Diabetes is linked to behavior and requires patients to engage in complex self-management practices to attain glycemic control and prevent complications. Group medical visits (GMVs)—which are shared medical appointments used in primary care—provide a model of care to help patients adhere to self-management behaviors. Developing, implementing, and translating this model of care in a clinical setting has proven challenging, and the underlying mechanisms related to improved outcomes found in participants of GMVs are undetermined. The purpose of this study was to implement and evaluate GMVs for diabetes care in a primary-care and residency-training facility and explore changes in behavioral intentions, self-management behaviors, and blood HbA1c levels. The study also explored whether behavioral intentions and self-management behaviors functioned as mediators of changes in HbA1C levels.
A repeated measures design with 37 participants examined the behavioral intentions to diet, to exercise, and to adhere to medication; self-management behaviors (i.e., diet, exercise, and adherence to medication); and HbA 1C levels of participants with Type 2 diabetes during and after the GMVs. Behavioral intentions and self-management behaviors were measured through self-report instruments at baseline, posttreatment, and 3-month follow-up; HbA1C values were measured at baseline and 3-month follow-up. Self-reported adherence to diet changed significantly from baseline to posttreatment and remained at 3-month follow-up.
Self-reported exercise changed significantly from baseline to posttreatment; changes were not sustained at 3-month follow-up. Clinical and statically significant changes in HbA1C levels were seen at 3-month follow-up. A reduction of 0.7% in blood glucose levels was observed; the majority of the participants (59.5%) attained diabetes control at 3-month follow-up. No mediation relationship was found between behavioral intentions, self-management behaviors, and HbA 1C levels.
This study is the first reported examination of GMVs that found significance in biophysical outcomes without research-based funding. GMVs focused on health-behavior change can be executed and sustained in primary care and residency-training facilities. This program modality is a promising model of care for motivated patients and may help patients reach self-care goals and diabetes control. Future research with a larger sample size and a control group is needed to enhance the current findings.
|Advisor:||Dulin, Patrick L.|
|Commitee:||Brems, Christiane, David, E. J. R., Rivkin, Inna D.|
|School:||University of Alaska Anchorage|
|School Location:||United States -- Alaska|
|Source:||DAI-B 74/09(E), Dissertation Abstracts International|
|Subjects:||Behavioral psychology, Psychology, Clinical psychology|
|Keywords:||Behavioral intentions, Diabetes care, Diabetes care group medical visits, Group medical visits, Group medical visits in primary care, Self-management behaviors|
Copyright in each Dissertation and Thesis is retained by the author. All Rights Reserved
The supplemental file or files you are about to download were provided to ProQuest by the author as part of a
dissertation or thesis. The supplemental files are provided "AS IS" without warranty. ProQuest is not responsible for the
content, format or impact on the supplemental file(s) on our system. in some cases, the file type may be unknown or
may be a .exe file. We recommend caution as you open such files.
Copyright of the original materials contained in the supplemental file is retained by the author and your access to the
supplemental files is subject to the ProQuest Terms and Conditions of use.
Depending on the size of the file(s) you are downloading, the system may take some time to download them. Please be