Self-monitoring of blood glucose (SMBG) can be effective in preventing poor outcomes associated with diabetes mellitus but previous research has identified that SMBG is not being undertaken in line with current recommendations. Guidance informs health professionals to educate patients on how they should self-monitor but very little is know about how patients self-monitor in the real world. In this thesis, a quantitative scoping study is first presented. This study used routine data sources to examine the levels and patterns of self-montoring in different population groups and then proceeded to a larger qualitative study to explore and question what patients are doing in practice in relation to self-monitoring, and why. This involved a qualitative multi-case study of patients, their support people, health care practitioners (HCPs) and patient diaries. Ten individuals and their nominated support people and HCPs formed ten cases among whom 21 in-depth semi-structured interviews were carried out and six patient diaries analysed. The exploratory work was framed around Stones’ version of structuration theory and uncovered a complex linkage of individual motives for monitoring, associated responses and behaviours in relation to the motive, and the underpinning attitudes and beliefs behind the motive. The following key points emerged from the analysis. People have differing relationships with their diabetes and this links with the level of engagement they have with their condition. Resistance to support people and health services was commonly observed. Experiences of diabetes reviews were important, with an identified need for them to feel more like collaboration and less like surveillance. A significant factor was the gaps and limitations in knowledge and understanding around diabetes for patients, relatives, support people and HCPs; and, finally, there was a noted maintenance of blood glucose levels higher than recommended through SMBG in several participants, which stemmed from a fear of hypoglycemic episode. The analysis concluded that although self-monitoring of blood glucose, in theory, and when considered in isolation, is a simple process to undertake, its application in the wider context of self-management and the individual is much more complicated. The process is influenced by many complex factors and generates a variety of responses and behaviours, some not in keeping with good diabetes self-management. There was a significant lack of person-centered approaches to managing diabetes which was, in part, due to existing health systems and processes. Therefore, there is a need to raise awareness of the gaps that exist in terms of such approaches as well as the gaps in knowledge and understanding of individuals with diabetes and those caring for and supporting them. In more specific terms, it is essential to develop and evaluate individual approaches to patients in relation to their self-monitoring and associated self-management in the context of their own lives, which involves the assessment of engagement and understanding around self-monitoring.

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-04-13T17:35:52Z No. of bitstreams: 1 LEILA APARECIDA ALVIM DE PAULA FERREIRA - DISSERTAÇÃO PPG-CEMat 2014..pdf: 2101894 bytes, checksum: 086e0e07fb7a86bb4092c49f395ed931 (MD5) / Made available in DSpace on 2018-04-13T17:35:52Z (GMT). No. of bitstreams: 1 LEILA APARECIDA ALVIM DE PAULA FERREIRA - DISSERTAÇÃO PPG-CEMat 2014..pdf: 2101894 bytes, checksum: 086e0e07fb7a86bb4092c49f395ed931 (MD5) Previous issue date: 2014-07-18 / Este trabalho teve como objetivo a avaliação físico-química, morfológica e estrutural das bolsas de Policloreto de Vinila (PVC) para acondicionamento de sangue e hemocomponentes. As amostras de bolsas plásticas Nacionais e do Exterior utilizadas para este estudo foram selecionadas no Sistema de Dados da ANVISA - DATAVISA entre as bolsas regularizadas junto à ANVISA. As bolsas constituídas de PVC foram caracterizadas por Espectroscopia na Região de Infravermelho com Transformada de Fourier (FTIR), Difração de Raios X (DRX), Microscopia Óptica (MO), Microscopia Eletrônica de Varredura (MEV)/ Espectroscopia por Energia Dispersa de Raios X (EDS), Microscopia de Força Atômica (MFA) e Ensaios Mecânicos (Tração). As análises foram realizadas no Laboratório de Desenvolvimento e Avaliação de Biomateriais (CERTBIO). De acordo com os resultados observados no ensaio de FTIR, pode-se afirmar que todos os componentes apresentam grupos funcionais semelhantes. No DRX foi observado que as amostras apresentaram um perfil de material com caráter semicristalino. Na MO e MEV observou-se um lado mais liso e outro mais rugoso com algumas irregularidades na superfície da amostra. Conforme o ensaio de EDS, os elementos químicos identificados, bem como a concentração dos mesmos, demonstrou que as bolsas seguem um mesmo critério de composição. Baseado nos resultados de ensaios mecânicos para ambos fabricantes, as bolsas de sangue sem anticoagulante apresentaram menor deformação em relação as bolsas de sangue com anticoagulante. Todas as bolsas apresentaram comportamento de material viscoelástico. Desta forma, pode-se concluir que todos os ensaios de caracterização utilizados neste trabalho foram relevantes para avaliação da qualidade das bolsas plásticas para acondicionamento de sangue e hemocomponentes existentes no mercado, considerando os requisitos gerais e específicos estabelecidos nas normas e legislações vigentes. / This research has the objective the physical chemical, morphological and structural evaluation of Polyvinyl Chloride (PVC) bags for blood filling and hemocomponentes. The samples from national and imported blood bags used for this research were selected through ANVISA database from blood bags regularly released by that. The PVC blood bags were characterized by Fourier transform Infrared (FTIR), X-ray Diffraction (XRD), optical microscopy (OM), scanning electron microscopy (SEM), energy dispersed spectroscopy X-ray (EDS), Atomic Force Microscopy (AFM) and Mechanical Testing. The analyses were performed on Biomaterial development and evaluation lab (CERTBIO). On Fourier transform Infrared (FTIR) it was observed that all components show chemical similarity. On XRD was noticed that the samples have showed a semi crystalline characteristics. On OM and SEM it was noticed that the sample has a smooth side and other with sprinkles on surface. ON EDS assay it was observed conformity on chemical compounds identified as well as on their strength. It demonstrates that blood bags follow the same composition criteria. Based on mechanical tests results for both manufacturers, the blood bags without anticoagulant showed less deformation compared to blood bags with anticoagulant. All bags showed viscoelastic material behavior. Thus, we can conclude that all characterization tests used in this study were relevant to assessing the quality of the bags that are used as containers of blood and its components existing on the market, considering the general and specific requirements established in rules and regulations.