Education and Human Sciences, College of (CEHS)


Date of this Version



Fuji, K.T. (2013). Impact of standalone personal health record use on clinical outcomes of patients with type 2 diabetes: An intervention mixed methods study. MA Thesis, University of Nebraska-Lincoln.


A THESIS Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Master of Arts, Major: Educational Psychology, Under the Supervision of Professor John W. Creswell. Lincoln, Nebraska: December, 2013.

Copyright (c) 2013 Kevin T. Fuji


The purpose of this study was to assess the impact of using an online personal health record (PHR) on clinical outcomes of patients with type 2 diabetes. This study used an intervention mixed methods approach with a quantitative randomized, controlled trial combined with a qualitative exploration of how patients used the PHR. A total of 140 participants with type 2 diabetes were randomized to either receive a PHR and training to use the PHR, or to a control group who received usual care. Both clinical and social cognitive outcomes were measured and compared at baseline and follow-up, three to six months after baseline. A linear regression was also used to model the relationship between PHR use, social cognitive factors, and hemoglobin A1c (HbA1c). The quantitative analysis revealed no differences in diabetes clinical outcomes (HbA1c or blood glucose) from baseline to follow-up between either the control and intervention groups, or within the intervention group, between individuals who continued to use the PHR after baseline (PHR users) and individuals who ceased use after baseline (PHR non-users). Additionally, the linear regression revealed no significant relationships between PHR use, social cognitive factors, and HbA1c. In-depth interviews were conducted with all members of the intervention group to explore how patients used the PHR in their diabetes self-management. Themes that emerged from the qualitative analysis were used to explain quantitative findings and identify continued research gaps that must be addressed in future research. Nine themes emerged from the qualitative analysis, seven of which expressed barriers that helped to explain the lack of quantitative difference between the groups. The additional two themes identified positive outcomes from PHR use that support hypothesized benefits from PHR use. Future research should focus on the integration of the PHR into patients’ regular diabetes self-care routine and identifying which features of the PHR have the potential to lead to clinical improvement.

Adviser: John W. Creswell