Date of Award

Summer 2014

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Holly Gaff

Committee Member

Elizabeth Locke

Committee Member

Ginger Watson


Diabetes is expected to affect more than 21% of the U.S. adult population by the year 2050 (Boyle, Thompson, Gregg, Barker, & Williamson, 2010). What is important to understand about diabetes is that there are safe, effective non-pharmaceutical lifestyle modifications and pharmaceutical treatment options that can prevent and delay the onset of complications. Telehealth efforts are practical solutions increasingly used in the health services delivery model to improve self-care management practices among patients with multiple chronic conditions (Davis, Hitch, Salaam, Herman, Zimmer-Galler, & Mayer-Davis, 2010; Eng, Gustafson, Henderson, Jimison, & Patrick, 1999; Fitzner & Moss, 2013; Gruman, 2011; Lin, 1999; Noell & Glasgow, 1999).

The purpose of this study was to examine the effectiveness of the Technology Acceptance Model (TAM) as a theoretical framework to identify predictors of system use of telehealth messages among diabetes patients, aged 18-65, in a primary care setting. This study employed mixed methods methodologies; a randomized, pretest-posttest research design was used with a quantitative survey. The qualitative component evaluated the response to the participant's likelihood of using the resources provided to enhance the self-care management of diabetes. One-hundred fifty participants, aged 1865 diagnosed with type 2 diabetes were enrolled in the study. Participants were randomized to experience seven weeks of telehealth messages on self-care behaviors or to receive educational handouts.

Blood pressure was statistically significantly higher at baseline compared to follow-up. Findings revealed that blood pressure readings decreased at follow-up. Experimental group participants had statistically significantly lower Behavior Score Instrument scores at baseline than at two months and follow-up. In the TAM framework, intentions predict actual system use. Multivariate statistics revealed that age was a stronger predictor of actual system use. As age increased, the number of messages participants listened to increased. Results showed a statistically significant relationship existed between behavioral intention to use and actual system use. Findings suggests that the telephone as a communication medium, coupled with traditional face-to-face self-care diabetes management education offers an opportunity to reinforce effective diabetes management practices and provide an immediate intervention to engage patients on healthier lifestyle modifications to manage diabetes and reduce its associated complications.