Dispositional hope and diabetes self-management: Exploring the roles of agency and pathways
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This dissertation examined relationships between dispositional hope (hope), and key diabetes treatment-related processes and outcomes (diabetes self-management, self-reported and objective medication adherence and glycemic control). It was hypothesized that higher levels of hope would be significantly associated with more favorable diabetes self-management and control. The final sample was comprised of 104 participants with type 2 diabetes recruited from Albert Einstein College of Medicine and Montefiore Medical Center. Participants included individuals from the original sample of 120 who completed follow-up measures of: hope and its component parts (agency and pathways), diabetes-related emotional distress, diabetes self-management and medication adherence. Participants provided blood samples or access to recent medical records of HbAlc. Adherence was monitored by MEMS caps over three months of follow-up. Moderation effects of hope on the relationship between emotional burden of diabetes and outcome variables were assessed, as were interaction effects between agency and pathways on diabetes self-management and control. Hope was associated with greater self-reported (r = .24,p < .01) and objective medication adherence (r= -21,p < .01). Entered separately into regression models, hope components were significantly associated with better adherence; however, entered into the model together, effects were generally not independent, with the exception of pathways remaining significantly associated with better objective adherence (MEMS). Hope was significantly related to better self-reported medication adherence, while only pathways was significantly related to better objective adherence (MEMS). Hope was not related to diabetes self-management or glycemic control. Results suggest hope might be used to better predict diabetes treatment adherence. Results did not generally support Snyder's two-factor model nor suggest that hope buffers against effects of diabetes distress on diabetes self-management and treatment adherence.