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Exploring the relationship among occupational functioning factors in adults with type two diabetes mellitus




Langton, Stacy, author
Malcolm, Matthew, advisor
Nelson, Tracy, committee member
Schmid, Arlene A., committee member

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Type two diabetes mellitus (T2DM) is a common diagnosis among the U.S. population, however many individuals struggle to effectively control their glycemic levels. T2DM can have an impact on individuals physically and psychosocially with worse outcomes in low social economic status (SES) populations. Several physical and psychosocial factors have been found to influence self-management behaviors in individuals with T2DM. Researchers have not examined self-efficacy, locus of control (LoC), quality of life (QoL), activity (a set of tasks consisting of goal directed actions), and mood simultaneously to better understand the multitude of factors that can influence diabetes control (HbA1c). Additionally, self-efficacy has not been evaluated as composed of various constructs related to diabetes self-management. The Occupational Functioning Model facilitates conceptualization of: self-efficacy, LoC, QoL, activity, mood, and HbA1c; and their possible relationships. The primary purpose of this study was to determine the predictor effect of the occupational functioning factors of self-efficacy, LoC, QoL, activity, and mood on HbA1c. The secondary purpose is to determine the predictor effect of the occupational functioning factors of self-efficacy, LoC, QoL, mood, and HbA1c on activity. Occupational functioning factors were assessed using validated questionnaires. Seventy-six individuals with T2DM who are patients at a safety-net primary care facility participated in the study. Correlational analyses, factor analysis, and hierarchical regression were conducted. Factor analyses determined that the self-efficacy measure was composed of two constructs related to diet and T2DM management. Several occupational functioning factors were found to have significant and moderate to strong relationships. Self-efficacy for diet (-0.50, p < 0.001) and T2DM management (0.24, p < 0.05) explained 17.80% variance of HbA1c. Self-efficacy for T2DM management (0.31, p < 0.01) and LoC attributed to chance (-0.26, p < 0.05) explained 29.4% of the variance in activity. According to the study results, having a strong sense of self-efficacy for diet predicts better diabetes control in adults with T2DM and low SES. However, participants who perceived a greater ability to recognize when and how to care for T2DM-related problems (self-efficacy for T2DM management) experienced higher HbA1c levels. Adults with strong self-efficacy for T2DM management and low attribution of diabetes outcomes to chance engaged more frequently in activities (including domestic, work/leisure, and outdoor activities). Considering specific aspects of self-efficacy (i.e. diet and T2DM management) seems to be an important area of assessment in determining individuals at risk for poor diabetes control and reduced activity. Future research may explore how T2DM self-management behaviors relate to occupational functioning, and whether they predict HbA1c and activity. Future studies should also determine how circumstances associated with low SES, such as food insecurity and limited healthcare resources, impact the relationship among self-efficacy, LoC, activity, and diabetes control. The results from the present study may be used to inform assessment and intervention in experimental research with the goal to improve self-management behaviors and diabetes control in individuals with T2DM.


2017 Fall.
Includes bibliographical references.

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diabetes control
occupational therapy
type II diabetes
occupational functioning


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