Defense Date


Graduation Date

Fall 12-17-2021


One-year Embargo

Submission Type


Degree Name





School of Nursing

Committee Chair

Melanie T. Turk

Committee Member

Pamela Spigelmyer

Committee Member

Mary K. Anthony


Diabetes Distress, Personal Health Record, Technology, Intention to Use


Background: Diabetes distress (DD) is defined by emotional and behavioral challenges caused from diabetes and its management. Diabetes self-care behaviors can be compromised by DD. Personal Health Record (PHR) use has been associated with improvements in HbA1c, blood pressure, and LDL-C, but the relationship between DD and PHR use is unknown. Aims: 1) to determine differences between sociodemographic variables and intention to use and actual use of PHR in hospitalized persons with Type 2 Diabetes Mellitus (T2DM), 2) to investigate the relationship between DD, intention to use a PHR and actual use of a PHR within 30 days of hospital discharge, 3) to investigate the relationship between DD, self-care behaviors, and clinical indicators of diabetes self- management, and 4) to investigate the relationship between DD and PHR-related performance expectancy, effort expectancy, social influence, and facilitating conditions. Method: Using a cross-sectional survey design, 99 inpatients reported their level of DD, self-care behaviors, and intention to use a PHR. Results: The mean intention to use the PHR score was 3.4; however, 85.9% did not use the PHR after discharge. Higher levels of DD were associated with higher HbA1c, rho= 0.26, p= 0.01, but DD was not related to intention to use or actual use of a PHR, p= 0.26 and p=0.66. Limitations and Implications: The small number of PHR users and possible recall or social desirability biases are limitations. Nurses should recognize that hospitalization might contribute to DD. Conclusion: Future research is needed to understand associations between diabetes distress and PHR use.



Additional Citations

Fisher-Grace K, Turk MT, Anthony MK, Chia LR. Use of Personal Health Records to Support Diabetes Self-management: An Integrative Review. Computers Informatics Nursing. 2021 Jun;39(6):298-305. doi: 10.1097/CIN.0000000000000682. PMID: 33315699.

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