The effects of American Diabetes Association (ADA)

402 Pages·2015·1.14 MB·English

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USF Tampa Graduate Theses and Dissertations USF Graduate Theses and Dissertations
2006
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Jodee Meisenhelder-Smith
University of South Florida
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Meisenhelder-Smith, Jodee, "The effects of American Diabetes Association (ADA) diabetes self-
management education and continuous glucose monitoring on diabetes health beliefs, behaviors and
metabolic control" (2006). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/2628
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Digital Commons @ University of South Florida. It has been accepted for inclusion in USF Tampa Graduate Theses
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The Effects of American Diabetes Association (ADA) Diabetes Self-Management
Education and Continuous Glucose Monitoring on Diabetes Health Beliefs,
Behaviors and Metabolic Control

by

Jodee Meisenhelder-Smith

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Department of Community and Family Health
College of Public Health
University of South Florida

Major Professor: Robert J. McDermott Ph.D.
Carol Bryant, Ph.D.
Elizabeth Gulitz, Ph.D.
Jeffery Kromrey, Ph.D.
Brendan O’Malley, M.D.

Date of Approval:
November 14, 2006

Keywords: Health Belief Model, Glycosylated hemoglobin, Diabetes patient care
assessment, diabetes outcomes, outpatient program

© Copyright 2006, Jodee Meisenhelder-Smith
Dedication
To my dad, Joseph Meisenhelder who inspired me to be a diabetes educator, to
my mom, Twila Meisenhelder-Hiatt, my husband, Michael Smith, and all my
family: Tyler, Dwana, Leslee, Barbara, Herb, Jean, Joe, Jolie, Cliff, Clifford,
Clodagh, Bill, Brigette and Philip.
Acknowledgements
Special thanks to the staff of the Diabetes Care Institute, University
Community Hospital, Tampa, Florida, my doctoral committee, Monika Wahi,
M.P.H. and MiniMed Medronic.
Note to the Reader
The original version of this document contains color that is provides
assistance in understanding some of the data presented. The original
dissertation is on file with the USF library in Tampa, Florida.
Table of Contents
List of Tables........................................................................................................v
List of Figures......................................................................................................vii
The Effects of American Diabetes Association (ADA) Diabetes
Self-Managementviii Education and Continuous Glucose Monitoring
on Diabetes Health Beliefs, Behaviors and Metabolic Control.................viii
Chapter One: Introduction...................................................................................1
Diabetes Self-Management Education ......................................................6
Statement of the Problem........................................................................18
Purpose of the Study...............................................................................25
Significance of the Problem.....................................................................27
Hypothesis...............................................................................................30
Research Questions................................................................................31
Research Plan.........................................................................................34
Assumptions............................................................................................39
Delimitations............................................................................................40
Limitations................................................................................................41
Definitions of Terms.................................................................................42
Chapter Two: Review of the Literature...............................................................47
Overview of Diabetes...............................................................................48
i
Etiology and Classification............................................................48
Epidemiology.................................................................................50
Diabetes Related Complications...................................................51
The Expanded Health Belief Model .........................................................54
Factors Affecting Metabolic Control.........................................................61
Diabetes-Specific Health Belief Instruments............................................66
Comprehensive Diabetes Self-Care Management Training.....................74
Continuous Glucose Monitoring...............................................................81
Implications for Future Research.............................................................83
Chapter Three: Methods.....................................................................................86
Purpose of the Study...............................................................................87
Hypothesis...............................................................................................89
Research Questions................................................................................90
Research Plan.........................................................................................93
Population and Sample.................................................................93
Procedures....................................................................................99
Physiological Instrumentation .....................................................100
Psychosocial Instrumentation......................................................103
Expanded Health Belief Model Questionnaire Reliability and
Validity Results.................................................................108
The ADA Diabetes Self-Care Management Training Program....128
Intensive Follow-up Care ............................................................144
ii
Documentation............................................................................146
Data Collection and Analysis ......................................................147
Summary...............................................................................................150
Chapter Four: Results ......................................................................................151
Introduction............................................................................................151
Participant Characteristics.....................................................................152
Drop Out versus Completers.......................................................159
Research Question 1 results..................................................................182
Research Questions 2-11 results...........................................................188
Chapter Five: Discussion..................................................................................196
Summary...............................................................................................197
Limitations..............................................................................................200
Conclusions...........................................................................................207
Implications for Diabetes Education, Clinical Practice, and
Glycemic Control.........................................................................208
Implications for Public Health.................................................................211
Lessons Learned and Recommendations for Future Research.............213
References.......................................................................................................217
Appendices.......................................................................................................253
Appendix 1: Assessment and Education Records and Baseline
Evaluation Form..........................................................................254
Appendix 2: Sample Flyer for Advertising Program..............................260
iii
Appendix 3: Informed Consent Form....................................................262
Appendix 4: Study Forms......................................................................276
Appendix 5: Follow-up Evaluation Form and Dex Glucometer
Monitoring System Summary......................................................302
Appendix 6: Diabetes Self-management Education Schedule..............308
Appendix 7: Patient Satisfaction Questionnaire....................................310
Appendix 8: Educational Materials........................................................313
Appendix 9: Division of Nursing Standards/Policies/Procedures..........316
Appendix 10: Box-plot and Stem-leaf Diagrams of Continuous
Variables at Baseline..................................................................324
Appendix 11: Chronbach Alpha Results for Individual Questions.........330
Appendix 12: SAS Output for Research Questions ..............................339
About the Author...............................................................................................388

iv
List of Tables
Table 1: Exclusion Criteria.................................................................................95
Table 2: Minimum Sample Sizes per Group for Testing the Hypothesis
of Equal Group Effects in a Two Group RM Design...........................97
Table 3: Revised Diabetes Health Belief Model Questionnaire
Formulae..........................................................................................110
Table 4: Reliability of Health Belief Scales and Subscales..............................113
Table 5: Cronbach Alpha Results for Health Belief Scales and
Subscales at Times 1 and 2.............................................................115
Table 6: Diabetes Self-care Practice Assessment...........................................121
Table 7: Matrix of the Educational Sessions and Applications of
the Expanded Health Belief Model Concepts...................................136
Table 8: Characteristics of Study Population Before Education
Intervention.......................................................................................148
Table 9: Baseline Characteristics by Treatment Group: Categorical
Covariates........................................................................................154
Table 10: Baseline Age, Health Belief Scores, and Hemoglobin
(HgbA1c) by Group........................................................................156
Table 11: Characteristics of Completers vs. Dropouts: Categorical
Covariates......................................................................................161
v