Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Cecelia Gatson Grindel, PhD, RN, FAAN - Chair

Second Advisor

Carolyn C. Kee, PhD, RN

Third Advisor

Eric Vanman, PhD

Fourth Advisor

Laura P. Kimble, PhD, RN


Diabetes mellitus affects 20.8 million Americans in the United States and is the fifth leading cause of death in the United States. Acute and chronic disease-related complications can have a devastating effect on the life of individuals with Type 2 diabetes. Reduction in acute and chronic complications can be best achieved by individuals’ adhering to appropriate lifestyle changes and maintaining tight glycemic control through a process of self-regulation. Self-regulation treatment decisions and lifestyle behavioral changes can be influenced by physiological and psychosocial factors. The purpose of this study was to examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of outcomes (self-care behavior and A1c levels) in individuals with type 2 diabetes. A descriptive, correlational design was used to examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of outcomes for self-care behavior and metabolic control in individuals with Type 2 diabetes as it relates to diabetes management. A convenience sample of 119 men (46.2%) and women (53.8%) between the ages of 22 and 93 years of age living in two urban cities located in a southeastern state with documented type 2 diabetes were recruited. Participants were recruited from four endocrinology offices, one internal medicine office, two medical clinics, and three diabetes education centers. The majority of the participants were caucasian (74.8%). Inclusion criteria were that participants a) had been diagnosed with type 2 diabetes for at least 1 year or more, (b) were able to read and write in English, (c) were 18 years of age or older, and (d) had an A1c level drawn within the past 30 days. Questionnaire booklets were mailed to participants. Participants’ A1c levels were obtained from their medical records. Data were analyzed with descriptive and inferential statistics including frequencies, percentages, means, standard deviations, bivariate correlations, multiple linear regressions, and hierarchical multiple linear regressions. Participants perceived their diabetes to be a chronic, moderately cyclical condition with negative consequences and with moderate amounts of symptomatology that greatly influenced their emotional status. Hierarchical multiple linear regression analysis revealed that coping efficacy uniquely accounted for 9% of the variance in self-care behavior. Perceptions of higher coping efficacy were associated with higher beliefs of personal control and treatment control, a greater understanding of diabetes, engagement in higher levels of self-care behavior, and lower A1c levels. In addition, hierarchical multiple linear regression analysis revealed illness representations, particularly timeline cyclical, accounted for 12% of the variance in A1c levels. Perceptions of a more cyclical disease course were predicted of higher A1c levels. Interestingly, a perception of diabetes being a less chronic illness was associated with higher self-care behavior. This study affirms the importance of how illness representations and coping efficacy influence self-care behavior and A1c levels. The findings from this study have important implications for nursing practice in the areas of assessment, diabetes management, coping skills training, behavior modification, motivational interviewing, and diabetes education. Further research is needed to expand the knowledge base and develop targeted interventions related to illness representations, especially timeline cyclical, and coping efficacy in the diabetes population.


Included in

Nursing Commons