Self-Management of Type 2 Diabetes in Appalachina Women.

74 Pages·2015·0.24 MB·English

by  Melissa Joy Magness

East Tennessee State University
Digital Commons @ East
Tennessee State University
Electronic Theses and Dissertations
12-2007
Self-Management of Type 2 Diabetes in
Appalachina Women.
Melissa Joy Magness
East Tennessee State University
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Magness, Melissa Joy, "Self-Management of Type 2 Diabetes in Appalachina Women." (2007).Electronic Theses and Dissertations.Paper
2156. http://dc.etsu.edu/etd/2156
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Self-Management of Type 2 Diabetes in Appalachian Women

_________________

A dissertation
presented to
the faculty of the Department of Nursing
East Tennessee State University

In partial fulfillment
of the requirements for the degree
Doctor of Philosophy in Nursing

__________________
by
Melissa J. Magness
December 2007
___________________

Kathleen M. Rayman,PhD,RN
Priscilla Ramsey,PhD,RNC
Judith Anderson,PhD,APRN
Tamera Pearson,PhD,APRN
Gary Kukulka,PhD

Keywords: Diabetes, Women, Appalachia,
Self-Efficacy,
Social Cognitive Theory
ABSTRACT
Self-Management of Type 2 Diabetes in Appalachian Women
by
Melissa J. Magness

Gender, minority, and regional-related disparities have been
documented in diabetes management. Self-efficacy, the belief in
one's ability to carry out the actions mandated by a task, has
been identified as a key predictor in glycemic control; however,
it has not been investigated in rural, female populations. This
cross-sectional, correlation investigation examined the
relationships among self-efficacy, depression, and diabetes
self-care management in women living in Appalachia with type 2
diabetes. Using Bandura’s Social Cognitive Theory, 85 women ages
≥ 21 with type 2 diabetes for a minimum of 6 months who were
residents in Appalachia completed the 1) Diabetes Self-Efficacy
Scale, 2) Beck Depression Inventory-II, 3)Summary of Diabetes
Self-Care Activities, and a 4) Diabetes Health-Related
Demographics tool. Descriptive statistics detailed the sample
characteristics. ANOVA, chi-square, and independent t-tests were
computed for between group differences as they related to
depression, various physiologic states, presence of self-
efficacy sources, and glycosylated hemoglobin. Pearson
correlation coefficients were used to describe the relationships
between self-efficacy, depression, and self-care management.
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Multiple linear regression analyses examined prediction models
for glucose control while controlling for potential confounders.

Eighty-four Caucasian and one African-American enrolled in the
study with a mean age of 61. The mean time since diabetes
diagnosis was 7 years with a mean glycosylated hemoglobin value
of 6.9% (SD=1.3). Higher self-efficacy scores were associated
with a lower glycosylated hemoglobin (r-.30, p=.005) and ability
to choose foods best to maintain a healthy eating plan(r-.415,
p=.001). The sources of self-efficacy associated with enhanced
self-care management were mastery experience and vicarious
experience. There were no significant relationships between
self-efficacy and depression or depression and glycosylated
hemoglobin. The diabetes self-care management regression model
resulted in self-efficacy and education accounting for 7.5% of
the variance in glycosylated hemoglobin.

Study findings support the social cognitive theory and the
utility of self-efficacy as a predictor of glycemic control.
Depression was not found to be a significant obstacle in this
Appalachian population. Comprehending the significant
relationship between self-efficacy and diabetes self-care
management allows providers to modify their interventions when
caring for women type 2 diabetes in the region.

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ACKNOWLEDGEMENTS

There are many people who are instrumental in an
individual's completion of a doctoral degree. I would like to
thank of all of those people who made this materialize for me.
First, I would like to thank my committee members, Dr. Judith
Anderson, Dr. Tamera Pearson, Dr. Priscilla Ramsey, and Dr. Gary
Kukulka for their guidance and support. Immeasurable gratitude
goes to Dr. Rayman, my chairperson, for her commitment to this
study and to my success from the beginning. Dr. Rayman was
readily available at all times providing support and
encouragement in the face of challenges that occurred inside and
outside of the academic setting; I am forever appreciative. I
would like to acknowledge Dr. Carol Macnee, Dr. Patricia Hayes,
and Dr. Joellen Edwards who have been particularly inspiring
throughout this process and are true exemplars of nurse
scientists. I want to thank Debi Pfortmiller, statistician, for
her patience and extensive work with this study from the
proposal stage to data analysis.
Joe Smith at ETSU public relations, Furnell Rife, MSN, and
Jennifer Persinger from MSHA Health Resources education center
played significant roles in recruitment of my sample, thus
facilitating completion in a timely manner. This study was
partially funded by the Center for Nursing Research at East
Tennessee State University, Sigma Theta Tau Epsilon Sigma
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Chapter, and the East Tennessee State University School of
Graduate Studies.
I would like to recognize Toobert and Glasgow as well as the
International Partners in Self-Management and Empowerment (IPSE)
for their contributions in the realm of diabetes self-management
and for granting permission to translate, reproduce, and use
their surveys in this investigation. Most importantly, without
the participants, there would be no study. Much appreciation to
all of those women who took their time, invited me to their
homes, and shared their experience of living with type 2 DM.
Thanks to my colleagues for being flexible and allowing me
the schedule to complete this academic endeavor. To my friends
who helped maintain my home and assisted with my personal
obligations while I traveled to East Tennessee, words cannot
express what you mean to me. Lastly, I have a permanent bond to
my classmates Patricia Vanhook PhD, APRN and Chris Smith, PhD,
APRN. Thanks for blazing the trail.

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CONTENTS
Page
ABSTRACT………………………………………………………………………………………………………………………………… 2
ACKNOWLEDGEMENTS…………………………………………………………………………………………………………… 4

Chapter
1. INTRODUCTION…………………………………………………………………………………………………………… 9
Diabetes……………………………………………………………………………………………………………… 9
Disparities and Diabetes…………………………………………………… 11
Appalachian Health-Beliefs..………………………………………… 12
Problem Statement…………………………………..……………………………………………… 13
Significance…………………………………………………………………………………………………… 14
Research Questions…………………………………………………………………………………… 14
Definition of Terms………………………………………………………………………………… 15
Self-Efficacy.………………………………………………………………………………… 15
Self-care……………………………………………………………………………………………… 15
Depression…………………………………………………………………………………………… 16
Mastery Experience……………………………………………………………………… 16
Verbal Persuasion………………………………………………………………………… 16
Vicarious Experience…………………………………………………………………… 17
Physiological States…………………………………………………………………… 17
Appalachia……………………………………………………………………………………………… 17
Theoretical Perspective..……………………………………………………………………… 18
2. LITERATURE REVIEW..…………………………………………………………………………………………… 22
Self-Efficacy..………………………………………………………………………………… 23
Appalachia..………………………………………………………………………………………… 23
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Page
Depression………………………………………………………………………………………… 25
Women and Depression……………………………………………………………… 26
3. METHODS……………………………………………………………………………………………………………………… 29
Design…………………………………………………………………………………………………… 29
Sample…………………………………………………………………………………………………… 30
Setting………………………………………………………………………………………………… 30
Measures…………………………………………………………………………………………………………… 31
Diabetes Management Self-Efficacy Scale……………… 32
Beck Depression Inventory-II…………………………………………… 32
Summary of Diabetes Self-Care Activities…………… 33
Diabetes Health-Related Questionnaire……………………… 34
Procedures..……………………………………………………………………………………………………… 34
Informed Consent.…………………………………………………………………………… 34
Data Collection.……………………………………………………………………………… 35
Data Analysis…………………………………………………………………………………… 36
4. RESULTS……………………………………………………………………………………………………………………… 38
Demographics……………………………………………………………………………………… 38
Diabetes Health……………………………………………………………………………… 39
Normative Comparisons……………………………………………………………… 41
Self-Efficacy and Diabetes Self-Care
Management…………………………………………………………………………………………… 41
Self-Efficacy and Depression…………………………………………… 42
Self-Efficacy Sources and Diabetes Self-Care
Management………………………………………………………………………………………… 43
Summary of Results…………………………………………………………………… 45

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Page
Study Limitations……………………………………………………………………… 46
5. DISCUSSION……………………………………………………………………………………………………………… 47
Self-Efficacy and Self-Care Management……………… 47
Self-Efficacy and Depression………………………………………… 48
Sources of Self-Efficacy, Depression, and
Self-Care Management……………………………………………………………… 48
Depression and Self-Care Management……………………… 49
Physiologic States and Self-Care Management…… 50
Study Conclusions……………………………………………………………………………………… 51
Nursing Implications……………………………………………………………………………… 51
Continued Study…………………………………………………………………………………………… 52
REFERENCES………………………………………………………………………………………………………………… 54
APPENDICES………………………………………………………………………………………………………………… 66
Appendix A: Diabetes Health-Related
Questionnaire………………………………………………………… 66
Appendix B: Spanish Diabetes Health-Related
Questionnaire……………………………………………………………… 67
Appendix C: Spanish Diabetes Management
Self-Efficacy Scale……………………………………………… 68
Appendix D: Spanish Summary of Diabetes Self-Care
Activities……………………………………………………………………… 70
VITA………………………………………………………………………………………………………………………………… 72

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CHAPTER 1
INTRODUCTION
Diabetes
The Centers for Disease Control and Prevention (CDC) report
that the total prevalence of diabetes mellitus (DM) in the
United States (US) for all ages is 20.8 million, or 7.0% of the
total population (CDC, 2005). In addition to the 20.8 million,
it is estimated that 41 million individuals have pre-diabetes, a
condition of impaired glucose tolerance or impaired fasting
glucose that generally leads to a diagnosis of type 2 diabetes
within a period of 10 years (American Diabetes Association,
2006a). Of the two major types of diabetes, type 2 accounts for
90%-95% of all diagnosed cases in the US. Women comprise 9.7
million of those with the illness; 8.8% of all women 20 years or
older have DM (CDC, 2005).
The American Diabetes Association (ADA)(2006b)categorizes
diabetes into four clinical classes. Type I diabetes is a
disorder that results from the destruction of pancreatic beta-
cells, usually leading to absolute insulin deficiency. Type 2
diabetes occurs from a progressive pancreatic insulin secretory
defect with a component of tissue insulin resistance. Clinical
class three, gestational diabetes, is an imbalance of glucose
and insulin during pregnancy. Class four outlines other
specific types of diabetes due to various causes such as genetic
defects in beta-cell function, genetic defects affecting insulin
action, diseases of the exocrine pancreas, and drug or
chemically induced diabetes.
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