Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Patricia Burkhart


Diabetes has reached epidemic levels, to the currently estimated 29 million individuals who are living with diabetes. Those with diabetes must manage their disease through a combination of medication, physical activity recommendations, and nutritional guidelines. The consequences of non-adherence to recommendations include cardiovascular disease, kidney failure, vision loss, or ultimately, death. Despite the risks of non-adherence, individuals often do not adhere to recommended treatment. Researchers have attempted to identify strategies to promote diabetes self-management adherence, thereby decreasing complications related to the disease.

Specific Aims:

  1. describe the factors that prohibit individuals from adhering from diabetes self-management behaviors as well as the factors that promote self-management adherence,
  2. compare adherence rates of individuals participating in an enhanced diabetes education program with the adherence rates of individuals that participated in enhanced diabetes education and also attended group social support sessions,
  3. evaluate the adherence to self-management behaviors of individuals participating in a diabetes care coordination program.

Results: A review of research articles from 2009 through 2013 identified barriers to diabetes self-management adherence as complexity of self-management, low health literacy, the financial burden of adherence, availability of resources, and lack of knowledge. Factors that promote diabetes self-management adherence include diabetes self-management education, self-efficacy, social support, and goal setting.

A retrospective chart review of participants in an employer-sponsored health program was performed to examine the effectiveness of a social support intervention administered through the health program to promote adherence to recommended diabetes treatment.

Results of the study revealed that individuals who participated in the social support intervention, in addition to the employer-sponsored health program, demonstrated increased adherence to recommended diabetes treatment from baseline to 12 months, in comparison to those who participated in only the health program (p = .048).

Additional chart review compared participants’ self-management behaviors at baseline with their self-management behaviors at 12 months after entry into the program. There was a significant improvement in adherence to self-management behaviors of receiving an influenza vaccination (p = .036), decreased reported use of alcohol (p = .002) and tobacco (p = .043), and fewer reports of skipped meals (p = .009).

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