These findings may generate direction for theory development and guide health and medical practitioners when intervening on the specific constructs. Population- and community-based surveys have utility for assessing diabetes health-related behavior (e.g., exercise behavior).

Background: The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP) perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center.

The purpose of this qualitative study was to gain an understanding of the response of English speaking adults with low literacy skills to screening of reading ability in order to facilitate the planning of patient teaching in a hospital setting. The Rapid Estimate of Literacy in Medicine (REALM) was the screening tool used to provide a screening experience for research subjects. A multiple case study design was employed to gain insight, describe participant experiences and generate an evidence-based conceptual model. While all participants supported the principle of screening in the context of the hospital, response to the actual experience was varied. Factors found to influence responses to screening included perceived risks of illiteracy exposure, perceived risks of non-disclosure during hospitalization and the attribution of characteristics to the hospital leading to it's designation as a 'special' place. A conceptual model of screening response was developed and compared to the Health Belief Model and Knox's Proficiency Theory of adult learning. Implications for the health professions are also discussed.

Exercise plays a key role in the prevention and delay of the onset of Type 2 diabetes and in the management of this disorder. To determine if there are differences in key social-cognitive determinants of exercise and self-reported physical activity levels between adults with diabetes and those without the condition, a random selected sample of adults was surveyed. A telephone interview assessed physical activity behaviour and key social-cognitive constructs from major health behaviour change theories/models. The mean energy expenditure was not significantly different between the diabetes (n = 46) and the non-diabetes (n = 1556) groups. The diabetes group reported significantly lower scores for self-efficacy and perceived behavioural control, but higher for fear of, and vulnerability to, general health and cardiovascular disease threat. The data suggest that it may not be necessary to promote health threat messages, as threat is already high for this diabetes population and studies have shown that excess threat does not promote recommended exercise and health behaviours. Instead, the low levels of self-efficacy and perceived behavioural control among those with diabetes emphasize the importance of designing specific strategies (e.g., skills, incremental success) to increase their self-confidence in undertaking physical activity.