Samuel Collier is a 2019 graduate of the PsyD Program in Clinical Psychology at Antioch University, New England

Dissertation Committee

  • Gargi Roysircar, Ed.D., Committee Chair
  • Susan Vonderheide, Ph.D., Committee Member
  • Amber Cahill, Psy.D. Committee Member


diabetes, primary care, behavioral health, biopsychosocial, self-efficacy, poverty

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The study evaluated the effectiveness of a diabetes management program in a co-located mental health and primary care setting in Nashua, New Hampshire. The patient-participants were primarily underserved, low-income, working-class or homeless patients from the surrounding region. A few participants were also older adults. Examination of the literature highlighted the growing diabetes epidemic at local, state, and national levels. A review of past clinical trials of diabetes programs indicated further investigation into diabetes self-management education programs that integrate medical and behavioral health components under the biopsychosocial model. Thus, for the present study, the Stanford Diabetes Self-Management Program (SDSMP; Lorig, Ritter, Villa, & Armas, 2009), was utilized as the cornerstone for building a comprehensive program for the population of the treatment site. SDSMP is a semi-scripted six-week peer-led psychoeducation course designed to enhance self-efficacy in the self-management of diabetes. The course meets the American Association of Diabetes Education Standards and teaches skills and knowledge around proper diet, exercise, lifestyle, and treatment adherence. Archived quantitative data from participant medical records (N = 12) were analyzed at the individual case level to verify whether the program was effective at increasing use of self-care practices and management of symptoms in individual diabetes patients. In addition, qualitative analysis of participant follow-up interviews (n = 4) depicted how and why individual changes may have occurred within each case. Some of these themes included Positive Changes, Social Influences, and Workshop Feedback. Quantitative results found that depression and anxiety scores decreased modestly for the group as a whole to a similar degree as shown by previous studies (Lorig et al., 2009, 2016). One patient’s depression score showed a clinically significant decrease. The group achieved similar results in their diabetes knowledge and adherence to diet and physical activity recommendations compared to regional norms for the SDSMP (New England Quality Innovation Network–Quality Improvement Organizations, 2016). Two patients also improved medically in their BMI and HbA1c% scores after attending the program. These results implied that the SDSMP may be an appropriate fit for the site’s population.


Samuel Collier

ORCID Scholar ID# : 0000-0002-7271-0509