Igniting the diabetes self-care pilot light : understanding influences on health activation : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand

Abstract

Diabetes presents a serious health challenge for New Zealand because it is a significant cause of ill health and premature death. It is well recognised that self-care in diabetes, can be demanding and is influenced by numerous factors. Health activation is a composite notion focusing on four major elements believed to influence active engagement in self-care: these are beliefs, knowledge, skills and confidence, and behaviours. In this study I set out to elicit an understanding of influences on diabetes-related health activation in general, and specifically to provide explanations for how diabetes-related distress and/or health professional communication and decision-making styles impact on health activation. An additional aim was to generate new ideas on how diabetes care can be structured to maximise personal resourcefulness and promote health activation.

Mixed methods methodology allowed for a pragmatically structured research approach. In particular the use of both quantitative and qualitative methods ensured that participants’ perceptions were comprehensively explored. Two hundred and twenty participants completed a semi-structured questionnaire and eighteen participated in a subsequent interview.

Health activation was found to be dynamic and influenced by many factors. Diabetes-related distress and health professional communication and decision-making styles explored in this study were important contributors to health activation. This information has complemented and expanded knowledge of these constructs and has extended understanding on relationships between them. In particular it has generated knowledge about health activation, diabetes-related distress and health professional communication and decision-making styles specific to the New Zealand context.