Diabetes mellitus affects 20.8 million Americans in the United States and is the fifth leading cause of death in the United States. Acute and chronic disease-related complications can have a devastating effect on the life of individuals with Type 2 diabetes. Reduction in acute and chronic complications can be best achieved by individuals’ adhering to appropriate lifestyle changes and maintaining tight glycemic control through a process of self-regulation. Self-regulation treatment decisions and lifestyle behavioral changes can be influenced by physiological and psychosocial factors. The purpose of this study was to examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of outcomes (self-care behavior and A1c levels) in individuals with type 2 diabetes. A descriptive, correlational design was used to examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of outcomes for self-care behavior and metabolic control in individuals with Type 2 diabetes as it relates to diabetes management. A convenience sample of 119 men (46.2%) and women (53.8%) between the ages of 22 and 93 years of age living in two urban cities located in a southeastern state with documented type 2 diabetes were recruited. Participants were recruited from four endocrinology offices, one internal medicine office, two medical clinics, and three diabetes education centers. The majority of the participants were caucasian (74.8%). Inclusion criteria were that participants a) had been diagnosed with type 2 diabetes for at least 1 year or more, (b) were able to read and write in English, (c) were 18 years of age or older, and (d) had an A1c level drawn within the past 30 days. Questionnaire booklets were mailed to participants. Participants’ A1c levels were obtained from their medical records. Data were analyzed with descriptive and inferential statistics including frequencies, percentages, means, standard deviations, bivariate correlations, multiple linear regressions, and hierarchical multiple linear regressions. Participants perceived their diabetes to be a chronic, moderately cyclical condition with negative consequences and with moderate amounts of symptomatology that greatly influenced their emotional status. Hierarchical multiple linear regression analysis revealed that coping efficacy uniquely accounted for 9% of the variance in self-care behavior. Perceptions of higher coping efficacy were associated with higher beliefs of personal control and treatment control, a greater understanding of diabetes, engagement in higher levels of self-care behavior, and lower A1c levels. In addition, hierarchical multiple linear regression analysis revealed illness representations, particularly timeline cyclical, accounted for 12% of the variance in A1c levels. Perceptions of a more cyclical disease course were predicted of higher A1c levels. Interestingly, a perception of diabetes being a less chronic illness was associated with higher self-care behavior. This study affirms the importance of how illness representations and coping efficacy influence self-care behavior and A1c levels. The findings from this study have important implications for nursing practice in the areas of assessment, diabetes management, coping skills training, behavior modification, motivational interviewing, and diabetes education. Further research is needed to expand the knowledge base and develop targeted interventions related to illness representations, especially timeline cyclical, and coping efficacy in the diabetes population.

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Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1991.

Background: The One Drop vertical bar Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A(1c) (HbA(1c)). Objective: We assessed the HbA(1c) change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop vertical bar Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA(1c) change. Methods: In June 2017, we identified people with diabetes using the One Drop vertical bar Mobile app on iPhone and Apple Watch who entered two HbA(1c) measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA(1c) change. Results: Users had T1D (n=65) or T2D (n=191), were 22.7% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA(1c) entries. There was a significant 1.36% or 14.9 mmol/mol HbA(1c) reduction (F=62.60, P<.001) from the first (8.72%, 71.8 mmol/mol) to second HbA(1c) (7.36%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA(1c) improvement (all P<.01). Conclusions: Using One Drop vertical bar Mobile on iPhone and Apple Watch may favorably impact glycemic control.

Contexte: Les résultats de plusieurs recherches mettent en évidence dans la population immigrante, une prévalence élevée des maladies bucco-dentaires, une faible accessibilité aux soins bucco-dentaires ainsi qu’un faible niveau de connaissances en matière d’hygiène bucco-dentaire, par rapport aux citoyens nés au Canada. L’amélioration des connaissances et des habiletés en matière d’hygiène bucco-dentaire, constitue un moyen efficace pour réduire les inégalités dans le domaine de la santé bucco-dentaire. La rareté des études, ainsi que la présence de nombreuses lacunes méthodologiques dans le domaine de la littératie en santé bucco-dentaire, notamment au sein de la population immigrante, a conduit à réaliser cette nouvelle étude. Objectifs : Le but de ce projet était de développer et évaluer l’impact d’une intervention sur les compétences en matière de santé bucco-dentaire pour promouvoir des attitudes positives en matière d’hygiène bucco-dentaire chez les immigrants Punjabi. Quatre études séparées ont été menées pour atteindre les quatre objectifs suivant : i) Faire une revue de la littérature pour identifier et synthétiser les données et les lacunes de connaissances actuelles dans le domaine des connaissances et habiletés en matière de santé bucco-dentaire; ii) Développer du matériel éducatif (roman-photo) culturellement et linguistiquement approprié pour les immigrants Punjabi en utilisant une approche communautaire participative; iii) Développer une intervention de littératie sur les compétences en matière de santé bucco-dentaire, fondée théoriquement, pour la promotion des compétences en matière de santé bucco-dentaire chez les immigrants Punjabi; iv) Évaluer l’efficacité de l’intervention de littératie en santé orale sur les compétences en matière de santé bucco-dentaire de promotion des comportements personnels de bonne hygiène bucco-dentaire chez les immigrants Punjabi. Résultats : Les principaux résultats de nos quatre études se répartissent de la façon suivante : 1) Les résultats de la première étude mettent l’emphase sur le besoin de développer de nouveaux outils d’évaluation afin de mesurer les niveaux de connaissance et d’habileté en matière d’hygiène bucco-dentaire et soulignent la rareté des interventions pour la santé bucco-dentaire. De plus, il a été confirmé que des compétences en matière de santé bucco-dentaires limitées sont positivement et significativement liées à de plus faibles connaissances bucco-dentaires et des indicateurs de santé bucco-dentaires plus faibles. En outre, nous avons constaté un déficit d'études sur les interventions parmi les populations vulnérables, en particulier chez les immigrants. 2) Dans la deuxième étude les réunions de groupe de discussion ont révélé quatre thèmes identifiant les perceptions sur les comportements personnels en matière d’hygiène bucco-dentaire chez les immigrants Punjabi : i) manque de compréhension sur les facteurs de risques et sur les connaissances reliées aux comportements personnels en matière d’hygiène bucco-dentaire; ii) manque d’habilités et de routines reliées aux pratiques personnelles d’hygiène bucco-dentaire; iii) manque de compréhension de l’importance de la prévention; et iv) les barrières perçues pour accéder à la santé bucco-dentaire. Les résultats de cette étude ont été utilisés pour développer du matériel éducatif (roman-photo) pour les immigrants Punjabi. 3) La troisième étude a permis de développer une intervention de littératie en santé orale fondée théoriquement sur les comportements personnels d’hygiène bucco-dentaire en utilisant la méthode « Behaviour Change Wheel (BCW) » (la roue du changement de comportement). En utilisant la méthode BCW, nous avons d’abord identifié les barrières et les facilitateurs et les relier aux fonctions d’intervention, des catégories de politiques et techniques par les de changement de comportement spécifique identifié parmi la gamme d'options fournies par la méthode BCW. 4) Dans la quatrième étude une analyse « Linear Mixed Model pour Repeated Measures (LMMRM) » à deux niveaux comparant les groupes d’intervention et contrôle avant et après l’intervention, a montré que les participants qui ont reçu l’intervention « Sauvegarde Ton Sourire » ont eu une amélioration significative de leur routine de brossage et d’utilisation de la soie dentaire, de leurs indices de plaques dentaire et gingivaux, et de leurs compétences en matière de santé bucco-dentaires. Conclusions: L’approche novatrice de la présente étude qui a pour but de développer et d’évaluer une intervention communautaire fondée sur une base théorique, pour la promotion des compétences en matière de santé bucco-dentaire chez les immigrants Punjabi, a abordé son déficit et proposé un modèle d’intervention qui peut être adapté à d’autres communautés ayant un faible niveau de connaissance et de pratique quotidienne en matière d’hygiène bucco-dentaire, afin réduire les inégalités de santé bucco-dentaire. Mots-clés : La littératie en santé orale, comportement personnel en matière d’hygiène bucco-dentaire, intervention, immigrants Punjabi. / Background: Research shows that immigrants have higher rates of oral diseases, poorer access to dental care services and lower levels of health literacy than their Canadian-born peers. Recently, oral health literacy has emerged as a potential pathway to reduce oral health disparities. Existent scarcity and methodological shortcomings of studies on oral health literacy interventions particularly among immigrants lent urgency to our present research study. Objectives: The overarching goal of present research study was to develop and evaluate the effectiveness of an oral health literacy intervention aimed to promote positive oral hygiene self-care behavior among Punjabi immigrants. To achieve this goal, we conducted four separate studies having following objectives: i) To conduct a scoping review to identify and synthesize the current evidence and knowledge gaps on the topic of oral health literacy. ii) To develop a culturally and linguistically appropriate educational material (photonovel) for Punjabi immigrants using a community based participatory approach. iii) To develop a theoretically grounded oral health literacy intervention aimed to improve oral hygiene self-care behavior among Punjabi immigrants. iv) To evaluate the effectiveness of the developed oral health literacy intervention aimed to promote positive oral hygiene self-care behavior among Punjabi immigrants. Results: The main findings of our four investigations were: 1) Findings of the first study affirmed a need to develop new assessment tools to capture all dimensions of oral health literacy and highlighted scarcity of oral health literacy interventions among vulnerable populations particularly among immigrants. Also, it affirmed that low oral health literacy is positively and significantly related to poor oral health knowledge, poor oral health behaviour and poor oral health outcomes. 2) In the second study, the focus group meetings revealed four themes identifying following perceptions held by Punjabi immigrants regarding oral hygiene self-care: i) lack of understanding about oral hygiene self-care related knowledge and risk factors; ii) lack of oral hygiene self-care related adequate skills and routine; iii) lack of emphasis on prevention by oral health care providers; and iv) perceived barriers to access dental health. Findings of the focus group discussions were used to develop an educational material (photonovel) for Punjabi immigrants. 3) The third study developed a theoretically grounded oral health literacy intervention aimed to improve oral hygiene self-care behavior by employing “Behaviour Change Wheel” (BCW) method. Using the BCW method, we first identified various barriers and enablers and linked those with specific intervention functions, policy categories and behavior change techniques identified from the range of options provided by the BCW. Six intervention functions (education, training, modeling, restriction, environmental restructuring and enablement) were subsequently mapped to two policy categories (communication and service provision) since they met the APEASE criteria. 4) In the fourth study, linear mixed model analysis for repeated measures comparing the intervention and control groups at pre-and post-intervention reported that participants who received “Safeguard Your Smile” intervention showed significant improvement in their adequately brushing and flossing routine and in their plaque and gingival indices and oral health literacy than control group participants. Conclusions: The novel attempt of the present research study of developing and evaluating a theoretically grounded and community based oral health literacy intervention among Punjabi immigrants has addressed a deficit in this field and proposed a model of oral health literacy intervention that could be adapted among other low oral health literate communities to reduce the oral health disparities.