Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Kathleen M. Rayman

Committee Members

Gary Kukulka, Judith Anderson, Priscilla Ramsey, Tamera Pearson


Gender, minority, and regional-related disparities have been documented in diabetes management. Self-efficacy, the belief in one's ability to carry out the actions mandated by a task, has been identified as a key predictor in glycemic control; however, it has not been investigated in rural, female populations. This cross-sectional, correlation investigation examined the relationships among self-efficacy, depression, and diabetes self-care management in women living in Appalachia with type 2 diabetes. Using Bandura's Social Cognitive Theory, 85 women ages ≥ 21 with type 2 diabetes for a minimum of 6 months who were residents in Appalachia completed the 1) Diabetes Self-Efficacy Scale, 2) Beck Depression Inventory-II, 3)Summary of Diabetes Self-Care Activities, and a 4) Diabetes Health-Related Demographics tool. Descriptive statistics detailed the sample characteristics. ANOVA, chi-square, and independent t-tests were computed for between group differences as they related to depression, various physiologic states, presence of self-efficacy sources, and glycosylated hemoglobin. Pearson correlation coefficients were used to describe the relationships between self-efficacy, depression, and self-care management. Multiple linear regression analyses examined prediction models for glucose control while controlling for potential confounders.

Eighty-four Caucasian and one African-American enrolled in the study with a mean age of 61. The mean time since diabetes diagnosis was 7 years with a mean glycosylated hemoglobin value of 6.9% (SD=1.3). Higher self-efficacy scores were associated with a lower glycosylated hemoglobin (r-.30, p=.005) and ability to choose foods best to maintain a healthy eating plan(r-.415, p=.001). The sources of self-efficacy associated with enhanced self-care management were mastery experience and vicarious experience. There were no significant relationships between self-efficacy and depression or depression and glycosylated hemoglobin. The diabetes self-care management regression model resulted in self-efficacy and education accounting for 7.5% of the variance in glycosylated hemoglobin.

Study findings support the social cognitive theory and the utility of self-efficacy as a predictor of glycemic control. Depression was not found to be a significant obstacle in this Appalachian population. Comprehending the significant relationship between self-efficacy and diabetes self-care management allows providers to modify their interventions when caring for women type 2 diabetes in the region.

Document Type

Dissertation - unrestricted


Copyright by the authors.