Date of Award

Spring 2019

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor


Second Advisor

Frenn, Marilyn

Third Advisor

Oswald, Debra


The overall aim was to understand the process of healthcare provider influence by exploring associations between professional influence measures and patient engagement in health behavior modification in women with Gestational Diabetic Mellitus (GDM). An integrative literature review resulted in defining and developing the Healthcare Provider Influence (HPI) conceptual model based on the Integrated Theory of Health Behavior Change and Transformational Leadership theory. HPI is defined as a process wherein a purposeful interpersonal interactive, collaborative, and transformative relationship develops between a patient and a healthcare provider working together toward a specific focus of health behavior modification outcomes. Measures for testing the HPI conceptual model were identified, modified, translated, and content validated. Using an observational, prospective, longitudinal, correlational and exploratory design, participants in control, non-GDMs (N=117) and study, GDMs (N=78) groups completed questionnaires at an initial high-risk GDM screening and subsequently at 34-36 weeks gestational age. To test the relationships in GDM patients, eight healthy eating, physical activity, and glucose monitoring behaviors were separately regressed on professional influence variables (social/professional influence, quality of information and interaction). Patient and healthcare provider characteristics were included in regression models to test for moderating effects. Self-efficacy was examined for a mediating effect. Differences in health behavior modification outcomes, by time and group (GDM, non-GDM) were explored. Professional influence by maternity healthcare providers (HPs), and quality of information and interaction during teaching encounters by HPs and diabetic nurse-educators were significantly associated with increased breakfast frequency/weekly and self-efficacy (p ≤ .10). Gender, race and language concordance and HP leadership style and specialty influenced healthy eating, physical activity and glucose monitoring behaviors (p ≤ .10). Three healthy eating and one physical activity outcomes differences were found by group and time, for which variance was explained with small effects (2-9%) by language, race, and GDM history. Patients’ perception of their healthcare providers’ influence, quality of information and interaction in teaching encounters and leadership style, and race, language, and gender concordance influence GDM patients’ engagement in health behavior modifications. Self-reflection on practice, interaction, and leadership style could impact individual professional transformation and increase influencing potential for patient engagement in health behaviors.

Included in

Nursing Commons