Doctor of Philosophy, Case Western Reserve University, 2018, Management

Overall healthcare spending in the U.S. is in the trillions and more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared to other OECD countries. The majority of spending is directed toward small patient populations with chronic diseases. Within the context of access to insurance coverage and a certain level of health literacy, experts believe increased patient–physician shared decision making (SDM) should result in better care and lower cost. However, the study of the physician's role in facilitating SDM is limited. By understanding what factors predict when physicians will implement SDM during the treatment of specific chronic diseases, we can begin to understand the dynamics that most influence behaviors and offer recommendations to improve certain aspects of healthcare in the United States. A sequence of three studies was completed by interviewing or surveying 369 physicians who treat hemophilia and primary immune deficiency (PID). The study used dual process theory to explain the relationship between patient-centered care and SDM within a wider framework of power balance, patient/physician traits, and organizational context. These studies were supplemented by an analysis of 1) survey of 33,162 individuals across theU.S.; 2) 25 million hospitalization records from New York State comparing two (2) five-year periods; and 3) data from 200 million individual-level, de-identified enrollment data and health insurance claims across a continuum of care (both inpatient and outpatient). The first study qualitatively explored decision making between hemophilia physicians in the U.S. and U.K. and found U.S. physicians to be more patient-centric and less rule-based. The second study quantitatively tested the relationship between slow/rational vs. fast/intuitive decision making by U.S. physicians treating PID and SDM as mediated by patient-centric care; results showed a statistically significant relationship between slow/rational deci (open full item for complete abstract)

Master of Science, The Ohio State University, 2016, Genetic Counseling

Women with a BRCA1 or BRCA2 mutation have a 40-74% breast cancer risk and 11-46% ovarian cancer risk by age 70. Due to this elevated risk, it is recommended that mutation carriers have increased breast screening and a risk-reducing salpingo-oophorectomy. They are also given the option to have a risk-reducing mastectomy. The process of deciding if and when to undergo prophylactic surgery has been found to be a complex and difficult process for many carriers. To evaluate the decision-making process, recorded interviews were conducted with 20 BRCA1 and BRCA2 mutation carriers. Information about the cancer risk management decision-making process was analyzed using grounded theory. Factors involved in decision-making, ease of decision-making, and individuals involved in the decision-making process emerged as major themes. Mutation carriers who have not had breast cancer (previvors) were found to have a more difficult time coming to a cancer risk management decision than women with a breast cancer history. Physicians were often discussed as being an integral part of the decision-making process by providing support and management recommendations. Family members and other mutation carriers filled a similar role during the decision-making process by providing decisional and emotional support for carriers. Genetic counselors were short-term providers of risk information and management recommendations for this study population. If a carrier was not receiving the information or support she needed from one of these groups, she often turned to another party, most commonly a healthcare provider. Thus, data from this study suggests that previvors or mutation carriers struggling with the risk management decision-making process may need additional support and information to assist them during this process. It is important that healthcare providers are educated about risk-management strategies for HBOC and work together to best help mutation carriers through the decision-making proces (open full item for complete abstract)

Doctor of Philosophy (PhD), Wright State University, 2019, Engineering PhD

Choosing between alternatives, regardless of the decision context in an organizational group setting is a difficult task. The integrity of the decision is under constant scrutiny and rarely are we ever able to characterize the magnitude of that with which we are consciously or subconsciously concerned: personal bias. This leads to long, drawn out timelines and loosely trusted decisions. This dissertation research focuses on using a traditionally, negatively viewed anchoring bias strategically in a series of experiments with a hypothesis that it can be used to positively reduce personal biases such as preference bias and judgement rooted in ambiguous or asymmetrically available information or replace them with more appropriate biases for the decision context. Anchoring has significant impacts on judgement. A decision maker will make judgements and adjustments favoring a dominant anchor rooted in numerical priming or selective accessibility of information. If information is unbalanced or irrelevant to the decision due to conflicting evaluability of alternatives, selective accessibility can result in preference bias. Part of this dissertation research explores the threshold between the causes of different anchors in a commonly debated topic: Minivan vs SUV. By presenting alternatives with inherently strong user preferences, we are able to make conclusions about the efficacy of specific information presentation modes and procedures and their ability to effectively reduce preference bias between alternatives. We reveal how different decision processes, as described in General Evaluability Theory, promote selective accessibility of irrelevant information; and which ones favor selective accessibility of alternative requirements and numerical anchoring between value judgments. Results show that joint evaluation significantly reduces preference bias and comparisons of alternative values are consistent with numerical anchoring. Additionally, we uncover how anchor (open full item for complete abstract)

Doctor of Philosophy (PhD), Wright State University, 2016, Human Factors and Industrial/Organizational Psychology PhD

The increasing emphasis in the medical community on shared decision making and patient centered care suggests that patients play a role in their care, but research on clinical reasoning almost exclusively addresses practitioner cognition. As patient involvement increases, it is important to understand the effect patients have on clinical cognition. This necessitates moving beyond a model that equates clinical cognition with practitioner cognition to incorporate the influence of patient cognition and dyadic patient-practitioner cognition. In this dissertation, I suggest that patient-practitioner interactions constitute a distributed cognitive system. As a result patient cognition and the nature of the interaction inherently contribute to clinical cognition. By analyzing different aspects of clinical interactions involved in managing Multiple Sclerosis (MS), I provide an exploratory observational study of how patient-practitioner dyads engage in clinical cognition that may serve as a guide to more conventional future hypothesis testing. To assess clinical interactions, I observed twenty-three patients interacting with three medical practitioners at a clinic specializing in the chronic disease of Multiple Sclerosis. Consistent with Institutional Review Board review, patients agreed to observations of their clinical session including audio recording and/or taking field notes and participated in follow-up phone interviews. Analysis employed techniques from grounded theory, task analysis, and discourse analysis. The results comprise four separate analyses focusing on different aspects of patient-practitioner cognition outlining the core functions of MS management, the fundamental role of the patient in the reconceptualization of management as a distributed task, the effect of patient expertise on clinical reasoning and the role of narrative in facilitating the exchange of information. Specifically, in the first analysis, I decompose the interactions involved (open full item for complete abstract)

Doctor of Philosophy, Miami University, 2012, Psychology

As process models of decision making have become increasingly nuanced, the methods by which these models are judged have not kept pace. Methods with the capacity to directly monitor the decision process offer a much-needed increase in resolution. One such method, here labeled as the study of response dynamics, capitalizes on the robust reciprocal connection between the motor and cognitive systems to study the online formation of a response (Spivey, 2008). Response dynamics research simply entails monitoring a participant's mouse response toward spatially disparate (on screen) choice options. Over the course of four studies, I validate and extend response dynamics in the realm of preferential choice (Experiments 1 and 2), before testing descriptive model predictions in the domain of moral decision making (Experiments 3 and 4). To validate this method for use in the domain of preferential choice I utilize stimuli from the International Affective Picture System (Lang, Bradley, & Cuthbert, 2008), and show that response dynamics captures the development of preference (Experiment 1). I then extend the paradigm to decisions under risk using both gain and loss gambles and provide a more nuanced picture of the risky decision making process (Experiment 2) than has previously been possible. Finally, I apply the method to test default-interventionist dual-systems models of moral decision making (Experiments 3 and 4) and show that emotion and deliberation most likely interact concurrently rather than serially. In summary, I show that by moving beyond the discrete outcome variables provided by existing techniques, response dynamics can provide an avenue by which ongoing theoretical disputes within judgment and decision making can be directly tested.

Doctor of Organization Development & Change (D.O.D.C.), Bowling Green State University, 2024, Organization Development

Research has established a case for the importance of diversity, equity, and inclusion (DEI) in arts organizations. Achievements in DEI "…will allow arts organizations to engage their entire communities on multiple levels. Arts organizations will benefit from utilizing new perspectives on chronic challenges that have plagued the arts." (Cuyler, 2013) Additionally, we know that there is a relationship between racial and ethnic diversity and better financial performance. "Companies in the top quartile for racial and ethnic diversity are 35 percent more likely to have financial returns above their respective national industry medians." (Hunt et al., 2015). While there is some research on the effectiveness of DEI initiatives, there is little research on how commitments to DEI have impacted the artistic programming choices of artistic directors in arts organizations. With over ten years of experience in artistic programming, I am invested in examining how DEI is presented in artistic programming decisions. This grounded theory study explores the artistic programming decision-making process of artistic directors at nonprofit arts organizations in New York City. Through research, I sought to understand DEI's role in the decision-making process of artistic directors and if artistic programming can be used to examine an organization's commitment to DEI. Based on the findings in this study, the Artistic Programming Decision-making Model is presented to explain the role DEI plays in the artistic programming decisions of artistic directors. The emergent model proposes that DEI influences the artistic director's values and experiences, artistic programming philosophies, and leadership role, and these factors impact the artistic programming decision-making process.

Doctor of Philosophy, The Ohio State University, 2024, Health and Rehabilitation Sciences

This dissertation presents the development and evaluation of the Agile Healthcare Performance Index (AHPI), a novel methodology designed to improve quality and measure performance within healthcare settings. It offers a framework designed to capture the complexities of healthcare delivery. Chapter 3 introduces the AHPI, emphasizing its significance in enhancing resource allocation and operational decision-making through an analysis of synthetic data across hospital service lines. The results underscore the adaptability and temporal sensitivity compared to static, unweighted indices, highlighting the potential to refine healthcare performance measurement. Chapter 4 extends the application of the AHPI to quality improvement (QI) initiatives, hypothesizing its effectiveness in aligning healthcare decision-making processes with the complex nature of care delivery. A simulation-based case study illustrates the alignment of the AHPI with the Cynefin framework's domains, demonstrating its strategic utility in navigating the dynamic challenges of healthcare. Chapter 5 focuses on the practical application of the AHPI in evaluating hip fracture care among the elderly, utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). The findings reveal the ability of the AHPI to accurately reflect variations in surgical outcomes, validating its role as a dynamic tool for quality improvement and policymaking across healthcare settings. Together, these studies advocate for the AHPI as a groundbreaking approach to healthcare performance assessment and QI. By integrating multidimensional metrics and a data-driven methodology, using the AHPI can provide a robust solution for enhancing care quality and operational efficiency, paving the way for a more adaptable and effective healthcare system.

EDD, Kent State University, 2023, College of Education, Health and Human Services / School of Foundations, Leadership and Administration

KELLERMANN, MARY K., JULY 2023 INTERPROFESSIONAL LEADERSHIP UNDERSTANDING THE WAYS TEACHERS ARE INFLUENCED IN THEIR CURRICULAR AND INSTRUCTIONAL DECISION-MAKING PROCESSES IN A FRESHMAN LEVEL MATHEMATICS CLASS (165 pp.) Co-Directors of Dissertation: Scott Courtney, Ph.D. Todd, Hawley, Ph. D. The purpose of this qualitative interpretive study was to understand the ways teachers were influenced in their curricular and instructional decision-making processes in a freshman level mathematics class. Understanding what influences teachers' decision-making processes, and how (the ways) these processes were influenced, may lead to improved practice and ultimately improved student learning. Data collection was from three purposefully selected participants at a Midwestern, midsize university and consisted of a two-part journal, questionnaire, and follow up interviews. The follow up interviews were after each data collection for a total of three interviews. The data were analyzed using Hatch's (2002) models of typological analysis, inductive analysis, and interpretive analysis. Codes, categories, and themes of the data were developed by using a thematic analysis by Braun and Clarke (2006). The key findings included what factors and how these factors influenced a teacher's curricular and instructional decision-making processes in a freshman level mathematics class. Many factors were found such as internal, external, constraints, positive, negative, coordinator position, piloting courses, and committee work. Implications of these findings may impact how teachers make decisions, decrease cognitive loads while teaching, influence teacher training and education, and may improve teacher practice and student learning.

Doctor of Education (Ed.D.), Bowling Green State University, 2022, Leadership Studies

Researchers have identified an academic insufficiency in investigating leadership during in-extremis situations both by emphasis and through difficulty in researching real-time events. These situations can and do commonly occur in settings involving the military and domestic safety forces such as police, fire, and emergency medical teams (EMS). This research has defined in-extremis circumstances as when the participants, whether civilians caught up in the circumstances, first responders to emergency incidents, or military personnel involved in combat situations are vulnerable to incurring significant injuries up to and including death. In plainer words, when people's lives are on the line and the decisions and actions performed during the event could greatly impact the outcome. This research utilized a mixed-methods design gathering online quantitative data from 401 fire officers (grouped into Exemplars and General Fire Officers) and qualitative data from a Delphi panel of Exemplars only. A purpose of this mixed-methods study was to investigate how career fire officers who were identified by their fire departments as exemplars in field command reported they make critical decisions during in-extremis moments and to explore whether there are commonalities in their leadership approaches. This was attained through a Delphi panel composed of 14 Exemplar fire officers. Three rounds of semi-structured interviews were conducted that attempted to reach consensus among the Delphi panel members. In addition, the Rational-Experiential Inventory-40 (REI-40) was offered online to 17 career fire department officers to help evaluate their tendencies towards rational/analytical and experiential/intuitive thinking. Results from the online REI-40 survey and findings from the Delphi interviews revealed that the Exemplars rely upon their experience and intuition to a greater extent and rely less upon written procedures than did their General Fire Officer counterparts. The Delphi p (open full item for complete abstract)

PhD, University of Cincinnati, 2021, Arts and Sciences: Psychology

This study aimed to examine decision-making abilities and debiasing techniques for individuals with epilepsy. Choice and decision-making tasks occur in everyday life and executing them well is critical for daily functioning; however, even typical individuals are often prone to making biased decisions. When unaware that there is a lack of relevant information, people may make overly confident but biased decisions, known as omission neglect. Studies have demonstrated that typical individuals can improve their decision-making using cognitive debiasing procedures. It is, therefore, of interest to determine if these findings can be replicated in individuals with epilepsy, who are at a disproportionate risk to experience cognitive difficulties in memory, attention, executive functioning, and decision-making. People with epilepsy often show high nonadherence (averaging 40%) to antiseizure medications. Medication nonadherence could be conceptualized as a perceived lack of relevant information to decide or a perceived uncertainty about outcomes. Therefore, the degree of nonadherence might be related to the degree of omission neglect. If engagement in episodic simulation effectively decreases the degree of omission neglect, this strategy could be a supplement to help improve medication decision-making and behavior. It was also of interest to explore the relationship between medication adherence, medication beliefs, and quality of life in people with epilepsy. The sample of this study consisted of N=17 participants with epilepsy (Mage=37.8, Meducation=15.2, 70.6% female, and 82.4% White). Participant recruitment occurred through two main avenues: during clinical appointments with their clinician and through an established Epilepsy Registry. The study included four self-report questionnaires and an omission neglect paradigm composed of two advertisement scenarios (one scenario under episodic simulation and one without episodic simulation). The r (open full item for complete abstract)

Bachelor of Arts, Wittenberg University, 2021, Business

This paper analyzes the role of social media in politics through the lens of emotional economic decision-making and hypothesizes that Donald Trump's short and impassioned tweets generate an instant emotional reaction from stockholders stemming from a sustained sense of uncertainty and anxiety about political and economic stability which results in immediate, but short-term, volatility within the stock market. This study categorizes Trump's tweets based on high-level content to analyze whether short-term, intraday change in the S&P 500 responds more significantly to time-lag value indicators or the category of content of Trump's tweets. A series of multiple linear regressions analyzing the relationship between minute-level intraday S&P 500 data and policy-related tweet content categorizations were run with results generally yielding little statistical significance. Despite a lack of substantiated results to support the overarching hypotheses, the prevalence of emotion in economic decision-making cannot be ignored.

MS, University of Cincinnati, 2021, Medicine: Genetic Counseling

Introduction: Myelomeningocele (MMC) is the most severe form of spina bifida caused by improper development of the spinal cord leading to prolonged in utero damage to the spinal defect. Surgical repair for MMC was historically performed at birth but can now be performed in the prenatal period. Prenatal MMC surgery is associated with improved outcomes for patients as proved by the 2011 Management of Myelomeningocele Study (MOMS) trial. Patients who qualify for both prenatal and postnatal surgery face the challenge of making the best decision for themselves, their child, and their family. Patient decisions may be influenced by factors outside of the medical information provided by physicians including social influences, financial concerns, and logistical impacts. This study aimed to determine what factors influence patients to choose prenatal or postnatal surgery to repair their child's MMC. Methods: This study utilized a retrospective cross-sectional survey distributed via email and social media. One-hundred and twenty-seven responses were collected that met all inclusion criteria. Results: Our study revealed that financial and medical factors influence patient decision making between the prenatal and postnatal surgical MMC groups. Financially, the costs of childcare (39.4% postnatal, 13.8% prenatal, p value=0.002), relocation (57.6% postnatal, 36.2% prenatal, p value=0.019) and travel (51.5% postnatal, 33% prenatal, p value=0.033) were found to be influential for the postnatal surgical group participants while only insurance coverage (36.4% postnatal, 68.1% prenatal, p value=0.003) was influential to those in the prenatal surgical group. Of the medical factors, the risk to mother for transfusion was significant only for the postnatal surgical group (39.4% postnatal, 18.1% prenatal, p value=0.015). The open responses suggest that both the pre- and postnatal groups found the quality of life for the baby to be significant to their decision-making Dis (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2019, Communication

Research on jury decision making is interesting because there is an expectation by the justice system that if jurors take their duty seriously and put effortful cognition into their task, they should be uninfluenced by irrelevant information and reach a fair decision. However, research has shown that although jurors think thoroughly and try to reach a fair decision, they are susceptible to a variety of irrelevant factors. There have been multiple models of jury decision making that have been proposed to account for how jurors reach their decisions, but none seem to be able to fully explain the wide range of irrelevant factors that influence jurors. However, this dissertation argues that cognitive-experiential self-theory (CEST) is a model of human decision making that also should be applied to juries. This dissertation sets out to give support to CEST as a model of jury decision making. CEST is a decision making theory that posits that humans have two systems of information processing. The first system is a rational system that engages in effortful cognition. The second system is the experiential system that is more based on emotion. This dissertation will support CEST as a model of jury decision making by showing the types of information that are considered based on how jurors process information, how these considerations will influence decisions, which jurors have the ability to update decisions based on new information, and that this model can make accurate predictions regarding these three areas at the state and trait-level. A pretest and study 2 both support CEST's assertion that people can be engaged two different types of processing at the same time. That is, information processing is not simply a tradeoff between effortful cognition and quick, heuristic based cognition. Because of this, people who are engaged in rational thought can still be influenced by irrelevant factors via the experiential system. Both studies show that jurors will (open full item for complete abstract)

Doctor of Education (Ed.D.), Bowling Green State University, 2018, Leadership Studies

Student conduct professionals find themselves balancing legal mandates, the needs of the community, and the needs of the student in decision-making. Theories such as the ethic of justice and the ethic of care can bring clarity to the decision-making process. This study examined several variables to predict the moral orientation of student conduct professionals including years of experience, current position, type of institution, educational background, gender, and age. Moral orientation was measured using the Moral Orientation Scale (MOS) developed by Yacker and Weinberg (1990). This study collected demographic information to predict how the moral orientation of student conduct professionals. The population for this study was drawn from the membership of the Association for Student Conduct Administrators (ASCA). Very little research exists on the decision making of student conduct professionals and the results of this study provides more insight into the profession. The findings of this study indicated the gender of student conduct professionals was a statistically significant predictor of the moral orientation of student conduct professionals. In addition this study found there to be significant differences in the age and years of experience among men and women within the profession of student conduct. These findings will assist student conduct professionals in providing rationale to their decision-making, will inform hiring practices and will guide the importance of training and professional development on topics of justice and care. In addition, this study provides insight into gender differences in the profession, which offers opportunities for future research.

Doctor of Philosophy, The Ohio State University, 1984, Graduate School

Doctor of Philosophy, The Ohio State University, 1974, Graduate School

Master of Science (M.S.), University of Dayton, 2014, Mechanical Engineering

Economic Input-output analysis (EIOA) is a powerful technique for studying the economic behavior of a policy. Using this technique, one can study the consequences of applying a policy in a society from economic, social, and environmental perspectives. Chapters one through five of the study capture the economic impacts of recycling used dry cell batteries collected as a result of effective recycling policies at the higher education institutions (HEI) of the United States. Applied methodology modifies intermediate transactions of the input-output tables. The results show an $11,522 decrease in the gross domestic product (GDP) of the United States by applying strong recycling policies at HEI. These results support effective tax or credit incentive budget allocations in favor of recycling as the most environmentally friendly end-of-life option. Chapter 6 designs a set of policies that aim to improve quality of the environment as well as the economic growth. A framework for analyzing the EIOA results regarding implementation of the proposed policies is developed. The developed framework applies Design and Analysis of Experiments techniques and provides reasonable insight into the selection of the most effective policies, which increases the GDP as well as the quality of environment.

Doctor of Philosophy, Case Western Reserve University, 2013, Organizational Behavior

I propose that current organization theories tend to cast organizations, especially companies, as entities that only pursue their own interests. Thus, existing research on why firms go “beyond compliance” in adopting socially or environmentally beneficial policies or practices depict them as responding to a perceived opportunity to either make gains in financial performance and legitimacy or avoid potential losses in these. I, however, argue that, in some cases, firms may do so because they view benefitting an external constituency as a desirable end in itself. I call this organizational benevolence and suggest that it is likely to be visible in the early adoption of social innovations by companies. I present the results of qualitative and quantitative research on U.S. companies' adoption of fair trade, a social innovation, which I conducted to inquire into the possible presence of organizational benevolence and to identify its characteristics. In the qualitative study, I found that some interviewees' accounts of the adoption of fair trade-certified coffee describe a commitment to furthering the well-being of coffee farmers strong enough to take precedence over many other concerns. This commitment was characterized as rooted in organizational identity, reflected in close, long-term relationships with coffee growers, and leading to a willingness to prioritize their material benefits over the firms'. Using two vignette-based decision-making experiments, I tested hypotheses which address the effects of institutional, organizational, situational and individual factors on the decision to have one's firm adopt fair trade-certified coffee or seafood. I find that, in addition to the extent of current diffusion, decision makers' interactions with potential beneficiaries and personal characteristics, such as moral identity, can have positive effects on adoption. I conclude that the organizational commitment to secondary stakeholders' welfare must be fairly strong and salient (open full item for complete abstract)

Doctor of Philosophy (PhD), Wright State University, 2009, Human Factors and Industrial/Organizational Psychology PhD

This research aimed at understanding bounded rationality – that is, how simple heuristics result in satisfactory outcomes – in a naturalistic setting where agents have to meet environmental demands with limited resources. To do so, two methodological approaches were taken, an observational and an experimental study of U.S. emergency physicians who have to provide a satisfactory level of care while simultaneously coping with uncertainty, time and resources constraints. There are three major findings. First, based on observations of 12 resident and 6 attending physicians at two Midwestern emergency departments (ED), ED physicians use at least two general heuristics. One heuristic exploits symptom-disease relationships with the goal to rule out ‘worst cases' that would require immediate medical attention. The other heuristic aims at identifying diseases that are commonly associated with a set of symptoms. Thus, whereas the former heuristic emphasizes medical safety by aiming at identifying even unlikely ‘worst cases,' the latter stresses efficiency by aiming at separating typical worst from common benign cases to allocate resources appropriately. Second, the selection of general heuristics is situated in an environmental context. This context is reflected in epidemiological constraints that delimit the range of patients' potential medical problems as well as sociocultural constraints that delimit the range of potential, desirable, or required care solutions. ED physicians' exploit these constraints to actively (re)formulate the problem to-be-solved and select strategies that satisfy requirements for safe and efficient care. Third, based on observations and data from 39 clinicians-in-training who participated in the experimental study, emergency care delivery is the solution of medical problems in a socially dynamic setting. ED physicians aim at understanding their patients' needs and circumstances to obtain salient information about potential (medical) problems and, ul (open full item for complete abstract)

Master of Science (MS), Wright State University, 2006, Human Factors and Industrial/Organizational Psychology MS

Expert decision making has been widely researched among professionals, but non-professionals make many equally complex decisions. This study uses the case of type II diabetes to explore complex decision making among non-professionals. It was hypothesized that three cognitive aspects of expertise, problem detection, functional relationships, and problem solving, would be linked with higher levels of self-management (higher adherence and lower glucose). Twenty participants with diabetes were interviewed concerning their knowledge and experiences with diabetes. Participants also completed a questionnaire concerning their self-management practices. Interviews were transcribed and thematically coded. Participants who displayed characteristics of expert cognition reported higher levels of adherence to prescribed treatments and higher glycemic control. Most participants identified the factors involved in glucose regulation; fewer understood the functional relationships among factors; and less than half were able to solve glucose imbalances. Participants knew more about diabetes self-management than they reported applying in their daily lives.