diabetes self-care activities in older adults and the ability of a nutrition and diabetes education

197 Pages·2004·1.62 MB·English

DIABETES SELF-CARE ACTIVITIES IN OLDER ADULTS AND THE ABILITY OF A
NUTRITION AND DIABETES EDUCATION PROGRAM TO EFFECT CHANGE
by
ELIZABETH H. REDMOND
(Under the Direction of Mary Ann Johnson)
ABSTRACT
This study was designed to test several hypotheses related to diabetes translation in elders
participating in Georgia’s Older Americans Nutrition Program (OANP). OANP populations are
at high risk for diabetes because of advanced age, low income, and minority group status (ASA,
2003; Boyle et al., 2002; Ponza et al., 1996). This study evaluates four primary hypotheses for
OANP participants with diabetes: 1) higher frequencies of diabetes self-care practices, positive
health beliefs, and certain demographic variables would be associated with lower blood A1C at
baseline in OANP participants with diabetes; 2) a nutrition and diabetes education program
delivered at senior centers would increase the frequency of diabetes self-care activities; 3)
improvements in diabetes self-care practices would be associated with decreases in blood A1C
following an educational intervention; and 4) healthcare providers would report patients’ lack of
ability to follow self-care behaviors, as well as their lack of confidence in facilitating change, as
a barrier.
Older adult participants with diabetes were a convenience sample (n = 105) of OANP
participants with a mean age 73 years (58% Caucasian, 42% African American, 70% women,
and 29% with < 8 years of education). Twenty-five percent of participants had an A1C blood
value > 8% (poor control). In regard to diabetes self-care activities, participants were most likely
to be compliant (> 5 days per week) with medication use (97%); moderately compliant with diet,
glucose testing, and daily foot checks (49% to 65%); and least compliant with exercise and foot
wear inspections (37% to 39%). More than half of the participants (60%) agreed that their lack
of understanding of the diabetes diet was a barrier to them. Following the intervention,
compliance (> 5 days/week) substantially increased from baseline for participants following a
healthful diet, following an eating plan, avoiding high fat foods, spacing carbohydrates, testing
blood sugar as recommended by their health care provider and inspecting shoes (p < .05).
Decreases in A1C among those with an initial A1C > 7% were correlated with post-intervention
self-care activities and/or increases in self-care activities related to consuming 5 servings of
fruits and vegetables a day, spacing carbohydrates, physical activity, and checking shoes and feet
(p < .05). Healthcare providers rated their older adult patients’ ability to undertake specific
diabetes related activities as a barrier to care. Overall, providers were much more confident in
their own ability to give instructions or examinations than in facilitating actual change.

INDEX WORDS: A1C, Older Americans Nutrition Program (OANP), Elderly, Diabetes
Self-Care Activities, diabetes translation, glucose testing, foot care, eating
plan.
DIABETES SELF-CARE ACTIVITIES IN OLDER ADULTS AND THE ABILITY OF A
NUTRITION AND DIABETES EDUCATION PROGRAM TO EFFECT CHANGE

by

ELIZABETH H. REDMOND
B.S. TEXAS CHRISTIAN UNIVERSITY, 1986
M.M.Sc. EMORY UNIVERSITY, 1989

A Dissertation Submitted to the Graduate Faculty of The University of Georgia in Partial
Fulfillment of the Requirements for the Degree

DOCTOR OF PHILOSOPHY

ATHENS, GEORGIA
2004
© 2004
Elizabeth H. Redmond
All Rights Reserved
DIABETES SELF-CARE ACTIVITIES IN OLDER ADULTS AND THE ABILITY OF A
NUTRITION AND DIABETES EDUCATION PROGRAM TO EFFECT CHANGE

by

ELIZABETH H. REDMOND

Major Professor: Mary Ann Johnson

Committee: Nancy L. Canolty
Joan G. Fischer
James L. Hargrove
Mary Ellen Quinn

Electronic Version Approved:

Maureen Grasso
Dean of the Graduate School
The University of Georgia
May 2004
DEDICATION
Zoe, Molly and Reese.
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ACKNOWLEDGEMENTS

I would like to thank my major Professor Dr. Mary Ann Johnson. You did a wonderful
job of accommodating the life I brought to school. I would also like to thank everyone in the lab
for all their help, it has been a wonderful place to work because of you. My committee members
have also been helpful and supportive, thank you.
Most of all I must thank all of the family and friends who have provided moral support,
child care and friendship through this academic undertaking. I would never have made it without
all the resources and support available and offered to me. I would specifically like to thank my
parents who have been extremely supportive, even though I am too old to still be in school.
Lastly, I would like to acknowledge and thank my wonderful husband and daughters, I Love
You! And the fur bus was fun too!

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TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS.............................................................................................................v
LIST OF TABLES.......................................................................................................................viii
CHAPTER
1 INTRODUCTION.........................................................................................................1
2 LITERATURE REVIEW..............................................................................................7
THE BURDEN OF DIABETES...............................................................................8
GLYCOSYLATED HEMOGLOBIN.......................................................................9
DIABETES SELF-MANAGEMENT.....................................................................15
SPECIAL CONCERNS OF OLDER ADULTS.....................................................21
ASSESSMENTS TOOLS IN DIABETES RESEARCH…………………….…...24
OLDER AMERICANS NUTRITION PROGRAM (OANP).................................32
PROPOSED STUDY: RATIONALE, SPECIFIC AIMS,
HYPOTHESIS AND DESIGN…………………………………………………...33
REFERENCES........................................................................................................38
3 CHARACTERSTICS, DIABETES SELF-CARE ACTIVITIES, HEALTH
BELIEFS AND A1C CONTROL IN OLDER ADULTS ATTENDING
GEORGIA’S OLDER AMERICANS NUTRITION PROGRAMS...........................50

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4 CHANGES IN DIABETES SELF-CARE ACTIVITIES FOLLOWING A
NUTRITION AND DIABETES EDUCATION PROGRAM IN GEORGIA’S
OLDER AMERICANS NUTRITION PROGRAMS……………………………..…72
5 GEORGIA HEALHCARE PROVIDERS’ PERCEPTIONS OF DIABETES
SELF-CARE ACTIVITIES IN OLDER ADULTS.....................................................95
6 SUMMARY...............................................................................................................107
APPENDICES
A DIABETES TRANSLATION FRAMEWORK........................................................115
B UPDATED “EAT WELL, LIVE WELL” CONSENT FORM.................................117
C ORIGINAL “EAT WELL, LIVE WELL” CONSENT FORM.................................120
D ORIGINAL “EAT WELL, LIVE WELL” QUESTIONNAIRE...............................124
E REVISED “EAT WELL, LIVE WELL” QUESTIONNAIRE……………………..145
F “EAT WELL, LIVE WELL” FLYER ……………………………………………..149
G HEALTH CARE PROVIDER QUESTIONNAIRE …………………………….…151
H INDIVIDUAL DIABETES SELF-CARE ACTIVITIES AND DOMAINS............156
I HEALTH CARE PROVIDER RECOMMENDATIONS.........................................172
J STAGES OF CHANGE.............................................................................................182

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LIST OF TABLES
Page
Table 3.1: RELATIONSHIP OF DEMOGRAPHIC AND DIABETES
CHARACTERSTICS TO A1C BLOOD LEVELS......................................................67
Table 3.2: A1C RANGE, MEANS AND LEVEL OF CONTROL
FOR EACH AGE GROUP............................................................................................68
Table 3.3: RELATIONSHIP OF SDSCA QUESTIONS TO LEVELS
OF CONTROL FOR A1C BLOOD VALUES.............................................................69
Table 3.4: RELATIONSHIP OF PARTICIPANTS WHO AGREE OR DISAGREE
WITH THE HEALTH BELIEFS IN EACH LEVEL OF CONTROL
FOR A1C BLOOD VALUES.......................................................................................71
Table 4.1: BASELINE DEMOGRAPHICS..................................................................................91
Table 4.2: MEANS AND PERCENTS OF SELF-CARE ACTIVITIES FOR ALL
PARTICIPANTS AND THOSE WITH LOW COMPLIANCE...................................92
Table 4.3: CORRELATIONS OF CHANGE IN SDSCA WITH CHANGES IN
A1C FOR PARTICIPANTS WITH BASELINE A1C >7 %........................................94
Table 5.1: HEALTHCARE PROVIDERS REPORTS’ OF THE IMPORTANCE
OF DIABETES SEFL-CARE ACTIVITIES..............................................................105
Table 5.2: HEALTHCARE PROVIDERS’ AND OLDER ADULTS’ PERCEPTIONS OF
BARRIERS TO SELF-CARE ACTIVITIES..............................................................106
Table 6.1: SDSCA DOMAIN SCORES......................................................................................167
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