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Diabetic Caregiver Finance Education and Resulting Stress

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Diabetic Caregiver Finance Education and Resulting Stress DIABETIC CAREGIVER FINANCE EDUCATION AND RESULTING STRESS: A QUANTITATIVE CORRELATIONAL STUDY by Michael Gambrel Copyright 2021 A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Healthcare Administration Franklin University Franklin University This is to certify that the dissertation prepared by Michael Gambrel “Diabetic Caregiver Finance Education and Resulting Stress: A Quantitative Correlational Study” Has been approved by the committee as satisfactory completion of the dissertation requirements for the degree of Doctor of Business Healthcare Administration Gail Frankle Gail Frankle (Jul 9, 2021 09:20 EDT) 07/09/2021 Dr. Gail Frankle, Committee Chair and Program Chair, DHA Franklin University Karen Lankisch Karen Lankisch (Jul 9, 2021 10:40 EDT) 07/09/2021 Dr. Karen Lankisch, Committee Member and Adjunct Faculty, Franklin University Leslie Mathew Leslie Mathew (Jul 9, 2021 12:56 EDT) 07/09/2021 Dr. Leslie Mathew, Committee Member and Program Chair, MHA Franklin University 07/09/2021 Dr. Wendell Seaborne, Dean, Doctoral Studies Franklin University ABSTRACT Type 1 diabetes is an autoimmune disorder requiring daily monitoring and care. A high percentage of Type 1 diabetics are diagnosed as children, resulting in the need for parents or other caregivers to provide the care needed. This study examined the education provided to those caregivers at the time of diagnosis or immediately following diagnosis that was related to the financing of care for the diabetic. It also examined the levels of financing-related stress reported by the caregivers. A survey of N=172 caregivers in the United States within the first two years post-diagnosis was taken. Hypothesis testing confirmed that the caregivers report financing of care as a significant contributor of stress. A correlation analysis on the education received at diagnosis and the reported stress levels was unable to reject the null hypothesis; therefore, it could not be concluded that financing education at diagnosis was related to financing stress in caregivers. One cause of this failure to show a correlation may be due to the high number of caregivers reporting that they received no financing education at diagnosis. Keywords: type 1 diabetes, T1D, diabetes, education, financing, finance, caregiver, stress, PTSD, PTSS, uncertainty, unpredictability, insurance, cost, healthcare iii DEDICATION This dissertation is dedicated to my family. Without each of them this would not be possible. First to my wife, Tosha, your patience and support have helped to push me through my entire academic journey. Without you there to hold my hand, I would not be where I am today. Thank you for picking me up when I was down and always pushing me ahead. Thank you for everything you took on in our lives so that I could pursue this dream. To my daughters Alyssa and Riley, I could not have done this without you both sacrificing countless hours of time and cheering me on through the entire process. From day one, I have said that my daughters are my motivation to finish my education. Thank you so much for staying with me on this journey. I am so excited to see where you both end up on your own journeys and will be there for you every step of the way just as you have been for me. Finally, to my daughter Sarah. Just like your sisters, you have sacrificed our time and cheered me on through this entire process. You have also been the inspiration for this study. I have watched you stand tall and face the challenges life has given you with a strength that most can only aspire to show. Even more incredible is that you do this all with a smile and joy in your heart. To Tosha, Alyssa, Sarah, and Riley, this dissertation is dedicated to you all. You made this possible through your sacrifices and your support. iv ACKNOWLEDGMENTS I would like to thank and acknowledge the following individuals who have been instrumental in the design, execution, and development of this dissertation. I would like to express my deepest appreciation to my dissertation committee, Dr. Gail Frankle, Dr. Karen Lankisch, and Dr. Leslie Mathew. The entire committee has been wonderful in their encouragement and feedback through this process. I would like to further recognize Dr. Frankle as my chair who has spent hours with me discussing my progress through every step of this process. I would also like to recognize Dr. Mathew who not only served on my committee but has been my faculty advisor from the beginning of my journey in this program. Special thanks also go to the team at the T1D Exchange. This organization was not only a significant part of my recruitment, but also provided me the opportunity to use my knowledge to help those who follow their organization through their blog. I would specifically like to thank those at the T1D Exchange who worked with me directly including Courtney Holubiak, Ginger Vieira, Deborah Taylor, and Sarah Tackett. I would like to thank all the groups who helped make this possible by sharing my study with the group. The admins and members of these groups have shown that the T1D community is a supportive and engaged group of people. These groups include The Juicebox Podcast: Type 1 Diabetes, Support for Parents of Type 1 Diabetics, Type 1 Diabetes Support Group, Parents of type 1 Diabetics, Type 1 Diabetes Support, and T1D Science. Thank you to all of the admins, moderators, and members of these groups who participated and shared this study. Finally, my success in my academic career would not have been possible without my father, Steven DeFields-Gambrel. He has helped me to aim for the stars and cheered me on as I reached new heights. v TABLE OF CONTENTS Contents ............................................................................................................................. Page List of Tables ................................................................................................................... xi List of Figures ................................................................................................................. xii List of Abbreviations ..................................................................................................... xiii Chapter 1: Introduction ..................................................................................................... 1 Study Background and Development ................................................................... 2 Background of the Problem .................................................................................. 3 Type 1 Diabetes Overview ...................................................................... 4 Caregiver Stress ...................................................................................... 5 Delivery Models...................................................................................... 6 Cost and Cost Components ................................................................... 10 Problem Statement .................................................................................................. 12 Purpose of the Study ............................................................................................... 12 Population and Sample............................................................................................ 13 Significance of the Study ........................................................................................ 13 Nature of the Study ................................................................................................. 14 Quantitative Methodology .................................................................... 14 Correlational Design ............................................................................. 15 Survey Instrumentation ......................................................................... 16 Rationale Summary ............................................................................... 16 Research Questions & Hypotheses ......................................................................... 16 Theoretical Framework ........................................................................................... 17 vi Uncertainty and Stress .......................................................................... 18 Uncertainty in Healthcare Finance........................................................ 18 Definition of Terms ................................................................................................. 19 Assumptions ............................................................................................................ 21 Limitations ............................................................................................................... 22 Delimitations ........................................................................................................... 22 Chapter Summary.................................................................................................... 23 Chapter 2: Literature Review .............................................................................................. 25 Title Searches and Documentation ......................................................................... 25 Table 1. List of search terms ................................................................. 25 Historical Content ................................................................................................... 26 Financing of Diabetic Care ................................................................... 26 Caregiver Stress
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