Abstract
Diabetes is a major problem in the United States but engaging in
specific diabetes care behaviors can lessen the disease's
complications. Healthy People 2020 is a set of national health
goals which include targets for diabetes care behaviors such as
self-monitoring of blood glucose (SMBG), biannual HbA1c tests,
diabetes education, and annual foot examinations. These
preventative and self-management behaviors have determinants at
multiple levels, including the state level. Therefore, the purpose
of this study was to determine if there were state-level
differences in the proportion meeting the recommendations for the
diabetes care behaviors, whether these differences changed over
time, and what their state-level determinants are. Data from
2000-2010 Behavioral Risk Factor Surveillance System (BRFSS) were
used to generate age-adjusted prevalences for each behavior across
all years and in two time points: 2000-2005 and 2006-2010. Results
indicated that there were disparities by state, but no large
changes occurred over time. Few states are currently on track to
meet the Healthy People 2020 objectives. Only HbA1c had one
significant state-level predictor, proportion on Medicaid, and SMBG
had two significant state-level predictors, proportion female and
proportion on Medicaid. Implications and directions for future
research are discussed.
Table of Contents
Table of Contents
Chapter 1 1
Diabetes Epidemiology 1
Diabetes Care Behaviors 2
Rationale for State-level Analysis 4
Andersen's Behavioral Model of Health Services Use 6
Research questions 8
Chapter 2 - Literature Review 10
Daily Blood Glucose Self-Monitoring and HbA1C Measurement 10
Annual Foot Examination 10
Diabetes Education 11
Determinants of and Disparities in Diabetes Care Behaviors 11
Surveillance of Diabetes Care Behaviors 14
Theory applications 16
Summary 17
Chapter Three - Methods 18
Procedure. 19
Outcome Measures. 19
Demographic Measures from BRFSS. 21
Predictors from other sources. 22
Analysis. 23
Chapter 4 - Results 25
Prevalence of state-level diabetes care behaviors. 26
Changes over time in state-level diabetes care behaviors 27
Bivariate associations of state-level diabetes care behaviors and
predictors. 28
Predictors of state-level diabetes care behaviors. 29
Chapter 5 - Discussion 31
Strengths and Limitations 36
Implications 39
References 43
Tables 49
Figures 94
About this Master's Thesis
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