Development of an evaluation method to assess prospective physicians' competence and intent to practice diabetes nutrition therapy

240 Pages·2000·8.7 MB·English

by  Schulman, Jessica Ann

DEVELOPMENTOFANEVALUATIONMETHODTOASSESS
PROSPECTIVEPHYSICL\NS'COMPETENCEANDINTENTTOPRACTICE
DIABETESNUTRITIONTHERAPY
By
JESSICAANNSCHULMAN
ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL
OFTHEUNIVERSITYOFFLORIDAINPARTL\LFULFILLMENTOF
THEREQUIREMENTSFORTHEDEGREEOF
DOCTOROFPHILOSOPHY
UNIVERSITYOFFLORIDA
2000
Copyright2000
By
JessicaAnnSchulman
ii
InMemoryof
NormanJackLebow
June9,1936-March13,1998
iii
ACKNOWLEDGMENTS
"Itisimportantofcoursetocountandmeasurewhatiscountableandmeasurable,butthe
mostpreciousvaluesinhumanlifeareaspirationswhichlaboratoryexperiencescannot
yetreproduce."
ReneDubos,MirageofHealth(1959)
Igratefullyacknowledgethecontributionsandadviceprovidedbysupervisory
committeemembersDr.SteveM.Dorman,AssociateProfessorofHealthScience
Education;Dr.R.PaulDuncan,ProfessorofHealthServicesAdministration;Dr.Delores
C.S.James,AssociateProfessorofHealthScienceEducation;Dr.DavidMiller,
ProfessorofEducationalPsychology;Dr.R.MorganPigg,Jr.,ProfessorofHealth
ScienceEducation;andDr.BarbaraA.Rienzo,ProfessorofHealthScienceEducation.
SpecialthanksisgiventoDr.Rienzo,thehelmspersonofthisextensivecommittee,who
facilitatedaseamlessdissertationprocessandprovideddirection,assistance,and
guidanceduringthisstudy.
ParticularthanksgotoDr.Piggwhoservedinmultiplecapacitiesasmyteacher,
advisor,editor,rolemodel,andsourceofwisecounselandcalm. Iamgratefultohimfor
believinginmyresearchideasandforsuggestingthatItakeonthisstudy. Itruly
appreciateDr.Millerforreviewingmyworkateverystageofthisstudy,providing
substantiverecommendations,andanswermgmyprobingquestionsplainlyandtruthfully.
IwishtoexpressthankstoDr.Dormanforhismoralsupport,helpgeneratmgresearch
ideas,andreviewofnumerousmanuscripts. SpecialthanksgotoDr.Duncanwho
iv
providedsupervisionanddirectionasIcarvedoutaminorinhealthservices
administration. Hishonestinsightsabouthowtoachievemyprofessionalaspirationswere
illuminatingandwillservemewell. IalsowishtothankDr.Jamesforherdonationof
professionaltimetoserveonthesupervisorycommittee. IamveryappreciativeofMs.
JaniceDouglaswho,withaterrificsenseofhumor,helpedmeclimbamountainof
administrativerequirementsandcoordinatedtheactivitiesthatledtothisaccomplishment.
SpecialthanksareduetoDr.LynnRomrellwhosecommitmenttoimprovmg
medicaleducationandgenumeinterestinunderstandmghisstudents'opinionsallowed
thisstudytobeconceived. WithoutDrRomrell'ssupportandinvaluablesuggestions,
thisstudywouldnothavebeenpossible. HeartfehthanksareduetoNancyHendricks,
Dr.Romrell'sadministrativeassistant,forhelpingmecoordinatethisproject. Ialsowish
tothankGeneCornwall,computerspecialistforUF'sCollegeofMedicine,forgeneratmg
theon-linesurveyandmakingdatacollectioneasy. Iwouldliketoacknowledgethe
medicalstudentswhohavegivenustheirtimeandhonestopinionsoverthethreeyearsof
thisproject. Mythanksextendtoover250individualswhoservedasparticipantsinthis
study.
Inaddition,IwishtoexpressmygratitudetoDr.LindaBehar-Horenstem,
DepartmentofEducationalLeadership,forhelpingmewritetheproposal,providing
excellentfeedback,andshowingmehowtobeamenschthroughthetrialsofthis
process. IamindebtedtoDr.DonaldMorisky,atUCLA'sSchoolofPublicHealth,
whoseencouragement,manyyearsago,sustamedmyinterestinnutritionandpublic
healtheducation.
Iamespeciallygratefultomyfamilies,theLebowsandSchulmans,whodid
backbreakingworktoprovidemewithcriticalresourcesthatmademyeducation
possible, himanywaysthisdissertationisalsotheirachievement. Particularthanksgo
tomymotherandherlatehusband,KarenandNormanLebow,whoseunfailing
encouragementandemotionalsupportenabledmetowillfullypursuemyprofessional
aspirations,despitetheclosureofthegraduatenutritiondepartmenttowhichIwas
accepted. Iamgratefultomyfatherandhiswife,HaroldandFloSchulman,whohave
beenaconsistentsourceofsupportand,bybeingextraordinaryparents,gentlyguidedme
towardameaningfulliferichinloveandlowinfat. Ialsowishtothankmyhusband's
family,theKamey's,fortheirencouragementandenthusiasmthroughoutthedissertation
process,andforenablingustolookbeyondourresearchtoexperiencewondrousplaces
intheworld.
ItiswithimmenseloveandadorationthatIthankmyhusband,BenjaminKamey,
whoinspiredmetopursueaPh.D.inhealtheducationandwhoseconstantcare,advice,
concern,devotion,and,ofcourse,fantasticcookingandstatisticalguidance,enabledme
tocompletethisprojectinrecordtime.
vi
TABLEOFCONTENTS
ACKNOWLEDGMENTS iv
LISTOFTABLES x
LISTOFFIGURES xi
KEYTOABBREVIATIONS xii
ABSTRACT xiv
CHAPTER
1 INTRODUCTION 1
PurposeoftheStudy 4
Hypotheses 5
DefinitionofTerms 1
SignificanceandNeedfortheStudy 8
Delimitations 9
Limitations 9
Assumptions 10
Summary 11
2 REVIEWOFLITERATURE 12
ContextandBackground 12
EpidemiologyofDiabetes 19
DiabetesandMedicalNutritionTherapy 24
AdvancesinDiabetesandNutritionResearch 26
ResearchBasisforInstrumentDevelopment 28
ValidityasaUnifiedConcept 46
3 METHODOLOGY 57
PhaseI:ScaleDevelopment 57
PhaseII:ScaleValidation 66
vii
Administration °°
Materials ^2
OperationalDefinitionofVariables 73
Permission,Confidentiality,andIRBApproval 75
PhaseIII:DataCollectionandAnalysis 76
4 RESULTS 85
OverviewofAnalyses 85
ResultsforStatisticalValidity 87
PreliminaryFindings
5 SUMMARY,CONCLUSIONS,DISCUSSION,«&RECOMMENDATIONS... 112
Summary
Conclusions:EvidenceforConstructValidity 114
Discussion 1^7
Recommendations
ConcludingRemarks 136
APPENDICES
A GUIDELINESFORDIABETESMEDICALNUTRITIONTHERAPY 140
B THEORETICALMODELFORPREDICTINGPHYSICIANPRACTICE
BEHAVIOR 143
C LISTOFCONTRIBUTORSFORPHASEI 145
D INSTITUTIONALREVIEWBOARDAPPROVALFORPHASEI«&U 147
E NOTIFICATION,CONSENT,&INSTRUCTIONSFORPARTICIPANTS.... 155
F QUESTIONNAIREFORMEDICALSTUDENTS 161
G QUESTIONNAIREFOREXPERTPANEL:INSTRUCTIONS&FORMS
FORPHASEII 169
H MESSICK'SUNIFIEDTHEORYOFCONSTRUCTVALIDITY 175
I DATITSITTRUIDBEUST,IOSNELOFF-ERFEFSIPCOANCSYE,S&TKONEOAWCLHEIDTGEEM:ANMUOTRNIGTPIROONSPECTIVE
PHYSICIANS 177
viii
J DESCRIPTIVESTATISTICSFORMEDICALSTUDENTS 193
K QUALITATIVESTATEMENTSFROMPROSPECTIVEPHYSICIANS 200
REFERENCES 209
BIOGRAPHICALSKETCH 223
ix
LISTOFTABLES
Table Page
3.L Reliabilityformajorindependentvariablesasafunctionofyearinschool 62
3.2. Multivariatecorrelations:Evaluationofcompetenceandintention 64
4.1. Dietitians'perceptionsoftheimportanceofnutritionself-efficacytasks 88
4.2. Dietitians'perceptionsoftheimportanceofspecificknowledgequestions 89
4.3. OverallMNQ-Dratingscaleevaluationforqualityassurance 92
4.4. Activitymeasurementreportforthenutritionself-efficacyscale 93
4.5. Correlationpatternsamongsimilarpresumedvariablesforprospective
physicians 95
4.6. Reliabilityforattitude,self-efficacy,andknowledgeoftheMNQ-Dasa
fiinctionofyearinschool 97
4.7. Multivariatecorrelationsforindependentandexternalvariables 99
4.8. Meanscoresforself-efficacy,attitudes,andknowledgeforfirst-andfourth-
yearmedicalstudents 102
4.9. Correlationsforself-efficacy,attitude,andknowledgebetweenclassesasa
functionofage 103
4.10. Acomparisonofmajorvariablesacrossclassesandgender:Mean,standard
deviation,t-value,andsignificance 103
4.11. Descriptivestatisticsforindependentvariables,nutritioneducationaccrued,and
intention 105
X