This research explored health decision-making processes among people recently diagnosed with type 2 diabetes. Our analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and deeply held reasons people gave as they made decisions concerning their health, eating and exercising. We propose this model, grounded in informant stories, as a heuristic, to guide further inquiry. From these stories, the patient is seen as more active and the interrelated influences of knowledge, agency, and purpose, synergistically interact to explain changes in health behaviors.


Type 2 Diabetes, Health Decision-Making, Qualitative, Knowledge, Purpose, Agency, Relationships, Patient-centered, Lifestyle Changes, Adherence, Grounded Theory

Author Bio(s)

Bill Garris, Ph.D., LMFT, HS-BCP is an Assistant Professor in East Tennessee State University's Counseling and Human Services program. Correspondence regarding this article can be addressed directly to: billgarris@gmail.com.

Amy Weber earned her Master’s in Public Health from East Tennessee State University. She is pursuing doctoral studies in Behavioral Health Management. Correspondence regarding this article can also be addressed directly to: garrisb@etsu.edu.


Declaration of Conflicting Interests: The authors declared no potential conflicts of interest for the research, authorship, and/or publication of this article. Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

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