Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Gia Mudd-Martin


Diabetes is the seventh leading cause of death in the United States, affecting roughly 13% of U.S. adults aged 18 years or older. Type 2 diabetes accounts for 90-95% of all diabetes cases and is characterized by the progressive development of insulin resistance leading to sustained elevated blood glucose levels. Management of type 2 diabetes includes risk-reduction strategies and continuous medical care to prevent the development of complications.

Lifestyle is a major contributing factor to morbidity and mortality rates in the United States. Preventative health behaviors, such as engaging in physical activity, maintaining a healthy weight, and following a healthy dietary pattern, are key for reducing risk for the development of type 2 diabetes and aid in the prevention of complications associated with diabetes, such as cardiovascular disease. While engaging in a healthy lifestyle has shown to prevent or delay the development of chronic diseases and their associated complications, few individuals adhere to all recommended self-management behaviors. The purpose of this dissertation is to increase understanding of the factors surrounding type 2 diabetes self-management and prevention through lifestyle modification.

This dissertation includes three original manuscripts that focus on the barriers to self-management and prevention of type 2 diabetes among individuals with or at risk for developing type 2 diabetes. The first manuscript is a qualitative descriptive study examining the barriers, facilitators, motivators, and strategies for engaging with dietary management of type 2 diabetes and heart failure among individuals dually diagnosed with these chronic diseases and their family caregivers. The second manuscript is a secondary analysis to examine psychosocial predictors (anxiety, depression, and fatalism) of a high versus low quality diet at baseline, and predictors of response to a healthy lifestyle intervention by assessing pre- and post-intervention diet quality. The third manuscript is a cross-sectional study examining the impact of the COVID-19 global pandemic on type 2 diabetes self-management and distress and whether attendance of the Diabetes Self-Management Education and Support program had an impact on diabetes self-management and distress during the pandemic. The findings of this dissertation will inform providers of the specific factors surrounding type 2 diabetes self-management and prevention, particularly as it relates to lifestyle modification.

Digital Object Identifier (DOI)

Funding Information

PhD Fellowship Award, University of Kentucky College of Nursing, 2017-2021

Jonas Nurse Scholars Program, American Association of Colleges of Nursing, 2018-2020

PhD Dissertation Award, University of Kentucky College of Nursing, 2020