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Dissertation/Thesis Abstract

The influence of group medical visits on patients' behavioral intentions, self-management behaviors, and clinical outcomes
by Zuniga, Ruth, Ph.D., University of Alaska Anchorage, 2013, 187; 3561520
Abstract (Summary)

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.

Indexing (document details)
Advisor: Dulin, Patrick L.
Commitee: Brems, Christiane, David, E. J. R., Rivkin, Inna D.
School: University of Alaska Anchorage
Department: Clinical Psychology
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
Publication Number: 3561520
ISBN: 978-1-303-08678-6
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