Date on Master's Thesis/Doctoral Dissertation

12-2014

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Psychological and Brain Sciences

Committee Chair

Stetson, Barbara A.

Committee Co-Chair (if applicable)

Newton, Tamara L.

Committee Member

Rosen, Paul J.

Committee Member

Salmon, Paul G.

Committee Member

Mokshagundam, Sri Prakash

Subject

Diabetics--Rehabilitation; Diabetics--Attitudes; Patient monitoring; Medicine and psychology

Abstract

The present study examined self-monitoring of blood glucose (SMBG) as part of a selfregulatory process of health decision-making using the Self-Regulation Model of illness perceptions, or Common Sense Model. Participants were N=185 individuals with type 2 diabetes from a specialty diabetes clinic prescribed subcutaneous insulin or other injectable diabetes medication at least daily. Collected information included both medical chart data and self-report questionnaires completed prior receiving lab results. Self-care burden was generally high; the modal prescribed times per day of injecting insulin was 4 with modal SMBG recommendations of 3-4 times per day. Participants reported high adherence to prescribed medication regimens, varied aherence to diet recommednations, and low engagement in exercise. Specific hypotheses were developed to examine the relationship between illness coherence and illness control beliefs (IPQ), SMBG decisionmaking behavior, and outcomes including diabetes distress (PAID) and hemoglobin A1c level. These hypotheses were not supported. Supplemental analyses revealed that SMBG decision-making use was related to illness perceptions, including a positive relationship with personal control and coherence beliefs, but not treatment control, and a negative relationship with both outcome variables (A1c at baseline and PAID score). Both treatment and personal control beliefs were not associated with glucose control outcomes, suggesting that illness beliefs alone do not explain why some individuals are more successful at managing their diabetes than others. Coherence was found to differ by education level and SES and greatly vary in an otherwise relatively homogenous sample. Study findings suggest that illness perceptions play an important role in the process of SMBG use for decision-making as it relates to glucose control and diabetes distress. Results also point to possible clinical targets such as illness coherence and diabetes distress. The study provides a foundation for future research related to SMBG as a decision-making strategy.