Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1977.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1977.

Thesis (M.S.)--University of Michigan, 1977.

Background. A reliable and valid instrument printed in English that measures self-management for adults with vascular diseases receiving hemodialysis therapy was not found in the literature. The Vascular Disease Self-Management Instrument (VSMI) was developed to support the measurement and assessment of self-management. Objectives. The primary objective was to assess the feasibility of the study methods to develop and explore the psychometric properties of the Vascular Disease Self-Management Instrument (VSMI) for adults receiving hemodialysis therapy. Feasibility outcomes included recruitment, consent and completion rates. The secondary objective was to begin to explore the reliability (internal consistency and test-retest), and construct validity using exploratory factor analysis and criterion-related validity. Method. This feasibility study used seminal work (Thabane et al., 2010) and clinical expertise to determine feasibility outcomes. Examination of psychometric properties was based on Streiner & Norman (2008). Results. Of the 267 eligible patients, a total of 136 patients were recruited into the study. The consent rate was 51% and completion rate was 32% for the test-retest analysis. Study participants were primarily male (61%), diagnosed with chronic kidney disease for 12 years and receiving hemodialysis therapy for 6 years. Half (50%) the participants were at moderate risk for psychological distress and used avoidant-oriented coping. Preliminary psychometric analysis suggested good reliability (Cronbach’s alpha = 0.945) and stability (Intraclass correlation coefficient = 0.927, p <0.0001). The results of the exploratory factor analysis indicated four main factors comprised the self-management instrument including collaborative partnerships, self-advocacy, self-monitoring and normalcy. Preliminary evidence of criterion-related validity demonstrated a significant positive relationship between task-orientated coping and self-management. Conclusion. Feasibility outcomes were successfully met. Preliminary evidence suggests that the VSMI has the potential to become a reliable and valid instrument. A full-scale psychometric evaluation with a sample that includes adults receiving peritoneal dialysis is needed to support utilization of the VSMI in research and clinical practice. / Dissertation / Doctor of Philosophy (PhD) / Background: Adults receiving dialysis therapy must engage in self-management of their illnesses. A questionnaire on self-management activities based on the individuals’ experiences would help health care providers to identify areas where people struggle. This information could be used to develop programs that support self-management. What Did We Learn: A total of 136 people took part in the study. The development and testing of a self-management questionnaire for adults undergoing hemodialysis is a worthwhile and reasonable goal. The questionnaire provided people with the opportunity to describe their self-management activities. Half the people that participated in the study were at risk for experiencing anxiety and depression and tried to avoid stress. Conclusions: The questionnaire would assist health care providers to engage in future research projects and develop programs and resources that help people more independently manages their illnesses.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of the Master of Science in Medicine, Johannesburg, 2013 / Cardiac disease is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Accurate evaluation of cardiac function is therefore important but difficult with commonly used imaging modalities such as echocardiography being subject to variable load changes in haemodialysis.