Thesis (Ph. D.)--West Virginia University, 2002. / Title from document title page. Document formatted into pages; contains viii, 170 p. Includes abstract. Includes bibliographical references (p. 108-157).

Thesis (M. Med. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 68-76).

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references.

Physical inactivity has been widely regarded as a leading cause of non-communicable chronic diseases such as type 2 diabetes mellitus (T2DM) and hypertension. Physical activity (PA) has been shown to be the most effective self-care behaviour in alleviating T2DM, an incurable chronic disease. Previous behavioural modification programs intended to encourage and maintain PA behaviour among middle-aged and older patients with T2DM have had inconsistent results. PA has remained as a recommended diabetes self-care behaviour with the lowest compliance rate in many regions of the world. This thesis proposes a program focusing on health literacy (HL) as a means to nurture T2DM patients’ ability to navigate, read, understand, process, comprehend and act on health information, and thereby modify PA behaviour. This approach is proposed for three reasons: (1) the flood of available health information of varying quality affects patients’ decision making with regard to self-care behaviour; (2) the high prevalence of low HL in the US, Europe, and Asia affects the comprehension of self-care behaviour programs; (3) because 50% of older T2DM patients are impaired cognitively due to the impact of aging and hence have difficulty in carrying out suitable self-care behaviour without proper guidance. All of these factors can influence the effectiveness of PA behavioural modification programs designed to help middle-aged and older T2DM patients make self-care decisions based on sound health information according to their level of HL. This thesis reviews existing HL-oriented programs and models and validates the instrument used to examine the effects of a culture-, language-, disease- and age-specific, theory-based, HL-oriented program on PA behaviour among middle-aged and older patients with T2DM. In the study, 324 middle-aged and older Chinese T2DM patients recruited from two hospital diabetes centres in Hong Kong were divided randomly into intervention and control groups. The intervention group participated in an HL-oriented program on PA behaviour. The program significantly improved the mean of PA behaviour of patients in the intervention group from a sedentary level (under 1,000 average Metabolic Equivalents/minutes/week; 4463 mean number of steps per week) to an internationally acceptable standard (over 2,000 average METs-minutes/week; 7459 mean number of steps per week), and this improvement was maintained at three- and six-month follow-ups. The PA behaviour of the control group actually subsided. This study showed that a program addressing and nurturing patients’ ability to explore, understand and manage health information on T2DM and PA was effective in improving the PA behaviour of middle-aged and older adults with T2DM. This thesis is the first study to use objective measurements to evaluate the effect of a culture-, language-, disease- and age-specific, theory-based, HL-oriented program on PA behaviour. It extends the generalizability of culture and language-sensitive HL oriented programming from the United States (where previous HL studies were conducted) to China. The study can serve as a model for future investigations of self-care behaviour among patients with different chronic illnesses in various regions of China. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Philosophy

Smoking causes Type II diabetes (T2DM). However, there were limited research on the needs, concerns and intention of smokers with T2DM about quitting smoking. This study aimed to explore the behaviors and perceptions on smoking and quitting smoking in patients with T2DM. I conducted both qualitative and quantitative studies. The qualitative study involved T2DM patients who were current smokers or ex-smokers, and could communicate in Cantonese. Semi-structured focus group and individual in-depth interviews were conducted. The quantitative study was cross-sectional, using a standardized questionnaire to identify the intention to quit smoking, knowledge regarding the health risks of smoking and their determinants in T2DM smokers who (1) were aged 18 years or above; (2) can communicate in Cantonese; (3) had daily consumption of at least 2 cigarettes in the past 30 days; and (4) diagnosed with T2DM for at least 6 months with stable condition. Structured multiphase regression analyses were used to identify factors associated with intention to quit smoking and knowledge on the health impact of smoking. In the qualitative study, I recruited 22 current smokers and 20 ex-smokers with T2DM at data saturation. The current T2DM smokers did not quit smoking because of satisfaction with their current health status, misconceptions of no association between T2DM and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive evaluation of quitting smoking, accepted the quit advice from medical professionals and received more family support. Moreover, psychological addiction and weight gain after smoking cessation were the major barriers for T2DM patients to quit smoking. In the cross-sectional study, I recruited 526 smokers with T2DM from nine outpatient clinics specialized in diabetes. They scored on average 47.5 (95% CI=45.6-49.4) out of 0-100 in knowledge regarding health impact of smoking, and 389 (74%, 95% CI=70.3%-77.8%) of them were in pre-contemplation stage. The multiphase regression analysis showed that T2DM smokers with no intention to quit were those who smoked during alcohol drinking (OR=5.98, 95% CI=1.89-18.98, p=0.002). In contrast, those less likely associated with pre-contemplation stage were those who perceived a worse level of health (OR=0.41, 95%, CI=0.19-0.86, p=0.019), perceived greater importance of quitting (OR=0.67, 95% CI=0.58-0.78, p<0.0001), had higher confidence of quitting (OR=0.77, 95% CI=0.67-0.88, p<0.0001), or had more knowledge regarding health impact of smoking (OR=0.98, 95%, CI=0.97-0.999, p=0.035). In addition, a higher score on Decisional Balance Inventory-Cons of smoking (coefficient=1.61, 95% CI=0.56-2.66, p=0.003) or confidence in quitting was associated with a higher knowledge score (coefficient=1.30, 95% CI=0.59-2.01, p<0.001). Conclusively, this is the first study to assess the smoking behaviors and perceptions in patients with T2DM. Many T2DM smokers were reluctant to quit smoking due to inadequate knowledge of the health impact of smoking. Patient education, weight control and behavioral counseling are suggested as the critical components of an effective smoking cessation intervention for T2DM patients. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

The purpose of this comparative study was to investigate the effect of coaching, as a nursing intervention, on comfort levels and blood sugar levels of individuals with diabetes. The hypothesis of the study was that individuals with diabetes who received coaching at specified intervals of time would have higher levels of comfort, as measured by the Diabetes Mellitus Comfort Questionnaire (DMCQ), and lower blood sugar levels, as recorded on the individual’s personal glucometer, than individuals with diabetes who did not receive coaching. Prior to conducting the study, approval of the university review board and hospitals was obtained. Participants were solicited from two accredited hospital-based diabetic education programs in a Midwestern city. Participation in the study was voluntary. The participants solicited from one hospital-based diabetic education program received coaching as a nursing intervention throughout the study while the participants from the other hospital-based diabetic education program did not. The participants were enrolled in the study the last day of the diabetic education program and completed a demographic data form, the DMCQ, and the Self Care InventoryRevised (SCI-R) to measure compliance. They also documented the average of their daily blood sugar levels from the past seven days as recorded on their personal glucometer. Two and four weeks after enrolling in the study participants from each group repeated the process of completing the DMCQ, the SCI-R, and documenting the average daily blood sugar levels over the past seven days as recorded on their glucometers. One hospital-based diabetic education group received coaching from the researcher via a telephone call two and four weeks after completing the formal diabetic education program and prior to completing the DMCQ, the SCI-R, and documenting their average daily blood sugar from the next seven days. Confidentiality of data collected from the participants was maintained. There was no risk of harm. Of the participants enrolled in the study, there were 30 participants who completed the study for one group and 35 participants who completed the study for the other group. Analysis of variance was used to analyze the data. Results showed no significant difference in comfort levels, compliance scores, or blood sugar levels between the two groups. The hypothesis of the study was not supported. Nonetheless, the information obtained from this study is valuable to nursing by contributing to the growing body of knowledge for developing cost-effective education and supportive strategies for individuals with diabetes to manage their condition. / Department of Educational Studies

Doctor-patient partnership has been advocated for achieving effective diabetes management. Such a partnership requires empowering patients with proper knowledge and skills so they are capable of participating in decision-making, effective communication with health professionals and successful diabetes self-management. Although it is well known that patient education should be tailored and prioritised, little research on Computer-based Patient Education Systems (CPESs) has aimed at customising information that is flexible enough to adapt to firstly, the dynamic nature of patients' ongoing information needs and secondly, changes in their personal health and social circumstances. Moreover, except for indirect support for doctor-patient communication through tailored information, current CPESs do not aid patients in formulating their questions. / This thesis targets limitations of current CPESs and explores approaches for using information technology (IT) to support the doctor-patient partnership. Two approaches used to achieve the research goal are 1) providing essential information to individual patients - information that is not only relevant, but also prioritised; and 2) providing direct support for patients to generate personalised agendas prior to scheduled health visits. The innovative technologies that have been developed for implementing these two approaches include a comprehensive Diabetes Information Profile (DIP) for each patient, information tailoring and prioritisation algorithms (information algorithms), quiz tailoring and prioritisation algorithms (quiz algorithms), and agenda personalisation algorithms (which serve to populate an agenda question pool). The DIP includes data elements on a patient's lifestyle, diet profile, psychosocial profile, risk factors of diabetic complications, behaviour change profile, self-management profile, and clinical status. The information algorithms take into account these DIP elements, as well as patients' diabetes knowledge level (based on educational exposure) and individual information preferences. Collectively, the implementation of these approaches, using an extensible architecture based on Extensible Mark-up Language (XML) and Java technologies, is called “Violet Technology” (VT). A VT-based web portal has been developed and evaluated. / A two-phase evaluation was conducted through the Diabetes Centre of a metropolitan hospital. The first study evaluates the validity of the information algorithms through patient and healthcare provider assessment of prioritised information topics. The participants of the first study include 11 patients with diabetes, one General Practician (GP), one endocrinologist, two diabetes nurse educators and one dietician. The second trial evaluates the VT-based portal overall - including information, quiz and agenda personalisation algorithms - through a field trial of the portal with random selection of patients to treatment and control groups. In total, 27 patients, one GP, one endocrinologist, two nurse educators, and one dietician were involved in the second trial. The evaluations provide qualitative support for the relevance of information prioritisation by VT, and show acceptable consumer usability, as well as healthcare provider support, for the portal. The evaluations also revealed further incremental refinements to the information algorithms. / This thesis contributes a specific framework for the use of IT to support the doctor-patient partnership through prioritised information and integrated agenda formulation services. While a larger scale of evaluation is needed to establish patient health benefits, the results of the two initial studies are encouraging. This framework could be adapted for other chronic diseases, such as depression or asthma. It could also be used for other purposes, such as an intelligent information searching facility. A future VT framework should provide more explicit representation of patients' emotional supports and have further mechanisms for promoting patient behaviour changes. / Thesis (PhDInformationTechnology)--University of South Australia, 2005.

Thesis (M.P.H.)--University of Adelaide, Dept. of Public Health, 1998. / Includes bibliographical references (leaves 274-289).

Thesis (Ph. D.)--Ohio State University, 2008. / Title from first page of PDF file. Includes bibliographical references (p. 168-189).

Thesis (M.S.)--Florida State University, 2004. / Advisor: Dr. Jeanne Flannery, Florida State University, School of Nursing, Dept. of Graduate Studies. Title and description from dissertation home page (viewed Sept. 29, 2004). Includes bibliographical references.