Doctoral Dissertations

Date of Award

8-2001

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Debra C. Wallace

Committee Members

Bill C. Wallace, Sandra McGuire, Sandra Thomas

Abstract

The purpose of this study was to explore diabetes self-management in middle aged and older adult women with Type 2 diabetes and to examine differences between the two groups. Both middle-aged and older adult women have high incidence rates of Type 2 diabetes and are faced with threats to their health and wellbeing when the disease is not controlled. An important part of diabetes control is through self-management of recommended care, which is primarily the responsibility of the person who lives with the disease on a daily basis. Factors that impact a person's ability to self-manage a complex disease may change at different life stages.This study was an exploration of the relationships of personal factors and the interaction of those factors to diabetes self-management in women with Type 2 diabetes at two different stages of life.This non-experimental, correlational study was guided by the conceptual framework of the Interaction Model of Client Health Behavior (Cox, 1982). Elements Of client singularity (background variables of demographic characteristics, social influences and environmental resources) and elements of perceptive response,(intrinsic motivation, cognitive appraisal and affective response) were examined in relation to participants' health outcome of adherence to a recommended regimen of diabetes self-management. Client-health professional interaction was viewed as diabetes education received by the participant and was examined in relation to diabetes self-management. Inclusion criteria were (a) women ages 50-64 in the middle-age group; women ages 65 and above in the older age group, (b) black or white race, (c) the ability to comprehend and respond in English, and read on at least a 6th grade level and (d) community-dwelling women who were personally responsible for self-management of their diabetes, and under the care of a health professional who directed the treatment regimen.The sample of 134 women (73 middle-age and 63 older age) was collectedfrom both rural and urban communities in southern Appalachia. Women responding to the invitation to participate in the study completed a questionnaire by self-report.The questionnaire included demographic information and also selected scales andquestions from the Diabetes Care Profile 2.0 measuring social support, self perception of health, diabetes understanding, attitude towards diabetes, diabetes education and diabetes self-management. Also included in the questionnaire were theHealth Self-Determinism Index for measurement of intrinsic motivation and a visual analog scale of self-reported stress. Data analysis, using SPSS-PC 10.0, included measures of central tendency, Pearson correlation, multiple regression, Durbin-Watson coefficients for analysis of multi-collinearity and Cronbach's Alpha Coefficient analysis to assess reliability of the instruments.Research questions were posed to explore the relationships of personal, social and interaction factors to diabetes self-management in the two groups of women at different life stages and to examine differences in those relationships in the two groups. Findings revealed that women in the middle-age group did differ significantly in their diabetes self-management from women in the older group. Women in the Holder group demonstrated a higher level of diabetes self-management than the younger women. Background variables of age, race, education, insurance, social support and income were not shown to be significant predictors of diabetes self management in either group by multiple regression analyses. However, analysis of the relationships of the individual factors and diabetes self-management revealed social support fi-om family and friends to be significantly related to better diabetes self-management in both groups.The personal response variables of intrinsic motivation, self-perception of health,diabetes understanding, attitude towards diabetes and stress were found to be significantly predictive of diabetes self-management in both groups by multiple regression analyses, (middle-age: p < .05; older age: p <.001). Individual factors relationship analyses in each group revealed that in the middle-age group,understanding of diabetes management, a positive attitude towards diabetes and lower stress were significantly related to better diabetes self-management. Whereas in the older group, in addition to the same variables mentioned for the middle-age group,having a more intrinsic motivation for health and a more favorable self-perception of health were also significantly related to better diabetes self-management. Women in the middle-age group were noted to demonstrate lower intrinsic motivation, higher stress levels, more unfavorable self-perception of health, but better in understanding of diabetes than the older group. Another finding of the study was that diabetes education was not related to diabetes self-management for women in the middle-age group, who had a higher rate of diabetes education, but significantly related to diabetes self-management for women in the older group who less diabetes education.These findings indicate that more information is needed to better understand factors impacting diabetes self-management in women at different life stages. The Middle age women in this study were shown to be at high risk due to their lower levels of diabetes self-management, lower intrinsic motivation for health and higher stress than the older women in the study. Diabetes education in itself was not shown to be a significant factor in diabetes self-management for women in the middle-age group. An implication for nursing practice is for assessment of stress and other psychosocial factors in planning diabetes management. Implications for nursing education are for examination of client outcomes, including self-management practices, in relation to educational objectives, and for teaching the impact of personal responses on diabetes self-management in community classes as well as in the formal classroom. The primary implication for nursing research is for a more in-depth exploration of factors related to diabetes self-management in women at different life stages.

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