Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Cheryl Forchuk


Type 2 diabetes affects 90% of people who live with this chronic disease. A primary goal of healthcare professionals is to assist patients with Type 2 diabetes to achieve optimal glycemic control to prevent the devastating complications of this disease. Research has demonstrated that optimal glycemic control can minimize or prevent macrovascular complications such as heart attack or stroke and the microvascular complications of retinopathy, nephropathy, and neuropathy. Historically insulin has been one of the last agents to be added in type 2 diabetes despite its efficacy and long term treatment data. Reluctance by both patients and clinicians to add insulin to treatment regimens, a phenomenon known as psychological insulin resistance, remains an issue. The perception of stress and ways of coping in participants who were initiating insulin therapy were examined in this research. The relationship between participants' stress and the education they received was also examined. The education provided was based upon a Registered Nurses Association of Ontario (RNAO) Best Practice Guideline (BPG).

In a pretest / posttest design, participants (N = 105) who were seen at a Diabetes Education Centre for initiation of insulin therapy were surveyed prior to receiving insulin initiation education and six weeks following the initiation of their insulin therapy. Three surveys were completed, the Perceived Stress Scale, Ways of Coping Questionnaire, and the Confidence in Administering Insulin and Managing Diet Scale at the pre/post timepoints. A BPG evaluation tool was also completed during the posttest appointment. A mediated regression analysis demonstrated coping to be a mediator of the relationship between stress and insulin self-efficacy. There was a statistically significant decrease in participants' stress and a statistically significant increase in insulin self-efficacy. Analysis of the BPG evaluation tool demonstrated that 80% of the BPG content was recalled by participants. This study provided evidence that the needs of these patients can be met with structured education through the use of a Best Practice Guideline and the assessment of patient stress and coping can improve patient self-efficacy with insulin therapy and decrease their stress burden.