Date of Award


Degree Type


Degree Name

Master of Arts in Psychology



First Advisor

Laurie Ruggiero


Recent research shows proper performance of self-care regimens helps postpone development, slow progression, and alleviate symptoms of the many complications of diabetes mellitus. The Transtheoretical Model (TTM) is a systematic approach to the acquisition of health behaviors, showing remarkable success across a wide range of behaviors.

A total of 2056 participants with Insulin Dependent Diabetes Mellitus and Non-Insulin Dependent Diabetes Mellitus were proactively recruited, and assessed regarding their typical performance of glucose testing and medication adherence. The two constructs of the TTM that were investigated were Stage of Change and Decisional Balance. For both behaviors, measure development followed the same procedure. When a Principal Component Analysis requesting two factors resulted in all decisional balance items loading on their theoretically appropriate constructs, the theoretical two-factor correlated structure was imposed on an exploratory sample. The fit indices for this model were excellent and the proposed model explained significantly more than even the next best alternative model. This model was then imposed on a confirmatory sample and a series of subsamples, and, again, fared quite well.

With high proportions of participants in the Action and Maintenance stages of both behaviors, participants were reassigned to stage. Similarity of the single- and four-item algorithms shows the algorithms are internally consistent, while the cross validations by related variables provide external validity. Two-way Multivariate Anayses of Variance were performed on decisional balance for both behaviors, one by stage and gender, and the other by stage and type of diabetes. For glucose testing, neither interaction was significant, but all three of the main effects were. For medication, neither the interaction of stage by gender nor the main effect for gender were significant, however, the main effect for stage and the interaction of stage by type were.

As can be seen, staging and decisional balance constructs of the TTM hold up in one area of chronic disease behavior management--diabetes self-management. Before developing interventions, however, measures for the other constructs of the TTM need to be developed. This study is only the first of many steps needed to develop an effective, efficient intervention.



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