Date of Award

Fall 12-2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Committee Chair

Dr. Sheila Davis

Committee Chair Department

Nursing

Committee Member 2

Dr. Anita Boykins

Committee Member 2 Department

Nursing

Committee Member 3

Dr. Bonnie Harbaugh

Committee Member 3 Department

Nursing

Committee Member 4

Dr. Kyna Shelley

Committee Member 4 Department

Educational Studies and Research

Committee Member 5

Dr. Lachel Story

Committee Member 5 Department

Nursing

Abstract

The use of the emergency department (ED) for chronic care management is a long-standing issue. There is a need to identify what best predicts this behavior. Identifying predictors can help determine the educational needs of patients, as well as, provide a foundation for the implementation of policy and procedures that would be useful in decreasing the economic burden of ED use in place of primary care providers. A decrease in non-urgent visits could assist with decreasing the patient load in currently overcrowded EDs. According to the Agency for Healthcare Research and Quality (2017), more than 650 million dollars were spent on Emergency Department Services in 2014.

The purpose of this study was to examine the relationships of health literacy, self-care behaviors, and social support as predictive factors on the use of the emergency department for chronic care management in patients with hypertension (HTN) and/or type 2 diabetes mellitus (T2DM) ages 30-64. This study utilized a cross-sectional correlational predictive design. A correlational predictive design was used in this study because it offered insight into the predictive relationship of health literacy, social support, and self-care behaviors (independent variables) and use of the emergency department for chronic care management (dependent variable) in patients with HTN and/or T2DM, ages 30-64. The study was conducted in a primary care clinic, small rural hospital, a church, and with the members of a social organization. Inclusion criteria for this study included: ages 30-64, English speaking, self-reported diagnosis of HTN and/or T2DM. A total of 86 participants were in this study. Data collection for this study was achieved by using the researcher developed demographic questionnaire, the Short Test of Functional Health Literacy for Adults, the Sidani Doran Therapeutic Self-Care Measure, and the Medical Outcomes Study Social Support Survey.

Logistic regression was performed to assess the predictive impact of health literacy, self-care, and overall social support on use of the emergency department for chronic care management. The overall findings of this study indicated that there is a predictive relationship between health literacy, social support, and self-care behaviors and the use of the emergency department for chronic care management in patients with HTN and/or T2DM ages 30-64. Social support was found to be the strongest predictor of emergency department use in this sample.

ORCID ID

orcid.org/0000-0001-9047-6341

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