. Numerous challenges to providing optimal diabetes care were reported by health professionals including high patient to staff ratios, lack of working equipment as well as a need to improve diabetes management skills. Record review revealed that only a limited number of patients (16%) had ever had HbA1c testing. Conclusions: The majority (84.2%) of patients attending the selected facilities for diabetes care had poor glycaemic control. Management of diabetes in these CHCs is suboptimal. Patients with a shorter duration of diabetes, those who were male, Black African, unemployed and treated with oral medication alone were more likely to have good glycaemic control. Although the study concludes that patient related factors are at the forefront in terms of factors influencing glycaemic control, improved strategies in all spheres can only improve diabetes management at the CHCs.