Semester

Summer

Date of Graduation

2008

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Not Listed

Committee Chair

Cynthia A. Persily.

Abstract

Background. Within adherence research, health beliefs have been identified as being significant predictors of adherence. Specifically, perceived threat as a health belief has received considerable attention. However, a gap in current knowledge exists in terms of understanding perceived threat of illness as an event that is appraised by the patient.;Aim. The purpose of this exploratory, descriptive study was to examine cognitive appraisal of perceived threat of illness in relation to adherence to self-management behaviors in uninsured/under-insured persons with type 2 diabetes.;Method. A convenience sample consisted of 80 subjects being treated for type 2 diabetes mellitus at a free clinic in West Virginia between January 2008 and May 2008 meeting the following inclusion criteria: (1) age > 18 years, (2) diagnosis of type 2 diabetes, (3) the ability to read, write, or understand English, and (4) uninsured/under-insured and receiving care at a free clinic. Subjects were administered the Summary of Diabetes Self Care Activities and the Cognitive Appraisal of Health Scale.;Results. Characteristics of the study sample included a mean age of 50.4 years (range 23 to 64 years), with 27.4% men and 72.4% women. The majority of subjects were white (94.7%), had diabetes for less than 10 years (82.9%), and reported having one to two co-morbidities. The sample followed recommendations for taking prescribed oral medications an average of 6.6 days/week, for general diet an average of 4.1 days/week, for specific diet 3.7 days/week, and for exercise an average of 2.9 days/week. The mean HbA1c = 7.56. HbA1c levels of 7% or greater were found in 49.4% of the subjects. Several significant relationships were found between cognitive appraisal variables and self-management variables. Persons with diabetes in this study perceived their diabetes as more of a challenge than as threatening or causing harm or loss. Cognitive appraisal did predict variance in adherence to diet and HbA1c level. Cognitive appraisal did not predict adherence to oral medication taking or exercise recommendations.;Conclusion. The persons with diabetes receiving care at the free clinic from this study did not differ in their levels of adherence to self-management behaviors from other types of patients reported in the literature. This study highlights the need for more research exploring the issues that persons with diabetes have with adherence to self-management behaviors, especially diet and exercise recommendations.

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